Shoulder Surgery

Options for Shoulder Impingement Treatment

Shoulder impingement syndrome is known by many names including painful arc syndrome, swimmer’s shoulder, and subacromial impingement and this condition occur when the tendons of the rotator cuff muscles become inflamed as they move through subacromial space. As a result, there is reduced the flexibility of the shoulder, and weakness and pain will usually be experienced too. Pain usually intensifies if the shoulder is moved to an overhead position or, at night, when the individual lays upon that shoulder. Restricted movement increases the sense of frustration experienced. Pain may manifest as a dull ache, gradually occurring, or, it may suddenly manifest and be acute. There may be a grinding motion or a popping sensation. Elevation of the arm is likely to be painful but will also occur when applying downward force too although this will ease. Seeking medical assistance for shoulder impingement treatment is paramount.

Although other options are likely to be considered first, a subacromial decompression may be required which helps to prevent the bones and tendons rubbing together. Subacromial simply means under the acromion which is a part of the shoulder blade helping to form the shoulder joint. This is usually done through keyhole surgery and a general anesthetic would be required. When there is subacromial impingement, this means that the actual space between the rotator cuff tendons and the shoulder blade is reduced, typically through swelling and irritation or, the development of bony spurs. Where the latter occurs, it’s often as a result of osteoarthritis. Treatment enables this space to be extended and any inflamed bursa or bony spurs can be removed.

Any surgery can be worrying and so, it’s important for good communication to be in place and to speak to specialists in the field such as the Orthopedic Center, Arizona who can explain the process reducing any fears about the procedure. Any surgical operation will be carried out by an orthopedic surgeon who will guide each person through the process as is relative to their case. As a general anesthetic is likely, fasting will be necessary prior to the operation. Any individual who smokes will be asked to stop as smoking increases the risk of infection. The procedure takes approximately one hour although this will vary on an individual basis and a local anesthetic may also be injected into the shoulder nerves to reduce any discomfort experienced following surgery. Pain management is important and there will be options to ease discomfort. The surgeon may also decide to repair any damaged tendons at the same time.

Shoulder impingement treatment does not always require surgery. There are various causes and symptoms which may not mean invasive treatment at all. Certainly, resting the shoulder joint and avoiding extensive movements can help and doctors may suggest non-steroidal anti-inflammatory medicines along with physiotherapy initially. Where necessary, steroid joint injections may be given. Note that subacromial decompression will only be recommended usually if other treatments have not helped. It can take up to four months for full recovery following surgery and most people will make a complete recovery.  Following up with physiotherapy is often beneficial to aid flexibility and to increase movement. It will also be important to build strength up in the shoulder joint too. Find out more by visiting OSPLarizona.com

What Happens in an Ulnar Collateral Ligament Injury?

Ulnar collateral ligament injuryAn ulnar collateral ligament injury is an injury to the elbow ligament. It happens due to overuse of one of the ligaments on the inner side of the elbow and can result in tearing the ligament.
The injury is very common in contact sports where athletes have to repetitively stretch their arms or where elbow dislocation occurs. The injury is caused by a force that exceeds the strength of the ligament with activities like throwing or overhead sports being very likely triggers.

Possible complications and treatment

Injuries of this type hold the potential to damage other structures of the elbow and cause elbow stiffness.
In most cases, where the injury is not too serious, ice and pain medications can be used to treat the swelling and discomfort. Ice helps target swelling while medications stop the pain temporarily. Where pain persists, the individual may also get a brace or cast to seek relief.

What is Tommy John surgery?

The surgical treatment for correcting an ulnar collateral ligament injury is called the Tommy John surgery. The procedure derives its name from a surgery performed on the MLB pitcher and LA Dodgers Tommy John for a tendon transplant.
The procedure works by replacing the torn ligament with a graft tendon taken from the hamstring, forearm, knee or foot of the individual. However, the surgery is only recommended for those patients who do not find relief from non-surgical methods.
Athletes who need to engage in grueling overhead throwing activities and whose careers depend on performance are ideal candidates for this procedure.
The surgery involves implanting the graft to the injury site by drilling tunnels in both the forearm and upper arm bones once the elbow is opened up.
Flexor muscles in the area are also opened up where the graft is woven and the reconstruction is performed. Any remaining portion of the original ligament is then attached to the reconstructed ligament.
While it might seem like a lot of work, the surgical procedure takes between an hour and an hour and a half to perform. Most patients are required to stay overnight in the hospital and are discharged the next day.

Post-operative care

Post-operative care after this procedure involves keeping the incision dry and clean and not showering for 3 days. The patient also needs to give the elbow a rest for a week with no driving for a minimum of six weeks. Other remedial steps include resting the elbow on a pillow when seated and keep it elevated to minimize swelling.
Most patients will recover from surgery in 6 to 8 weeks with motion achieved in this time without pain.

