My orthopedic doctor gave me two steroid injections in my shoulder. The next step is to see a physical therapist. What will this do for me?

May 2nd — admin

My orthopedic doctor gave me two steroid injections in my shoulder. The next step is to see a physical therapist. What will this do for me?

Physical therapy may be helpful when there is a subacromial (SA) bursitis or impingement syndrome. SA bursitis is a condition caused by inflammation of the bursa. The SA bursa is a small, fluid-filled sac that forms a cushion between bones and tendons or between muscles and joints.

SA impingement or pinching of the bursa and tendon occurs when the arm is raised up overhead. The supraspinatus tendon of the shoulder and its bursa get pinched between the head of the humerus and the end of the clavicle (collarbone). The bursa is the area where the steroid injection is directed.

Once the inflammation is under control, the therapist will help you learn how to move your arm properly. The goal is to avoid pushing the supraspinatus tendon up against the acromion (end of the clavicle). In some cases, this condition occurs because of injury or weakness to the supraspinatus. This tendon is part of the shoulder rotator cuff.

In other cases, weakness or imbalance of the scapula (shoulder blade) contributes to the problem. This is called scapular dyskinesia. The scapula and shoulder move together in a smooth and rhythmical way. When this is disrupted by scapular dyskinesia, then shoulder impingement can occur. The therapist will guide you in getting back your normal scapular position and motion.

If the shoulder is unstable, physical therapy is aimed at improving the function of the muscles that provide dynamic shoulder stabilization. A strengthening program to restore normal movement patterns 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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I had a steroid injection into my shoulder last week. My pain got much worse. What went wrong?

April 27th — admin

I had a steroid injection into my shoulder last week. My pain got much worse and I broke out in a skin rash. I’m not going to do that again. What went wrong?

You may have had what experts refer to as a corticosteroid flare. In a small number of patients, the body reacts negatively to the injection. Local irritation in the form of pain and/or a skin rash occurs.

This response occurs within the first eight to 24 hours after injection. The benefits of the injection (pain relief and reduced inflammation) are usually still experienced.

No one is sure just why this reaction occurs. It may be an immune reaction to the preservative in the product. Or it may be a response to the corticosteroid. Some experts have suggested needle penetration into nerve endings may be the cause. Others say that if this were the cause, then more patients would have the flare reaction.

When corticosteroid flare occurs, ice can be applied to the injection site. Your doctor may prescribe anti-inflammatory medications and analgesics (pain relievers). Analgesics used for this problem may include narcotic medications.

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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I’ve been told that an open repair of my torn rotator cuff is best, but I would like a smaller incision. Is the open method really so superior?

April 11th — admin

I’ve been told that an open repair of my torn rotator cuff may give the best long-term results. But I like the idea of a smaller incision with the less invasive operations. Is the open method really so superior that I should take the cut?

The open rotator cuff repair has been the standard operation for many years. Long-term studies show it has an 85 to 95 per cent success rate. Patients experience pain relief and improved function.

At the same time, arthroscopic surgery has made it possible to do a mini-open rotator cuff repair. This procedure still provides good pain relief and even better functional results. Studies show 93 per cent improved function at mid-term follow-up.

Studies comparing the two methods still conclude that the open repair has the best long-term results. The success of the operation depends on three basic factors. These include the strength of the tendon-to-bone fixation, strength of the suture, and strength of the suture-to-tendon fixation.

Failure of fixation after the first rotator cuff repair occurs in 13 to 68 per cent of all cases. The wide variability in this failure rate is affected by these three factors. Results after re-repair aren’t very good. There’s only a 20 per cent chance of a good to excellent result.

Using the right sutures and suture placement is important in getting a fixation strength that’s equal to or greater than the force of the muscle pull. An open repair makes it possible for the surgeon to see everything more clearly and make the best repair for the damage present.

Massive rotator cuff tears are still largely done with the open method. Arthroscopic techniques are confined to small tears that can be repaired easily.

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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A 54 year old, fell playing ice hockey and now feels a “squishy” sensation in his shoulder. What should he do?

March 3rd — admin

I’m 54-years old and still like to get out on the ice and play broom ball or a little pick up game of ice hockey. Last season, I fell onto my elbow and felt a squishy sensation in my shoulder. Now I can hardly lift my arm up and hold it there without pain and weakness. What should I do?

