| Shoulder Injuries Questions |
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Q: Two months ago I had surgery to fix the rotator cuff tendon in my right shoulder. I was steadily regaining strength and motion with therapy after surgery. Last week I felt a pop with a sharp pain after helping my wife move furniture. The shoulder pain has continued and I now have more weakness. What can be done?
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| Answer: |
You probably have retorn your rotator cuff tendon because your initial repair has not fully healed. You should be re-examined by your doctor to confirm that your injury was a re-tear and not something else. An arthrogram, where dye is injected into the shoulder and the area viewed with an X-ray, can outline the location of the tear. A more costly MRI can provide a more detailed picture. The rotator cuff tendon re-tear can be operated on again. Results are influenced by the quality of the torn tissue, the amount of motion before surgery, the degree of arthritis and the age of the tear. A torn tendon can have a tendency to retract away from the torn edge because the muscle contracts. In time, scarring can fix the tendon in a retracted position, making it difficult to mobilize and restore the tendon. Prompt attention is imperative if a second surgical rotator cuff tendon repair is going to be successful. |
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Q: For years my shoulder problems have been blamed on a condition called
shoulder impingement. What would you, as an orthopedic doctor, do to prove or disprove my impingement?
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| Answer: |
Shoulder impingement is a term used to describe pain that occurs with
overhead movements. As the arm is brought overhead, the rotator cuff and overlying bursal tissue is squeezed between the shoulder blade and the ball of the socket. There are many factors that contribute. Some people are born with bony shoulders that create a tight space for the rotator cuff tendon and bursal tissue to maneuver. Some older individuals develop bony spurs over time. The spurs encroach upon the rotator cuff and bursa creating pain. As an orthopedic physician, I would look for a history of pain with overhead activities and pain at night that wakes you. Your response to overhead maneuvers, instability, loss of range of motion and strength would be assessed by a physical exam. Your response to a local anesthetic injected into the shoulder can help localize the problem area and assist in the diagnosis of impingement. Special X-ray views are helpful to detail bony anatomy to identify tight spaces or bone spurs.
A magnetic resonance image study (MRI) can show the amount of impingement and whether a rotator cuff tendon tear has developed from the impingement. Arthroscopic surgery is a valuable tool, not only for confirming the diagnosis, but also with treatment when conservative measures fail.
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Q: I am a 45-year-old woman and have been experiencing mild pain and loss
of motion in my left shoulder. I have been told I might have a frozen
shoulder. I am not aware of any trauma to the shoulder. For exercise I speed walk. I have well-controlled diabetes. Could you explain what frozen shoulder is?
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| Answer: |
Motion loss in the shoulder with no apparent cause is termed idiopathic frozen shoulder syndrome. The term ''idiopathic'' is used when motion loss occurs for no apparent reason. Certain medical problems may contribute to the condition, such as diabetes, cardiovascular disease and neurologic conditions. Patients with diabetes are at greater risk of developing a frozen shoulder. Often both shoulders are involved. A frozen shoulder is characterized by the joint capsule and the soft tissue that covers the joint becoming progressively thickened and scarred. This process limits motion. Most people will respond to a physical therapy program and
anti-inflammatory medication. A manipulation of the shoulder joint under anesthesia to break up the scarring of the capsular tissue may be needed for those who do not respond to therapy. A small percentage of patients will continue to lose motion. In this situation, we would consider arthroscopic surgery to remove scarred tissue and restore motion.
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Q: My 19-year-old son dislocated his shoulder for the second time while windsurfing. He was advised to have surgery. His father dislocated his shoulder five years ago while skiing. He has not had any subsequent problems. What treatment would you advise for my son?
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| Answer: |
The term dislocation of the shoulder is used to describe the disruption and displacement of the normal contact between the head of the humerus (ball) and the glenoid (socket) of the shoulder joint. Both your son and your husband had to have had sustained a significant trauma to dislocate a shoulder if they have had no prior history of instability. The age at which a person dislocates his or her shoulder becomes an important factor when considering treatment. The potential for recurrent dislocation episodes is high in individuals under 20 years of age. Some studies report as high as 90 percent recurrent dislocations in those individuals under 20 years of age who are athletic. Your husband, on the other hand, has had no subsequent dislocations of his shoulder over the past five years. This history is consistent with studies that have evaluated and followed individuals over 40 who have had a dislocation. Since the likelihood of recurrent dislocation occurring in people over 40 is low, nonoperative treatment is indicated. Thus, one would expect your husband to respond well to a brief period of immobilization with a shoulder sling followed by physical therapy and rehabilitation. Because your son's initial dislocation occurred under age 20, the likelihood is high for subsequent dislocations. Nonoperative treatment has a high failure rate in this age group. With each subsequent dislocation, further damage to the shoulder can occur as well as injury to the nerves around the shoulder joint. Surgery to restore stability to the shoulder joint should be considered in your son's case. |
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Q: About 4 months ago, I was diagnosed with a shoulder impingement. I'vecompleted physical therapy and continue to exercise my shoulder regularly. My question is this: I continue to play softball during which I still have a little bit of shoulder pain. Am I risking further injury by playing through the minor pain?
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| Answer: |
Repetitive minor pain can have an accumulative effect on the rotator cufftendon and bursae. If nonoperative treatment has failed to alleviate yoursymptoms you may want to consider surgery. An arthroscopic shoulderprocedure, performed through several 1/4 inch incisions, can widen the bony space which contacts over the bursae and rotator cuff tendon when you perform overhead activities such as softball. |
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Two months ago I had surgery to fix the rotator cuff tendon in my right shoulder. I was steadily regaining strength and motion with therapy after surgery. Last week I felt a pop with a sharp pain after helping my wife move furniture. The shoulder pain has continued and I now have more weakness. What can be done?