Ski jump results in torn cartilage plus frozen joint, how is this possible?

June 8th — admin

My 21-year-old son hurt his arm during a ski jump last winter. At first the surgeon thought he had a labral tear. But now his arm is frozen with no movement past 90 degrees. Does this makes sense? How can you have a torn cartilage and a frozen joint?

The labrum is a dense fibrocartilage ring that is firmly attached around the acetabulum (shoulder socket). It provides both depth and stability to the normally shallow acetabulum.

A labral tear can result in a painful and unstable shoulder. A stiff, painful (frozen) shoulder is not uncommon after shoulder trauma. This may be the body’s protective response. It is usually self-limiting. This means it will eventually get better on its own.

If conservative care does not take care of the problem, then surgery may be needed. The surgeon may just manipulate the shoulder. This is a careful moving of the shoulder through its full motion while the patient is anesthetized. If that doesn’t help, then incision and release of the anterior shoulder capsule 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 a 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 83 too old for rotator cuff repair?

June 3rd — admin

At age 83, am I too old for a rotator cuff repair? I’m not a senior athlete but I’d sure like to do more with this bum shoulder.

An orthopedic surgeon would be the best one to answer your question. Age is an important variable but there are many other factors to consider. The condition of the torn tendon is one. Excessive scar tissue, weak tendon fibers, and poor bone quality can reduce the changes of a successful repair.

The location and extent of your tear must be considered. The surgical technique used may depend on these factors. There are numerous types of sutures and anchors used to repair the tear. Placement of the fixation may affect the outcome.

Many surgeons use a double row of sutures. This can be done arthroscopically or through a mini-incision. A newer technique of suture anchor without knots has simplified the arthroscopic procedure. Fewer anchors are needed and they are easier to make. They also withstand greater loads than previously used corkscrew anchor repair.

Some methods of repair seem to work better for younger patients. Your surgeon will take into consideration both anchor and suture designs for your particular rotator cuff tear. Future improvements are needed to reduce the friction between the suture and anchor. Research is ongoing to find ways to increase the strength of the suture against rubbing.

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 a 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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College basketball player dislocated shoulder, is surgery necessary?

May 31st — admin

Our college-aged son dislocated his shoulder playing basketball. We are trying to figure out if he needs surgery or not. The staff at the local clinic say he can wear a sling for eight weeks and come out alright in the end. Is this sound advice?

Studies show that immobilizing the arm after a primary (first) shoulder dislocation doesn’t change what happens in the long-run. Even applying the sling several weeks after the dislocation first occurred doesn’t seem to change what will happen a year or even more than a year later.

Over half of all shoulder dislocations stabilize and recover well. In fact, according to a study over a period of 25 years, many patients with a shoulder dislocation couldn’t even remember which arm was dislocated.

Some experts have advised immediate surgery for anyone with a shoulder dislocation who is an athlete, especially throwing athletes. Results of the long-term study just mentioned did not agree with this counsel. According to their data, athletic activity was not linked with recurrent shoulder dislocation.

A trial period of immobilization followed by a rehab program is considered a good first step following shoulder dislocation. Even if surgery is eventually needed, the strengthening program will prepare the shoulder for a better result after surgical reconstruction takes place.

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 a 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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Could intraoperative fracture during total shoulder replacement have been prevented?

May 26th — admin

We are really bummed as a family. We all encouraged Mom to have a shoulder replacement and then her upper arm broke during the surgery. Is this a fluke? Could it have been prevented?

There are many possible reasons why a bone fracture occurs intraoperatively. Sometimes it’s completely unavoidable. There are some known risk factors such as decreased bone mass (osteopenia or osteoporosis). Shoulder instability from a previous rotator cuff tear can make a difference.

Fractures of this type occur most often during a total shoulder replacement (versus a hemiarthroplasty where only one side of the shoulder joint is removed and replaced). Sometimes the surgeon has trouble getting to the shoulder socket. The angle and force needed may be too much for the brittle bones.

Older women seem to be at increased risk for humeral (upper arm) fractures. They are especially at risk if they also have rheumatoid arthritis or other health issues such as diabetes contributing to delayed or poor healing.

Surgeons must be aware of potential risk factors for fracture. Surgical approach and techniques must be chosen carefully with these risks in mind. Patient position during the operation is important. The elbow should never be used as a lever to get increased shoulder motion when under anesthesia.