If you haven’t already seen either your primary care physician or an orthopedic surgeon, that might be your first step. A clinical exam and some imaging tests (X-rays, MRI) will probably help identify the problem.

A traumatic injury through the elbow to the shoulder can cause damage to a number of different structures in the arm. The doctor will make sure there isn’t a fracture that hasn’t healed. The muscles, ligaments, and shoulder capsule will need to be examined.

The most common shoulder injury from this type of fall is a rotator cuff tear. Painful and weak motion suggests a major tear in one or more of the four muscles of the rotator cuff. Painless and weak is more typical when the tendon has ruptured completely.

The rotator cuff covers the shoulder and helps stabilize the head of the humerus (upper arm) in the shoulder joint. Sometimes other injuries accompany a rotator cuff tear. This is impossible to tell without further testing.

Sometimes a specific rehab program can give good results. But in some cases, surgery is needed. Again, a medical exam is needed to know for sure the cause of your symptoms and the best course of action.

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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Boomeritis – a real diagnosis?

November 26th — admin

I just came back from my doctor’s office. After examining my shoulder, she said that I have boomeritis. I’ve heard of bursitis, but what’s boomeritis?

There’s been a dramatic increase in the number of exercise- and sports-related injuries in adults aged 50 to 60. Since most of these adults were born during the post World War II baby boom era, these problems are being referred to as boomeritis.

Tacking the ending or suffix: itis on a word indicates inflammation. So a bursitis would refer to inflammation of the bursa in a joint. Boomeritis is just a nickname for who (you, the baby boomer) and what (inflammation from overuse) but doesn’t identify the true underlying problem. You could have a bursitis, shoulder impingement problem, or tendinitis.

If you are unclear about your problem and what to do about it, don’t hesitate to call your physician back and discuss your situation further.

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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Bristow procedure linked to higher rate of arthritis

September 23rd — admin

Thirty years ago I had a special operation called the Bristow for a shoulder dislocation. It seems to have held up pretty good but now I’m getting some arthritis. Is that from the surgery or the dislocation?

Cases of joint arthritis after a traumatic injury are very common. This is true for any joint, not just the shoulder. The type of operation you had is also linked with a higher rate of arthritis afterwards.

The Bristow procedure named after W. Rowley Bristow, MD was used most often back in the 1970s when shoulder repairs were done with an open incision. Today, arthroscopic surgery has replaced open procedures in many cases.

The Bristow procedure transferred the tip of the coracoid process to the front of the shoulder socket. The coracoid process is part of the scapula (shoulder blade) that juts forward toward the front of the shoulder.

The idea was to use this piece of bone to reinforce the shoulder socket. It kept the head of the humerus (upper arm) from popping out of the socket. Usually a piece of muscle was also attached like a sling to help as well.

The Bristow procedure is still used in Europe but has been replaced by other methods now in the U.S. There were concerns about restricted motion and arthritis leading to the development of other methods of surgical repair. The coracoid transfer is still used for some patients. Long-term results have been excellent bringing this method back to the attention of orthopedic surgeons for a second look.

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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Simple movements can stress shoulder

August 4th — admin

I’m in a sling after shoulder surgery for the next six weeks. I’d really like to just try out my new arm. Is it such a bad thing to move it around?

We don’t really know how much force can be applied to normal tendons much less healing soft tissues. Animal and cadaver studies have given surgeons a general idea. The amount of acceptable force will increase over time as the tissues interface with the bone.

You’re best off to follow your surgeon’s advice carefully. The healing tissue is very weak and can’t hold together with stress or pull. Even the simplest of movements can put a greater load on the surgical site than it can handle.

Most surgeons give their patients specific guidelines to follow. There are some general guidelines for everyone having the surgery you had. There are some just for you based on your age, the condition of your soft tissues and bones, and the type of surgery done. Be sure and ask if you don’t know what are the limits in your case. You wouldn’t want to undo what the surgeon just spent hours (and your money) fixing.

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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Time for total shoulder replacement? Not so fast!

June 4th — admin

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.

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Therapy needed for soldier with shoulder problem

April 12th — admin

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.

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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What is Friedrich’s disease?

March 25th — admin

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.

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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