Volleyball player surprised by shoulder dislocation

September 2nd — admin

I dislocated my shoulder playing a neighborhood pick up game of volleyball. I never knew it was coming. One minute I spiked the ball over the net and the next I was on the ground in pain. How is that possible?

Many shoulder dislocations occur at work or during recreational or sports activities. Most people give the same report the first time it happens. They didn’t have pain, popping, or any symptoms to suggest the shoulder wasn’t stable.

Once a shoulder has dislocated, it can happen again. Warning signs and symptoms of repeated dislocations called prodromal symptoms may not be present. Most of the symptoms of first or repeat shoulder dislocation such as pain, muscle spasm, and loss of motion occur after it’s already happened.

Some people can pop their own shoulder out of the socket. This is called voluntary dislocation. Patients are advised not to do this since the soft tissue around the shoulder can get stretched, putting the person at greater risk of chronic dislocation.

The more times a shoulder is dislocated, the greater chance there is for rotator cuff tears around the shoulder.

The specific dynamics of the first dislocation may not be fully understood. Repetitive motion is a likely factor. Was there a partial tear of the rotator cuff already present? Or do the rotator cuff tears seen with shoulder dislocations happen after the joint dislocates? Researchers are investigating these questions with the hope of preventing shoulder dislocation and the damage that can occur.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Options for hang glider who crashed, tearing rotator cuff

August 30th — admin

I’m a certified hang gliding instructor with 20 years of experience. Even so I hit an updraft and crashed, tearing three of the tendons in my shoulder. I’ve had two surgeries to try and repair this massive tear. They didn’t work. Are there any other options left to me?

Repair of massive tears of the rotator cuff can be problematic. In some cases they are considered irreparable. Studies have been done trying different surgical methods of treatment for this problem. So far there hasn’t been a single type of surgery that works best.

For the most part the best approach seems to be cleaning up the damaged tendons. This is called debridement. Then the bone across the top of the shoulder (acromion) is removed. This is called an acromioplasty. If just the underside of the acromion is shaved, it’s called a subacromial decompression.

When any part of the rotator cuff is torn and can’t be repaired, an imbalance occurs at the shoulder. That’s why the rest of the rotator cuff can get impinged. Reducing or removing the acromion leaves room for the remaining tendons of the rotator cuff to slide and glide without getting pinched.

Other surgeries used to reconstruct massive rotator cuff tears include tendon transfers, fusion, and tendon grafting. No one method seems to have better results than the others.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Rotator cuff tear result of trauma, aging

August 9th — admin

I’ve just been diagnosed with a rotator cuff tear but I’m not an athlete and I can’t remember any injury or trauma. How is this possible?

There are actually two ways to tear the rotator cuff. Trauma is the most common in the young, athletic population. Aging is more common in the over 50 crowd. Aging comes with its own wear and tear process in the shoulder.

The rotator cuff is a group of four tendons surrounding the shoulder. Over time and with use, it’s possible to wear a hole in the rotator cuff. Many people aren’t even aware it’s happening. It a lot like wearing a hole in the seat of your pants.

Weakness and then pain start to get our attention. It’s not until the person has trouble reaching behind to unfasten a bra or put on a coat that the problem is recognized.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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What are the activity limits after rotator cuff surgery?

July 30th — admin

I’m in the early weeks of recovery from surgery for a rotator cuff tear. Just how much activity can the repair take? I’d like to know what are the limits.

Each surgical repair is different based on a few factors. First is the size of the tear and the method used to repair it. Second is the timing. You mentioned being in the early weeks of recovery. The amount of load the repair can handle increases as the tissue heals. In the first six weeks the load limits are much less than after six to eight weeks.

For example the load on the repair is much less with forward flexion of the arm compared to other shoulder movements. Passive motion (someone else moves the arm) versus active movement (you move the arm) has different load limits.

Your surgeon should have given you some idea of the limits both in terms of motion and lifting. Sometimes patients don’t realize the paperwork they take home with them has this information in it. Read everything given to you. Contact your surgeon directly if you don’t find what you are looking for.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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MRI or MRA to diagnose rotator cuff tear?

July 22nd — admin

I’m going to be seeing the doctor for a shoulder exam. I’m pretty sure I have a torn rotator cuff. Should I ask for an MRI?

Your surgeon will know the best tests to order based on your history and the examination. MRIs give good contrast of the soft tissues. It’s an ideal way to see inside the joint without actually opening it up.

MRIs are only 84 to 96 percent accurate in finding rotator cuff tears (RCT). Magnetic Resonance Arthrography (MRA) may be a better choice if a RCT is suspected.

