Naples Orthopedic Surgeon - Dr. Robert J. Zehr » shoulder pain

What happens during a shoulder manipulation?

admin — Fri, 29 Jul 2011 14:16:37 +0000

Can you tell me how they do a shoulder manipulation? I know I’ll be asleep for the operation but what happens exactly?

Surgical manipulation of a joint refers to a procedure whereby the surgeon moves the joint slowly and gently through its full range of motion. The patient is anesthetized to allow for full relaxation of the muscles, which would hold and contract otherwise to avoid the pain of movement. Once you are asleep, the surgeon moves your arm carefully through each motion: flexion, extension, and rotations (internal and external). The arm will also be moved across the body. This movement is called horizontal adduction. Adhesions and fibrous scar tissue will be torn in the process. The surgeon feels and hears the snapping, popping, grating sound called crepitus that signals release of the adhesions. Once the adhesions are released, the shoulder will move more smoothly and fully. The manipulation procedure is complete when the affected shoulder has the same range-of-motion as the uninvolved side.

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.

Which surgery method is best for golfer with torn rotator cuff?

admin — Tue, 26 Jul 2011 11:02:55 +0000

I’ve been getting ready to have shoulder surgery for a rotator cuff tear. I’m an avid (middle-aged) golfer. I’ve looked at arthroscopic surgery versus open surgery. I really want to get back on the golf course. Which one of these is better for golfers?

There’s still quite a bit of debate on this point. Studies don’t show a big difference in results between these two approaches. The arthroscopic procedure is minimally invasive. There is less soft tissue disruption and a smaller incision. But there is some concern that this method leaves some people with a repair that won’t remain stable or hold up.

Surgeons tend to use open repair techniques for over-head throwing athletes. The belief is that they need a mechanically stronger repair. But there are other surgeons who report that they are using all-arthroscopic surgeries for all patients including athletes. There are two other things to consider when making this decision. The first is return-to-sports and the level of activity you may achieve. It is possible to return to the game at your pre-injury level. But some patients who have the arthroscopic repair do so at a level below their former playing ability. And secondly, it is possible to retear the repair. Retear rates compare equally between open and arthroscopic techniques. In many reported cases, the patients with retears did not follow the rehab protocol and did more than was advised.

Can you have a torn rotator cuff and not know it?

admin — Thu, 21 Jul 2011 11:48:50 +0000

Is it really possible to have a torn rotator cuff and not know it? My aunt tells me she was diagnosed with this type of injury. But they aren’t going to treat it because it doesn’t hurt. Does that seem reasonable to you?

Rotator cuff injuries can be difficult to diagnose. It is indeed true that many older adults with degenerative soft tissue changes have no symptoms. They are said to be asymptomatic. Studies show that it is possible to have a full-thickness tear of the rotator cuff without any symptoms. Finding a clinical test that can accurately diagnose a rotator cuff tear has been a challenge. There are four different tendons that form the rotator cuff. There’s a different clinical test for each one. But sometimes it’s impossible to separate out the supraspinatus from the infraspinatus (two of the commonly involved tendons). The surgeon may have to rely upon ultrasound or other more advanced imaging to make an accurate diagnosis. Many prefer arthroscopic exam because the repair can be done at the same time. Ultrasound does have the advantage of being able to compare one side to the other without invasive surgery.

How to determine if total shoulder replacement will relieve your pain

admin — Mon, 18 Jul 2011 11:39:51 +0000

At what point do the doctors decide to replace a joint like the shoulder? Mine’s been hurting for what seems like forever, but my doctor says that he doesn’t think a shoulder replacement would help.

Joint replacements can be a wonderful life-changing surgery. By removing the painful joints and replacing them with mechanical ones, people can regain proper movement with little pain. However, joint replacements are not for everyone. The treating doctor has to assess if the injury or deterioration in your shoulder is something that would be fixed by a replacement – not all shoulder problems are. The doctors also have to look at risk when assessing if a patient is medically well enough to undergo surgery and if providing surgery may or may not cause complications. Finally, some doctors want patients to wait as long as they can before performing a replacement because the new joints have a certain life span and the doctors would prefer to avoid having to do a second surgery down the line, if at all possible.

If you are not happy with your care, perhaps you should seek a second opinion and you may ask the doctor as many questions as you feel are necessary.

Torn rotator cuff? Reverse total shoulder replacement may be the answer

admin — Wed, 13 Jul 2011 11:33:24 +0000

My father is going to have a shoulder replacement but the doctor said it is a “reverse” replacement. What does that mean?

While regular shoulder replacements can be very successful for the right patients, if the patients have torn rotator cuffs, this is not the ideal solution. The movement of the shoulder places a lot of strain on the rotator cuff. The regular shoulder replacements include replacing the ball at the top of the humerus (the upper arm bone) with a metal ball. The socket in the scapula (shoulder blade) is replaced with a plastic socket. However, if the patient has a torn rotator cuff, this replacement can come loose. In the reverse replacement, the ball is at the top, where the scapula is, and the socket is part of the humerus. With this arrangement, the upper arm muscle, the deltoid takes on the responsibility of the movement rather than the rotator cuff.

What’s the difference between shoulder replacement and resurfacing?

admin — Wed, 29 Jun 2011 10:52:47 +0000

What’s the difference between shoulder replacement and resurfacing?

Shoulder replacement is the removal of the shoulder socket and head of the humerus (upper arm bone). These parts are replaced with an artificial implant.