Rehabilitation

Rehabilitation consists of gentle exercises such as squeezing a softball while avoiding moving the elbow. With improvement, the patient can advance to an active motion from passive motion.
Once comfortable, the patient can move to engaging the elbow more by working with a fuller range of motion. Care needs to be taken not to cause direct stress to the elbow during recovery.
It usually takes 12 months for returning to normal sports.

How to Treat Sharp Pain In Front Right Shoulder?

Having sharp pain in front right shoulderPain experienced at the front of the shoulder may be acute or chronic. Also known as bicep tendonitis, this condition can occur from injury, strain, tear or an inflammatory response. Here is what to do when experiencing sharp pain in front right shoulder:

Reduce inflammation

The first line of treatment is to address the inflammation in the affected area. This can be done by taking adequate rest along with anti-inflammatory medication to start the healing process.

Improve range of motion

When pain starts to subside, individuals can start working on getting their range of motion back. In most cases, the overreach is affected and suffering individuals need to reclaim their overhead full flexion.

One consideration while doing so is that any tightness felt in the back of the shoulder may cause increased stress at the front of the shoulder and trigger more pain.

Build strength

As part of early recovery, individuals can try to strengthen affected muscles in the shoulder along with others in the back which support the shoulders.

When doing so, try strengthening the rotator cuff muscles as this muscle group and their tendons provide strength and stability during movement of the shoulder.

Go for functional training

Once the healing process starts and inflammation subsides, the individual can then start functional training. This step focuses on enhancing movement in a coordinated manner.

Functional training promotes proper mobility of shoulder, trunk, and scapula to allow synchronized movement.

There are a number of flexibility exercises that can help with bicep tendonitis treatment and may even help prevent the condition in the first place.

These can include the following:

  • Pec stretch
  • Rhomboid stretch
  • Inverted Rows
  • Side lying external rotation
  • External arm rotation
  • Push up to side plank

Other Bicep Tendonitis Treatment Options

Where exercise alone does not suffice, it may be paired up with other treatment options like the following:

  • Medications such as NSAIDs are typically the first option to treat the discomfort associated with the condition. The drugs can be helpful in alleviating the pain in the initial stages.
  • Icing is an elementary injury management technique and a drug-free method of relieving pain. An application of an icepack to the skin can soothe symptoms from strains, sprains, bruises as well as tendonitis.
  • Stretching on a regular basis may also help prevent tendonitis from occurring in the first place. Gentle stretches before and after workouts are highly recommended.
  • Massage is another effective way to loosen tissue and keep it from clogging muscle fibers. This therapy not only sustains the range of motion but also keeps muscles more supple to minimize the chance of further injury.

Among the different type of massages, deep tissue massage helps reduce inflammation and relieve muscle tightness. Sports massages, on the other hand, target muscle-tendon junctions to improve endurance and flexibility.

  • Surgical intervention is typically considered a last resort for people who do not benefit from other types of treatments.
  • Non-operative management involves the administration of injections to the inflamed area to manage inflammation and pain.

FAQs on Rotator Cuff Repair in Arizona

Rotator cuff repair surgery is used to repair a torn shoulder tendon or muscle, or to repair a group of tendons and muscles. This procedure is done with a large open incision, or through a buttonhole-sized incision via shoulder arthroscopy.

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons that form a cup over the shoulder joint. These structures hold the arm bone (humerus) in the rotator cuffglenoid joint (shoulder area). One or more of the tendons and muscles can be torn from trauma or overuse.

How common is a rotator cuff tear?

In a recent study, researchers evaluated rotator cuff tendinopathy. They found that the annual prevalence was 1-7%, and some evidence suggested that the incidence increased with age.

Does the procedure hurt?

You will receive general anesthesia before the rotator cuff surgery. You will be asleep and have no pain. After surgery, you will be given pain medicine to alleviate discomfort.

What procedures are used to repair a torn rotator cuff tendon?

Three main types of surgeries are:

  • Open repair – With traditional surgery, a large incision is made over the shoulder. The deltoid (large muscle) is moved to the side so the tendon can be repair. This procedure is used for large or complex tears.
  • Arthroscopy – With this procedure, a small incision is made, and a scope is inserted into the joint. The camera projects images on to a TV monitor, so the doctor can use tiny instruments to make repairs.
  • Mini-open repair – This procedure involves using an arthroscope and a couple of small incisions to repair the rotator cuff.

How is the rotator cuff repaired?

Rotator Cuff TearTo repair the rotator cuff, the tendons are re-attached to the bone if possible. This is done using small rivets (suture anchors) that hold the tendon in place. These are made of metal, or they can be made with dissolvable materials. At the end of surgery, the incisions are closed and a dressing is applied.

What can I expect before the rotator cuff repair surgery?

