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

Time for total shoulder replacement? Not so fast!

admin — Fri, 04 Jun 2010 13:41:18 +0000

I have arthritis in my left shoulder. It hurts constantly, but I can use it for most things. How can you tell when it’s time for a shoulder replacement?

The first place to start is with a medical exam. An orthopedic doctor is the specialist to see for this kind of problem. In some cases, medications and exercise may be all that’s needed. Muscle weakness can cause pain. A good rehab program can reduce pain, improve motion, and increase strength.

Sometimes, surgery to repair a torn tendon or muscle is advised. Many patients with shoulder pain have undiagnosed soft tissue damage. This could have happened years ago after a fall or other injury. A total joint replacement isn’t always the first answer to shoulder problems.

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.

Therapy needed for soldier with shoulder problem

admin — Mon, 12 Apr 2010 12:11:16 +0000

I am a 24-year old soldier in the U.S. Army. During basic training, I did hundreds of push-ups in a single hour. Two days later, I developed a problem called rhabdomyolysis. I’ve been taken off all physical training and go to physical therapy instead. Will I ever be able to do push-ups again?

Yes. Military physical therapists have a special program worked out for soldiers with this problem. Rehab begins with range of motion exercises and works toward getting back full motion. Stretching and resistive exercises are slowly added.

Push-ups are also added slowly and start with a modified form. Modified push-ups include wall push-ups, then push-ups done from a high table top. Before going to regular push-ups, the exercise is done from a low table. When the patient is ready, wide arm, diamond, and single-arm push-ups can be included.

What is Friedrich’s disease?

admin — Thu, 25 Mar 2010 20:22:48 +0000

My 62-year old sister was just diagnosed with Friedrich’s disease. Can you tell me something about this disease?

Friedrich’s disease is a rare condition affecting the collarbone (clavicle) where it attaches to the breastbone (sternum). The patient reports pain or discomfort, swelling, and crackling or popping of the joint called crepitus. There may even be a loss of arm motion on that side.

The cause of this disease remains unknown. For some reason there is a loss of blood supply to the area. The bone starts to die and decay. This process is called osteonecrosis. The bone becomes fragmented with normal, healthy bone surrounding small islands of necrotic (dying) bone.

Most often the problem solves itself and treatment isn’t needed. Sometimes the end of the bone must be removed surgically before healing can occur.

Capsular pattern of frozen shoulder explained here

admin — Wed, 17 Feb 2010 21:51:21 +0000

The doctor and physical therapist told me I have a frozen shoulder with a capsular pattern. I understand the frozen shoulder part but what does ‘capsular pattern’ mean?

The shoulder is a very complex joint with muscles, tendons, ligaments, bursae, and fibrous cartilage helping to hold it together and give it smooth motion. Four muscles and their tendons called the rotator cuff surround the shoulder joint like an envelope. These are covered by a fibrous connective tissue called the capsule.

The head of the humerus (upper arm bone) and the shoulder socket are enclosed by the capsule. Normally the capsule is large and loose. When injury or immobility damages the capsule a frozen shoulder can develop. This means the shoulder doesn’t move smoothly in the socket. It gets stuck or frozen in place. The medical term for this is adhesive capsulitis.

With a frozen shoulder a typical pattern of movement restriction starts. This is known as the capsular pattern of the shoulder. The greatest loss of motion is in outward or external rotation of the shoulder. Moving the arm away from the body is also limited. This is called shoulder abduction. In a severe capsular pattern inward or internal shoulder motion is also stuck.

Best form of surgery for torn rotator cuff depends on location

admin — Thu, 15 Oct 2009 10:45:33 +0000

I have a moderate rotator cuff tear. I haven’t had relief from physical therapy and medications. Now we’re talking about surgery. My doctor says there are a couple of ways to approach surgery for tears like mine. What type of surgery is best?

There are a few ways to operate on rotator cuff tears. The most extensive surgery is open repair of the rotator cuff. With this procedure, surgeons use a large incision to operate. During surgery, they suture the tear to help the shoulder function properly. This approach is the best option for severe tears, or those that affect more than half of the rotator cuff tendon.

An alternative for minor tears is called acromioplasty. With this procedure, surgeons shave part of the acromion bone on the point of the shoulder. A ligament over the top of the shoulder is cut, and injured tissues are removed. This takes pressure off the injured rotator cuff and promotes healing. For patients with tears that affect less than half of the tendon, this procedure usually have good, lasting results.

