Muscles can heal, but shoulder surgery may be necessary

February 4, 2010 — admin

I’m a construction worker. I tore my right biceps muscle lifting a heavy cement block. Can the muscle heal by itself?

Muscles in the arms and legs can heal after injury but it’s very slow. Recovery usually takes four to six weeks and may not be complete. You may have some loss of strength. Re-injury is common after these types of muscle strains.

Healing occurs in several steps or phases. First there’s bleeding at the site of injury. A bruise or bleeding into the muscle called a hematoma may occur. Some muscle cells will die, then inflammation occurs. Special cells called phagocytes clean up any damage or debris. Scar tissue forms to fill in the damaged area. Small blood vessels also form to supply the new tissue with blood.

The final result depends in large part on how severe the injury is. Good nutrition and rest are important to promote healing. The right amount and kind of movement can also help muscles heal at the right length-tension ratio needed for normal range of motion. In some cases, surgery is an option to reattach the tendon and muscle unit.

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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Different types of dislocated shoulder, different treatments

February 1, 2010 — admin

Three years ago I dislocated my left shoulder. They called it a Bankart lesion. Now I’ve dislocated the shoulder again with even more damage. This one’s called a Hill-Sachs lesion. How is that different from the first dislocation?

The shoulder joint is a ball-and-socket joint. The socket is fairly shallow. This puts the joint at risk for dislocation. To help deepen the socket, the shoulder joint has a rim of cartilage called a labrum. The labrum forms a cup for the end of the arm bone (humerus) to rest and move inside.

A Bankart lesion is an injury to the labrum caused by forward (anterior) shoulder dislocation. The force of the head of the humerus (upper arm bone) as it dislocates, tears the labrum and the ligaments attached to it. The shoulder joint is unstable when the labrum is torn. There isn’t anything to keep the head of the humerus from slipping forward out of the socket again. Surgery to repair the damage is usually needed.

A Hill-Sachs lesion is an injury that causes damage to the head of the humerus. It also occurs with shoulder dislocation. When the shoulder dislocates, the smooth surface of the humerus hits against the bony edge of the socket (called the glenoid). The collision causes a dent in the bone of the humerus. This is also called an impaction fracture.

The Hill-Sachs lesion can usually be seen on a normal shoulder x-ray. Surgery may not be needed. Treatment is designed to prevent further damage (and later arthritis) to the surface of the humerus.

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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Mastectomy could be cause of shoulder pain

January 28, 2010 — admin

I’m a 48-year old woman and I had a mastectomy for breast cancer three months ago. Now that I’m back to swimming, I notice I’m having trouble with my stroke. My husband says when I reach forward to stroke, the shoulder blade pops out noticeably. Could this be caused by the mastectomy?

You may be describing an injury to the long thoracic nerve that controls the serratus anterior (SA) muscle. When there is weakness in the SA the shoulder blade or scapula can’t rotate and slide like it should when the arm is lifted up. The result is called scapular winging.

Mastectomy is one possible cause for this problem. During the surgery for the mastectomy, the nerve can get stretched from the position of the arm. There are many other possible reasons such as a viral illness, working with the arms overhead, or lifting a heavy weight.

The best way to know for sure what’s going on is to have some testing done. Electromyography or EMG studies can find out for sure which muscles are involved. Nerve conduction velocity (NCV) tests can be done to see if the nerve is damaged. Talk to your doctor about these symptoms and see what he or she suggests.

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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Diagnostic injection used to treat shoulder pain

January 25, 2010 — admin

I had a sudden onset of shoulder pain that sent me to the doctor’s office in a hurry. I couldn’t remember any kind of injury or recent illness. The bill I received describes the treatment as a “diagnostic injection.” What does that mean exactly?

You may have had a steroid injection into the shoulder or one of the nearby joints. This is an anti-inflammatory drug given locally right to the potential source of the problem. It’s called diagnostic because the doctor is using it to figure out what’s wrong. This step can cure the problem for some patients and avoid expensive imaging studies such as MRIs.

If you got good pain relief from the injection, then it’s likely there was some swelling or inflammation in the joint pressing on soft tissues or a nerve causing the pain. If the pain relief was only temporary (an hour, several hours, a day up to a week), then more tests may be needed.

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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Thermal energy tightens unstable shoulder

January 12, 2010 — admin

I just had a special heat treatment to tighten up an unstable shoulder joint. Now I’m worried that the joint won’t be able to relax. How do they shrink the capsule but still keep the motion? I’m in a sling so I can’t move it just yet anyway.

Studies using thermal energy to heat the shoulder capsule were first done on animals. There were no obvious problems seen afterwards in relaxation of the tissue. Studies were done next on cadavers (human bodies preserved after death for study) and finally, on live humans. Loss of joint motion hasn’t been reported.

If anything there are some concerns that shrinkage alters the elasticity of the tissue. Under too much load there’s a risk of stretching out the tissues. In this case, the shoulder can become unstable again with too much motion.

Your best bet for a good result is to follow your doctor’s directions and report any problems early on.

For information on total shoulder replacement, please visit www.zehrcenter.com.