Soft tissue release around the shoulder may be needed before moving the arm through its full range of motion. Special care must be taken when reaming out the humeral bone to place the stem of the implant inside. Hand reaming instead of power reaming is advised. The bone should be compressed, rather than removed, in patients who have low bone density.

These are just a few of the many considerations surgeons must include in the surgical process. When many risk factors present at the same time, then the risk of fracture goes up. Even being aware of all the risks doesn’t guarantee complications won’t occur. The surgeon can’t always predict who might develop intraoperative fractures.

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 a 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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Hair stylist concerned about arthroscopic surgery for shoulder

May 23rd — admin

I need to have surgery on my shoulder because it clicks and hurts whenever I raise my arms over my head. Since I work as a hair dresser, I use this motion all day long. The surgeon I saw wants to put two puncture holes in my shoulder to repair this problem. Should I go through with it? Will the holes cause problems later?

It sounds like your surgeon is suggesting arthroscopic surgery. A long needle with a tiny TV camera on the end is inserted through the skin into the joint. The surgeon can see on a screen what is going on inside the joint.

The scope makes it possible to find and repair damage to the joint capsule, cartilage, and ligaments or tendons in the area. Studies show this type of surgery is very successful. There is no need for a large, open incision. Rehab and recovery is faster because major muscles haven’t been cut through.

The two or three puncture holes needed for placement of the scope usually present no problems. There is a small risk of infection at those sites. Usually, they just fill in with collagen fibers and scar tissue. They may only be visible on close inpsection.

The recovery process does take some time. Depending on what the surgeon has to do, you probably won’t be able to go back to work right away. Most patients are placed in a sling with a pillow under the arm.

You’ll probably see a physical therapist several weeks after the operation. The focus of rehab will be on restoring range of motion, strength, and function. Specific exercises may be prescribed to help you prepare to return to overhead work.

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 a 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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Pitching arm vulnerable to shoulder instability

May 18th — admin

I’ve been to three orthopedic surgeons now about a problem with my pitching arm. It hurts, clicks, and feels like it’s going to pop out of the socket. No one could figure it out. I finally had an arthroscopic exam that showed a posterior tear of the shoulder capsule. Why was this so hard to diagnose?

Posterior instability as a cause of shoulder pain and/or clicking is an uncommon, but not unheard of, condition. Anterior shoulder problems are much more common. In fact, many pitchers or throwing athletes suffer from an anterior instability. Posterior refers to the back of the shoulder. Anterior refers to the front of the shoulder.

In either case, repetitive microtrauma from the action of overhead throwing is the cause of the problem. During the follow-through phase of pitching, the shoulder is close to the body, flexed, and rotated inwardly. This repetitive motion may put stress along the back of the shoulder.

The shoulder capsule and labrum (rim of cartilage around the shoulder socket) can also get pinched causing pain. This is more likely to occur during the late cocking phase of throwing when the arm is drawn back and externally rotated.

The problem is made worse if the athlete has any natural laxity (looseness) or contracture (tightness) of the soft tissues in this area. Repeated stresses from throwing 100′s of pitches can lead to labral tears or a stretched capsule.

These types of injuries are not easy to diagnose. There can be different directions of instability at the same time causing confusion. Clinical signs and symptoms and results of testing aren’t always consistent for multidirectional injuries. Diagnosis is delayed when there is more than one lesion (and even a combination of problems).

The surgeon will have to sort out the site of damage and resulting structural and biomechanical problems. Even with history, physical exam, and imaging studies, arthroscopy may be the only way to make the final diagnosis.

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 a 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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Will heat treatment to shrink loose joints work on my daughter?

October 25th — admin

I’ve heard there’s a heat treatment to shrink loose joints. My 13-year old daughter has very loose joints. Sometimes it’s a problem when she’s trying to do something in gymnastics that requires strength and stability. Could this treatment help her?

There is a treatment method called thermal capsulorrhaphy used to treat shoulder instability. Usually the patients have injured the soft tissues around the joint or the cartilage around the shoulder socket.

The laser or radiofrequency energy heats the tissue up enough to damage some of the cells. As the tissue cools down, it contracts or tightens up. The process of healing the damaged tissue brings about more normal cells to replace the “loose” ones.