For patients whose tears go through about 50 percent of the tendon, repair of the rotator cuff may offer better results than acromioplasty. This choice also depends on where the tear is located. Ask your doctor which surgery is best, given the size and location of your injury.

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.

How did I get adhesive capsulitis – a frozen shoulder?

admin — Fri, 25 Sep 2009 16:44:51 +0000

My doctor diagnosed my tight shoulder as “adhesive capsulitis.” What is this, and how did it happen?

Adhesive capsulitis, also called “frozen shoulder,” is a condition in which the shoulder becomes tight and painful, making it difficult to do daily activities.

With frozen shoulder, inflammation in the joint causes the lining surrounding the joint to stick together. This causes the shoulder to “freeze” and seriously limits movement.

It’s hard to say how you got a frozen shoulder. Most cases can’t be traced to one event. One theory is that this condition is caused by an auto-immune reaction. An auto-immune reaction happens when the body’s defense system, which normally protects it from infection, mistakenly begins to attack the tissues of the body.

A frozen shoulder may arise gradually, with no injury or warning. It sometimes happens to people who’ve had past shoulder problems, such as rotator cuff tendonitis or bursitis. Others are affected after surgeries unrelated to the shoulder–even after heart attacks. The condition likely results when pain or inflammation in the shoulder causes a person to start using the shoulder less, setting the stage for a frozen shoulder.

Testing for tears in rotator cuff not always accurate

admin — Thu, 24 Sep 2009 10:41:13 +0000

The arthrogram for my shoulder showed no tear in the rotator cuff. But when I went for an MRI, it showed a complete tear. Why didn’t the arthrogram show the tear?

The arthrogram is an older test. It is based on the idea that a special dye will leak out if the rotator cuff is torn. If a scar forms over the tear or if the dye can’t leak out for some other reason, the test will appear negative. This is known as a “false negative” result, meaning the test appears normal even though the tendon is actually torn.

A “false positive” is when a test shows there’s a problem where there isn’t one. For example, because the MRI scan is so sensitive, it can sometimes show what looks like a tear. Yet when surgery is performed to fix the tear, the surgeon may find that the tendon is not torn.

The most accurate test of all is surgical exploration. However, because surgery is costly and has certain risks, doctors prefer to use tests like MRI first to try to confirm the presence of a tear.

Too busy for physical therapy? Rethink surgery!

admin — Tue, 22 Sep 2009 11:14:37 +0000

I recently dislocated my shoulder. I’ve heard about a new surgery available to fix it. Does that mean I won’t need to go through physical therapy? Frankly, I don’t have the time.

The surgery you are talking about is arthroscopy surgery, and it’s not all that new. However, it is being looked at more closely as an improvement over the traditional approach of simply placing the shoulder in a sling. Physical therapy is an integral part of the recovery process, regardless of the treatment approach. Since it’s your body, you need to have a say in how it is cared for. That said, many surgeons prefer not to operate if the plan for rehabilitation afterward can’t be agreed upon. Discuss your concerns with your surgeon.

What is snapping scapula syndrome?

admin — Mon, 21 Sep 2009 13:25:40 +0000

What is snapping scapula syndrome?

Snapping scapula syndrome is a fairly rare condition where the shoulder blade thumps, grates, or snaps as it moves along the chest wall. It can happen when the bursa between the shoulder blade and chest wall becomes inflamed. (A bursa is a lubricated sac that cuts down on friction between muscles, tendons, and bones during movement.) People who have had a fractured rib or shoulder blade sometimes feel grating because the bones may have healed out of alignment. Weak muscles under the shoulder blade can increase the chances of having snapping scapula syndrome because there is less muscle padding between the shoulder blade and chest wall.

Shoulder Impingement May Be Causing Swimmer's Pain

admin — Fri, 21 Aug 2009 12:44:38 +0000

I am on my high-school swim team. I have been swimming competitively since I was eight years old. Last season, I started to get shoulder pain doing freestyle. The pain is the worst when my hand goes into the water. Is there any kind of stretching or exercise program I can do for this?

You may be describing a problem called shoulder impingement. Impingement of a tendon causes pain for swimmers at the point of hand entry into the water. In this position, the arm is rotated inward with the hand turned palm and thumb down. The supraspinatus tendon of the shoulder rotator cuff may be getting pushed up against a ligament that crosses the tendon just above it.

Before starting any kind of exercise program, it is important to find out exactly what is causing your symptoms. There are a variety of specific tests that can be done by an orthopedic doctor. Early identification of the problem can help prevent small problems from getting worse. Treatment may involve anti-inflammatory medication, physical therapy, or surgery.