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

June 13th — admin

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.

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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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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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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What is bursitis? I’ve heard of it and wonder if that’s what’s causing my shoulder pain.

March 16th — admin

What is bursitis? I’ve heard of it and wonder if that’s what’s causing my shoulder pain.

Bursitis is an infection, irritation, or inflammation of a bursa. The bursa is a small fluid-filled sac or cushion. There are many bursae throughout the body. They are found where a muscle or tendon slides across bone. 

Bursae decrease friction between two moving surfaces. With aging, they can become paper thin. Then they no longer provide the necessary cushion. When the two body parts start to rub together, bursitis can occur. Sometimes repetitive motion causes the bursae to become inflamed.

The shoulder is a very complex joint with many moving parts, ligaments, tendons, and muscles. There is a fairly large bursa between the rotator cuff and the head of the humerus (upper arm bone). The rotator cuff is a group of four muscles and tendons that surround the shoulder joint.

An orthopedic surgeon can help diagnose the problem. A careful history and examination may pinpoint the exact cause of your painful symptoms. There is treatment available for bursitis, if that’s what’s causing your pain. 

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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Football player’s shoulder gives way – catch it before it dislocates

October 20th — admin

Our son is a high school football player. When he plays offensive lineman he complains afterwards of shoulder pain. He says when he uses his arms in the blocking position and comes up against another player, his left shoulder “gives way.” Is this something we should talk to the coach about?

It’s possible your son is having some shoulder instability. The head of the humerus, a round ball at the top of the upper arm bone may be moving backwards out of the joint. This is called subluxation if it’s not fully dislocating.

Repetitive loading in the blocking position can put the shoulder at risk for instability from dislocation. You should talk with the coach or trainer but the best thing may be to see an orthopedic surgeon. X-rays, scans, and special tests may be needed to accurately diagnose the problem.

A special rehab program designed for this problem should be tried before jumping into surgery. Most of the time there’s a muscle imbalance that can be overcome with the right kind of strength training. The joint itself may have to regain its full joint sense of position called proprioception. The physical therapist will also address this problem during rehab.

Early detection and intervention are the keys to getting back on the field and staying there without further injury. Don’t put this off when it may be a small problem and before surgery or other invasive treatment is 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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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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