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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Arthroscopic procedure to relieve frozen shoulder pain described here

January 20, 2010 — admin

I’m going to have an arthroscopic release of a frozen shoulder next week. Can you tell me what is done during this operation?

The basic steps to this operation are the same from patient to patient. There may be some small differences based on what the doctor finds during the procedure.

First you will be anesthetized or put to sleep (some patients have a nerve block and remain awake but feel no pain). The doctor will gently mobilize the shoulder joint. This means while lying on your back, your arm will be lifted and rotated inwardly. This shows the doctor how the back (posterior) half of the joint capsule is moving (or not moving if it’s stuck or bound down).

Then the arm is gently moved out to the side away from the body. This motion is called abduction. Next the arm is rotated outward. This is done first with the elbow bent and then with the elbow straight with the arm down at the side. This gives the doctor information about the front (anterior) half of the joint capsule.

In the final step, the doctor uses a special tool (arthroscope) to look inside the joint for any areas of scar tissue, inflammation, or tears in the capsule. The scar tissue will be released and any rough spots shaved smooth. The doctor may cut and remove the joint capsule from the front and the back. Any other damage will be repaired and space made for all structures to move freely.

Most patients are seen in physical therapy right away. Rehab often continues after discharge from the hospital. A home program is essential.

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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Is total joint replacement a preventative option?

December 30, 2009 — admin

I need part of my shoulder replaced (the ball portion but not the socket). Will I just develop arthritis in the socket later and need to have it replaced eventually? Maybe I should just have the whole shoulder replaced now. What do you think?

As the old saying goes, “If it’s not broke, don’t fix it.” Joint replacements don’t last forever. Just removing the damaged part and replacing it can cause problems. The muscles around the joint must be cut and a certain amount of bone removed.

Many doctors would agree when only half the joint is a problem then a hemiarthroplasty is the way to go. This operation only replaces the part of the joint that is damaged. This is usually the head of the humerus or ball portion that fits into the socket. Any part of the joint that is still in good health should be saved.

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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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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Shoulder pain traced to AC joint

November 30, 2009 — admin

I thought I had a shoulder problem. The doctor says it’s the AC joint. My shoulder still hurts. What’s the difference between these two problems?

The true shoulder joint is where the head of the upper arm bone (humerus) inserts into a shallow cup in the shoulder blade. The cup is called the glenoid cavity. It’s a ball and socket joint.

Just above the true shoulder joint is a bony projection coming around from the back of the shoulder blade. This piece of bone is called the acromion. The end of the acromion meets the collarbone to form a shelf over the shoulder.

Pain from any of the structures around or above the shoulder joint can cause pain that seems like it’s coming from the joint. A careful exam by your doctor can pinpoint the exact cause. This is helpful information so the right problem is treated.

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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Shrink wrapping may help dislocated shoulder

November 11, 2009 — admin
One of my shoulders dislocates anytime I reach overhead and pull down with my arm. The doctor has suggested doing a shrink-wrap operation to tighten it up. How do they keep from melting the cartilage?
You may be talking about thermal shrinkage of capsular tissue that surrounds the shoulder joint. The capsule gets stretched out when the shoulder dislocates. More than one dislocation makes the problem worse.

Thermal shrinkage uses a heat source to raise the temperature of the tissue. In the process of heating and cooling down, the capsule tightens up. Research shows there’s an ideal temperature the tissue must reach during this procedure. Doctors are careful to keep within the “safe” range.

They also use a “striping” technique. The heat probe is passed up and down over the loose tissue. Some areas are left untreated between areas of shrinkage. The tissue is only heated up once. Studies show passing over the tissue more than once can cause injury to the capsule.

Doctors are also careful not to leave the probe in one spot too long. Some tissue can’t be treated with this method. Thin, torn, or poor quality tissue won’t hold up under the high heat. No one really knows yet how much tissue shrinkage gives the best result. More studies are underway.

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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Frozen Shoulder Not Improving with Physical Therapy

August 18, 2009 — admin
I’ve been going to physical therapy for my frozen shoulder. The shoulder hurts a lot and doesn’t seem to be improving. What are my options for treatment?

 
Doctors generally prefer to try conservative treatments before using more aggressive forms of treatment. When symptoms don’t improve with physical therapy, doctors may recommend an injection into the shoulder joint. The injection is typically a steroid medicine, a painkiller, or both. Filling the joint with medicine helps with inflammation and pain. It also stretches the tight joint capsule. Resuming physical therapy soon after the injection enhances the benefits of the shoulder stretches you do in therapy.

If symptoms continue and shoulder motion still does not improve, your doctor may recommend a treatment called manipulation under anesthesia. This procedure is done by forcefully stretching the tight shoulder of a patient who is asleep from anesthesia.

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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