Immature or undeveloped tissue doesn’t shrink like adult tissue. The bonds that form and hold the cells together aren’t strong enough to withstand the heat. The proteins “melt” turning the tissue into jelly. The end result is an unstable rather than a “tight” joint.

Just the opposite happens in older adults. There are so many cross-links in aging tissue (that’s what makes us stiff), shrinkage is very limited. It’s unlikely this treatment would be recommended for your daughter. She may benefit more from a strengthening program. A physical therapist may be the best one to assess the stability of her joints and advise you.

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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TV method for reducing dislocated shoulder often painful, ineffective

October 1st — admin

Our 14 year old son dislocated his right shoulder after falling off his mountain bike. He had to have anesthesia to put the joint back in place. Can’t they do this without surgery like you see on TV shows like ER or Scrubs?

Not all TV drama is real or accurate. Screen writers do try to research conditions, illnesses, and medical procedures and present them accurately.

In the case of shoulder dislocation, there are several ways to “reduce” or put the joint back in place. The most common method of shoulder reduction after dislocation is the traction counter-traction technique. The doctor pulls on the hand of the dislocated arm.

At the same time, pressure is applied into the armpit in the opposite direction. This method of shoulder reduction is often painful and doesn’t always work.

Using sedation such as general anesthesia relaxes the muscles around the joint. This allows the head of the humerus to slide over the rim of the socket and slip back into the joint.

What you saw on TV could have been the traction-counter traction method of reduction. Another way to do this is an old method called the Milch technique. The Milch method is a safe and easy way to reduce a dislocated shoulder joint. The patient’s arm is moved by the doctor or examiner into a position of 90 degrees of abduction and flexion as if to put the hand behind the head.

The head of the humerus slips back over the rim of the socket and fits back into the joint. No anesthesia and no surgery is required. Because it’s not a recent discovery and because it’s an old method, all doctors today may not know about the use of the Milch method to avoid surgery for shoulder dislocation.

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 dead arm syndrome?

September 20th — admin

What is the “dead arm syndrome”? I heard on ESPN that my favorite baseball pitcher is benched for the season with this problem.

Dead arm syndrome starts with repetitive motion and forces on the posterior capsule of the shoulder. The posterior capsule is a band of fibrous tissue that interconnects with tendons of the rotator cuff of the shoulder. Four muscles and their tendons make up the rotator cuff. They cover the outside of the shoulder to hold, protect, and move the joint.

Overuse can lead to a build up of tissue around the posterior capsule called hypertrophy. The next step is tightness of the posterior capsule called posterior capsular contracture. This type of problem reduces the amount the shoulder can rotate inwardly — a motion needed by pitchers to throw the ball forward before releasing it.

Over time, with enough force, the player may develop a tear in the labrum. The labrum is a rim of cartilage around the shoulder socket to help hold the head of the humerus (upper arm) in the joint. This condition is called a superior labrum anterior posterior lesion. The final outcome in all these steps is the dead arm phenomenon.

The shoulder is unstable and dislocation may come next. Dead arm syndrome won’t go away on its own with rest — it must be treated. If there’s a SLAP lesion, then surgery is needed to repair the problem. If the injury is caught before a SLAP tear, then physical therapy with stretching and exercise can restore it and return the player to the field.

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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Sharp, aching shoulder pain should be examined

September 15th — admin

I have a sharp, aching pain in the front of my shoulder. I can point to it with one finger. Would an X-ray show what the problem is?

You’ll need to see an orthopedic surgeon to find out for sure. Being able to point to the pain with one finger suggests a local problem in one of the soft tissue structures along the front of the shoulder. This could be a tendinitis or acromioclavicular (AC) joint problem. Shoulder pain can also be referred from one of many other structures including the neck, heart, chest, kidney, or stomach.

The doctor will take a history and examine you first before deciding if X-rays or other imaging studies would offer helpful information. Your symptoms especially when it hurts and how you move help the physician tell what’s wrong. He or she will also palpate (feel) different structures to see what’s hurting.

The AC joint (acromioclavicular) occurs where the outer end of the collarbone meets up with the curved acromion coming around from the shoulder blade. This is a common area of injury and instability with young people and degenerative changes in older folks.

Sometimes an injection of a local numbing agent is helpful. Lidocaine and a steroid mixed together and injected into the AC joint can rule out or verify the joint as the source of pain.

There are many clinical tests the doctor can use to find out what’s wrong. Early diagnosis and treatment may help prevent further problems later.

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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