Three professionals = three diagnoses for shoulder pain. Who’s right?

March 12, 2010 — admin

I saw two orthopedic surgeons and one physical therapist about a shoulder problem I’m having. All three gave me different explanations for the problem. None of them was the same problem. What’s going on here?

Shoulder pain is a common problem especially as we get older. The way the shoulder is examined isn’t the same from doctor to doctor or therapist to therapist. It’s not uncommon to get a different diagnosis from each specialist who sees a patient.

The shoulder joint itself is very complex. The way it works often causes more than one soft tissue structure to get pinched or pulled. This makes it hard to find out the actual cause of the problem.

Experience and training go a long way in making a correct diagnosis of shoulder pain. Besides musculoskeletal problems, shoulder pain can be caused by cancer, infection, or problems in other parts of the body. For example, a kidney infection or ruptured spleen can cause shoulder pain.

Researchers are trying to find a reliable way to test the shoulder. One model being studied is the selective tissue test (STT) first developed by an orthopedic surgeon (James Cyriax, MD). Many doctors and therapists use this skillfully and successfully to make a shoulder pain 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 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.

Posted in Shoulders. Tags: . No Comments »

Steroid injections for pain relief – how long do they last?

March 9, 2010 — admin

I had a steroid injection into my shoulder for a problem with bursitis. I got immediate relief that lasted about a week. Now my symptoms are starting to come back. How long do steroid injections usually work?

There aren’t too many studies just on the duration of pain relief with steroid injections into the joints. Results range from one week as in your case up to 13 weeks.

It’s clear that steroid injections work better than placebo injections with saline solution. And studies show that some steroids work better than others. Long-term pain relief may require a higher dose of the steroid.

In some cases steroid injections are used to control pain and reduce rehab time after arthroscopic surgery. In a patient with recurring bursitis there may be other factors such as posture and overuse to be addressed. The injection may help calm the joint enough to work on improving alignment and motion. Combining physical therapy with steroid injection may be one way to improve overall results.

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.

Posted in Shoulders. Tags: , , , . No Comments »

Still have pain 3 weeks after shoulder surgery?

March 4, 2010 — admin

I had some shoulder surgery three weeks ago. I am doing my exercises faithfully, but there’s still quite a bit of pain. Is this normal?

Pain is a normal sign at certain points in the recovery process. This is most common during the early phase after an operation. Drugs to control pain and inflammation are used from one to three weeks after surgery.

At the same time, physical therapy to stretch and move the tissue is begun. The therapist will include exercises to retrain the muscles, restore normal posture, and begin motion. The program is progressed from three to six weeks postop.

Throughout this time, it’s best to complete the exercises without pain. Pain is a sign that something is wrong. Either the exercise is being done too soon or improperly. It’s better to do a little often than doing a lot occasionally.

Keep at it with the help of your therapist. Quality is more important than quantity. Good muscle control comes first before the ability to do many repetitions. Stop when the muscle gets tired. You’ll know you’ve reached this point when the muscle starts to shake or you can’t go through the same motion as during the first few repetitions.

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.

Posted in Shoulders. Tags: . No Comments »

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.

Posted in Shoulders. Tags: , , . No Comments »

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.

Posted in Shoulders. Tags: , , . No Comments »

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.

Posted in Shoulders. Tags: , , , . No Comments »

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.

Posted in Shoulders. Tags: , , , . No Comments »

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.

Posted in Shoulders. Tags: , . No Comments »

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.

Posted in Shoulders. Tags: , , , , , , . No Comments »