MRA uses the natural fluid in the joint as a way to look for “holes” in the capsule from a RCT. A contrasting agent is injected into the joint. Any fluid that shows up outside the capsule must have moved through the defect.

MRA isn’t available everywhere. Ask your surgeon if it’s available in your area and if it’s recommended for your situation.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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How many steroid injections is too many?

July 2nd — admin

I’ve had three steroid injections in my shoulder for a torn rotator cuff. I don’t really want to have surgery. The injections work for a couple months. How many total injections can I have?

Corticosteroid injections are often used for back or joint pain and swelling from an inflammatory condition. The maximum number of steroid injections that can be given safely is a debatable topic.

Some doctors advise no more than two to three to the same joint in one year. The concern is for systemic side effects of the steroids. Steroids can also thin the skin and underlying layer of protective fat in the area of the injection.

Steroid injections have the best chances of helping patients when used early on in the condition. They are not as helpful in chronic conditions. They seem to work best when combined with pain relievers and physical therapy. The goal is to reduce pain, thereby increasing motion and function. The need for surgery can be avoided in some cases.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Is it ever too late for surgery to repair torn rotator cuff?

June 22nd — admin

I have a large rotator cuff tear in my left shoulder. I’ve been putting off surgery and trying everything else first. I’m ready to throw the towel in and have the surgery. How do you know when it’s too late for an operation to help?

There’s nothing wrong with trying conservative care before going for a rotator cuff repair. In some cases, anti-inflammatory drugs help. In other cases, cortisone injections or physical therapy can make a difference.

But for patients who still have pain, loss of motion, and reduced function, surgery may be the best option. Many patients put it off for months and even years. They still report a good result after the operation.

New methods using arthroscopic surgery and tiny incisions have changed the results of this operation. Even full-thickness tears or tendons that have retracted far away from the place where they normally attach can have a good outcome.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Can all rotator cuff tears be repaired surgically?

May 27th — admin

Can all rotator cuff tears be repaired surgically?

Yes and no. Some doctors repair all types of rotator cuff tears that can be repaired. This depends on their location and if there’s enough tissue to cover the head of the humerus (upper arm bone). The decision is more complicated if more than one tendon is torn.

New surgical techniques using arthroscopy have changed things. The arthroscope is a long needle-like tool with a tiny TV camera on the end. It’s inserted into a joint and gives the doctor a view inside. The arthroscope has made it possible to repair tears that couldn’t be fixed in the past.

If a tear is left unrepaired for years, there may be too much damage to fix it later. This can happen when someone injures the shoulder, but recovers without seeing a doctor. If the joint needs replacing years later, the doctor may find the tear during the operation.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Which test is best to show torn rotator cuff?

May 11th — admin

Is it possible to have a normal tendon show up as torn on an ultrasound study? I just had an MRI and an ultrasound. The MRI was normal but the US showed a tear in my rotator cuff. Which test should I believe?

Depend on your doctor’s final word to guide you. Doctors rarely rely on imaging studies without knowing the patient’s history and doing an exam. Many clinical tests can be done to find the exact tendon that’s involved.

A misdiagnosed torn rotator cuff usually goes the other way. In other words, there’s a tear but the image shows a normal tendon. It would be rare (but possible) to have a normal tendon diagnosed as torn. This could occur when there is what’s called an artifact, a blip in the picture. Artifacts come from extra electronic signals. Another possible reason for a wrong diagnosis is that the radiologist looking at the image can misread it.

One benefit to in-office ultrasound testing for orthopedic surgeons is the doctor’s knowledge of the patient. The patient doesn’t have to depend on the results read by a radiologist who has never seen the patient.

The surgeon has the advantage when looking at the image of knowing how the patient presented. The test can be done at the time of the exam, saving the patient from having to make another appointment on another day.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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Shoulder surgery complications perhaps caused by fluid

May 6th — admin

My father-in-law had surgery on his shoulder to repair a torn rotator cuff. Afterwards he had a lot of swelling on the back of his neck down into the back of his shoulder. What could cause this problem?

Swelling of the neck, nerve problems, and even death of skin tissue can occur after arthroscopic surgery. Evidently the surgeon pushes fluid into the joint during the operation. This helps keep the joint open. It also washes away any blood that might keep the surgeon from seeing what he or she is doing.

The longer the surgery takes, the more fluid is forced into the joint. This increases the chances of problems occurring. Surgeons are encouraged to shorten the operating time as much as possible to reduce the amount of fluid put into the joint.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

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