On the shoulder socket side, a cup-shaped metal or ceramic implant is pressed or cemented into the bone. On the humeral side, an implant shaped like the head of a humerus with a long stem is inserted down into the shaft of the humerus. New bone from the humerus grows into and around the implants.

With joint resurfacing, the surgeon removes any bone spurs and smooths the joint surface. Then the joint surface is covered with tissue from some other part of the body. This could be a piece of tendon, flap of muscle, or rim of meniscus. The tissue usually comes from a donor bank.

Biologic resurfacing is also known as interpositional arthroplasty. It has been around in one form or another since the mid-1800s. It is one alternative to a total joint replacement for young, active adults. Less bone is removed. This makes it possible to convert to a total shoulder replacement later, if needed.

How many patients who have surgery for shoulder dislocation develop arthritis?

admin — Fri, 24 Jun 2011 10:47:39 +0000

About five years ago, I dislocated my shoulder repeatedly. Eventually I had surgery to clean out the joint and tighten it up. I’m starting to notice some crackling noise in that joint when I move my arm overhead. Does this mean something has come loose? Do I need to do something for this before it becomes a problem?

You may be noticing some early signs of joint degeneration. Arthritic changes aren’t uncommon after shoulder surgery for recurrent shoulder dislocations. In fact, some studies show up to 20 per cent of patients who have surgery for shoulder instability develop postoperative arthritis.

Sometimes early arthritic changes are already present in the shoulder before the surgery. This has been observed in about nine per cent of patients with chronic shoulder instability. Loss of shoulder motion and function seem to be linked with deficiencies leading to arthritis.

A follow-up visit with your orthopedic surgeon may be in order. At the very least, an X-ray of the joint will be done to rule out fracture or loose fragments in the joint. The X-ray can also confirm the presence of arthritic changes.

Early diagnosis of orthopedic problems is always recommended. Taking care of a minor problem can help prevent major problems later.

When can patient play tennis again after arthoscopic shoulder surgery?

admin — Tue, 21 Jun 2011 10:42:15 +0000

I’m going to have an arthroscopic surgical procedure for a problem with a chronic left shoulder dislocation. I’d like to get back on the tennis court in time for the adult summer league. What kind of rehab program should I expect?

Rehab programs after a shoulder stabilization procedure may be the same whether it was an open versus closed procedure. Sometimes this depends on the surgeon’s preferences. Type of sutures used, amount of damage to the soft tissues, and condition of the joint capsule are only three of the important considerations.

Most often, the protocol used during the early phase of rehab is one that can be modified for each patient. Your therapist will advance you along as quickly as possible. The rehab protocol is really just a guideline.

Most likely you will be put in a shoulder immobilizer (sling) in the operating room. This is worn for two to four weeks. Exercises are started at two weeks. Passive and active-assisted partial range of motion is allowed. Full, active range of motion is permitted at six weeks.

The therapist will progress you to and through a series of strengthening exercises. The speed at which you will be able to advance may depend on your level of pain, degree of stiffness, and strength. You will be able to start training for tennis participation between eight and 12 weeks. If there are no complications or problems, you may expect to return to your sport about four months after surgery.

Arthroscopic vs. incision approach for golfer’s shoulder, which is better?

admin — Thu, 16 Jun 2011 10:37:00 +0000

I’m a semi-pro golfer with a bad shoulder from chronic dislocations. The surgeon has offered to do a stabilization procedure with either an open incision or arthroscopically. Is there much difference between these two operations?

Improvements in both surgical procedures has narrowed the gap of advantages of one over the other. The arthroscopic approach uses two or three puncture wounds to insert a long, thin scope into the joint. It has been suggested that this approach has a more pleasing appearance and shorter operative and recovery time.

The incision approach uses a fairly small open incision to access the joint. The main difference is that the subscapularis muscle is split during the open surgery. Some surgeons feel this puts the patient at a strength disadvantage.

To check out this theory, a team of surgeons and sport medicine staff from Canada put it to the test. They compared before and after muscle strength of the shoulder for an equal number of patients treated arthroscopically versus with an open incision.

They were surprised to find out that patients in both groups had significant strength deficits. External rotation was affected more than internal rotation for both groups. But there wasn’t a discernible difference between the two groups. The reason for these two findings remains unknown but a point of interest for future research.

Frozen shoulder follows rule of threes – do you know them?

admin — Mon, 13 Jun 2011 10:30:19 +0000

I somehow managed to get a frozen shoulder. No one seems to know what caused it. My doctor has suggested a wait-and-see approach. She says these things tend to take care of themselves, and that it will probably go away on its own. Isn’t there something I could or should be doing to get better?

A stiff and painful shoulder with limited motion is known as a frozen shoulder. It can be the result of trauma, diabetes, or from unknown causes. The condition does tend to follow the rule of threes. It has three stages that each last about three months.

The first stage is the freezing phase. The arm starts to lose motion and become painful. The second stage is the frozen phase. The pain is less but stiffness prevents functional movement. This phase lasts at least three months (sometimes longer). In the final stage, the shoulder starts to thaw. Range of motion slowly returns to normal.

The wait-and-see approach is sometimes referred to as benign neglect or supervised neglect. This treatment method seems to work about as well as any other. Some patients prefer to seek the services of a physical therapist to help them regain motion and strength.

Other forms of conservative (nonoperative) treatment may include cortisone injections, oral steroids, or nerve block. Manipulation (movement) of the shoulder can be tried under anesthesia before surgical release of the capsule is considered.

Studies have not been done to show which approach works best — or if any treatment is really even needed. Until proven differently, the wait-and-see management style is considered acceptable at this time.