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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Into sports? Don’t let an unstable shoulder stop you.

January 8, 2010 — admin

I’ve heard there are braces that can be worn during sports play for an unstable shoulder. What can you tell me about these?

There are many versions of one brace used most often for this problem. The most common names are the Sully brace, SAWA max shoulder brace, and the Wyre brace. Sometimes these are referred to as shoulder stabilizers.

Most of these braces are similar. They all fit like a vest, with a single short sleeve on the involved shoulder. Motion is limited with straps. The brace holds the shoulder girdle and limits arm motion on the affected side. You adjust it to limit or restrict motions. Some are made of soft material (neoprene) with elastic straps held by velcro. Others are cotton canvas.

Any of these braces can help hold the shoulder joint in place. They assist or restrict movement according to the needs of the athlete. The athlete can wear the support while participating in sports. It allows natural movement of the muscles and joints. The Sully brace is suggested for athletes who throw overhead. The Wyre brace is used for non-overhead throwing athletes in contact sports.

To learn more about shoulder injuries and the options for treatment and even total shoulder replacement, visit the Patient Education Center at The Zehr Center for Orthopaedics online.

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 is “shoulder instability”?

December 21, 2009 — admin

What is “shoulder instability?”

Shoulder instability refers to a range of disorders. Instability can occur when soft tissues like ligaments, capsule, and tendons are damaged around the shoulder joint. The result may be a partial dislocation. This means the head of the humerus (upper arm bone) comes out of the socket but can go back in by itself. This is called a subluxation.

The other end of the spectrum occurs when the shoulder completely dislocates and must be put back in or reduced under anesthesia. Most shoulder instabilities are caused by trauma. If the damaged tissue doesn’t heal properly, the shoulder can dislocate many more times.

The treatment for chronic shoulder instability is usually surgery to repair the damage. This operation is done as an outpatient. The doctor puts a tiny lighted telescope and small instruments into the shoulder joint. Small anchors with suture attached are inserted right into the socket of the shoulder. The torn ligaments are reattached to the socket. Complete healing takes about four to six months.

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. For more information on this subject, visit www.zehrcenter.com.

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Injured shoulder? Don’t worry about Apprehension Test.

December 16, 2009 — admin

What is an “apprehension sign?” I saw in my medical report that I have a positive apprehension sign. I’m not usually an anxious person so I don’t understand why the doctor wrote this in the report.

The Apprehension Test is used to look for instability in the shoulder. The test is performed on patients who have injured or even dislocated the shoulder. The test is done by moving the patient’s arm out to the side and rotating the arm (and shoulder) outward into external rotation. This is the position you would use to throw a ball.

An apprehension test is positive if the patient looks alarmed or concerned. The patient may ask the doctor or therapist to stop the test. Many patients say it feels like the shoulder is going to dislocate again. In fact, if the test is done too quickly the shoulder can dislocate.

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. For more information on this subject, visit www.zehrcenter.com.

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Injury to one shoulder affecting the other?

November 16, 2009 — admin

I injured my left shoulder in a hang gliding accident. It’s odd, but I feel as if my right shoulder is affected by my left shoulder problems. Is this possible? The right shoulder just doesn’t seem to move as smoothly as before the accident.

Of course it’s possible some minor damage occurred in the right shoulder at the time of the accident. Perhaps an injury is present but undiagnosed. Be sure and ask your doctor to check this for you.

It is possible that you are experiencing a change in the joint position sense. This is the ability of the joint to tell where it is in relation to the body. It’s called proprioception. Proprioception also tells the joint where it is as it moves.

Proprioception is regulated centrally by the nervous system. If one side is injured, the other side is also affected. Usually patients aren’t aware of any difference, but testing reveals the change.

A recent study from Germany suggests the shoulder is able to regain its own sense of joint position after surgery to repair the injury. In fact, even the proprioception in the uninjured arm improves. Researchers aren’t sure why this happens, but future studies are planned.

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. For more information on this subject, visit www.zehrcenter.com.

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Dislocated shoulder may require surgery

October 13, 2009 — admin
I dislocated my shoulder. Should I have surgery?

 
Traditionally, doctors have treated dislocated shoulders with slings and physical rehabilitation. Unfortunately, this approach isn’t very effective in preventing repeat dislocations. This is especially true if you’re young. Studies show that athletes under age 25 re-injure their shoulders up to 94 percent of the time.

Surgery to stabilize the shoulder is a more aggressive approach. A new procedure uses an arthroscope– a camera-like device that lets doctors see inside the joint. With this instrument, doctors don’t have to make big incisions in the skin. This makes surgery less invasive. Doctors implant special tacks to hold the shoulder in place.

How effective is this procedure? It was recently tested on cadets at West Point. In this group of young, highly active patients, surgery resulted in stable shoulders 88 percent of the time. These patients had no complications from surgery. They were able to return to all their activities. Twelve percent of the patients had another injury within a year and a half of surgery. Still, this re-injury rate was felt to be small compared to that of patients who didn’t have surgery.

Talk to your doctor about your options for surgery, given your age and history.

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. For more information on this subject, visit www.zehrcenter.com. 

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