After the Phoenix shoulder doctor diagnoses a rotator cuff tear, you meet with the orthopedic surgeon to discuss surgery. Two weeks before the procedure, you must stop taking any medicine that thins the blood (aspirin, ibuprofen, and naproxen). Be sure to discuss all allergies and medications with the doctor. You cannot eat or drink for 8 hours before your surgery, and should leave all valuables at home the day of surgery.

What can I expect after the rotator cuff repair procedure?

You will wake up from sedation or anesthesia with a bulking bandage on your shoulder, your arm in a sling, and an immobilizer on your arm. This is to protect the shoulder while it heals. Most patients are discharged home the day of surgery. Recovery may take up to six months, and you will wear the sling for 4-6 weeks. The doctor gives you medications for pain, and you will follow-up with a physical therapist who helps improve strength and function in the shoulder joint.

What is the prognosis after the rotator cuff repair surgery?

Surgery to repair a torn rotator cuff is successful for relieving shoulder pain. The procedure usually returns strength to the shoulder structure. Rotator cuff repair requires an extended recovery period, and not everyone heals the same. The doctor will advise you on which activities you can and cannot perform following recovery. Poorer results often are related to:

  • Advanced age
  • Large tears
  • Weak or previously torn rotator cuff
  • Not following aftercare instructions
  • Smoking

Orthopedic and Sports Performance Institute provides  rotator cuff repair procedures with expert shoulder surgeons in Arizona. Most insurance is accepted, with the procedures being offered in a minimally invasive fashion. Call us today!

Resources

Littlewood C, May S, & Walters S (2013). Epidemiology of rotator cuff tendinopathy: a systematic review. Shoulder & Elbow, DOI: 10.1111/sae.12028.

Treatment Options for a Rotator Cuff Tear in Arizona

Rotator Cuff info from OSPI in Gilbert Arizona

 

A rotator cuff tear is a common cause of disability and pain. A torn rotator cuff can weaken your shoulder, causing problems performing simple daily activities, such as getting dressed or brushing your teeth.

How common are rotator cuff tears?

According to a study in 2008, around 2 million people visit their doctors due to a rotator cuff problem. In cadaver studies, researchers found that 39% of deceased individuals older than Rotator Cuff Tear60 years had full-thickness rotator cuff tears. The incidence in the general population is around 20% for partial and full tears.

What structures are affected by a rotator cuff tear?

The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The shoulder forms a ball-and-socket joint, with the ball being the head of the humerus and the socket being a groove in the scapula.

The arm bone is held in the socket by the rotator cuff, which is a network of four muscles and several tendons that form a covering around the humeral head. This cuff attaches the arm bone to the shoulder blade, and it helps elevate and rotate the arm. The lubricating sac of the joint is called the bursa, and it lies between the acromion bone (at the top of the shoulder) and the rotator cuff

How does a rotator cuff tear occur?

If one of the rotator cuff tendons tears, the tendon can no longer attach to the humerus head. Most tearing occurs in the tendon or the supraspinatus muscle. A partial tear involves only soft tissue, and it is not completely severed into two pieces. A full-thickness tear involves splitting into two pieces of soft tissue. The causes of a rotator cuff tear are:

  • Injury – Includes a fall onto an outstretched arm, or from lifting something heavy in a jerking motion. This often occurs along with a dislocated shoulder or broken collarbone.
  • Degeneration – Most rotator cuff tears occur from wearing down of the tendon that occurs gradually over time. Degeneration is related to aging. The factors that contribute to degeneration include repetitive stress, lack of blood supply, and bone spurs.

What are the risk factors for rotator cuff tears?

Certain people have a greater chance of suffering a rotator cuff tear. Risk factors include:

  • Aging – Normal wear-and-tear occurs with aging, so people age 40 and older are at greater risk.
  • Certain activities – People who do overhead activities and repetitive lifting are at risk, including carpenters, painters, and laborers. In addition, athletes who use their arms/shoulders (tennis players and baseball pitchers) are also at risk.

What symptoms are associated with rotator cuff tears?

The most common symptoms are pain at rest, particularly at night with lying on affected shoulder, pain with lifting and lowering the arm, weakness when rotating the arm, and crackling sensations (crepitus) when moving the shoulder through certain positions.rotator cuff

How is a rotator cuff tear diagnosed?

The doctor will ask you questions about your activities, inquire about your symptoms, take a medical history, and conduct a physical examination. The doctor checks for deformities, tenderness, and range of motion. In addition, the doctor checks arm and muscle strength. Tests used to make the diagnosis include:

  • X-rays – Do not show soft tissues of the shoulder but show bony deformities and fractures.
  • Magnetic resonance imaging (MRI) scans – Used to show rotator cuff tears, and shows if the tear is old or new. Also, it can dhow the quality of the rotator cuff muscles.

How are rotator cuff tears treated?

The goal of treatment is to restore arm and shoulder function, as well as to relieve pain. In planning your therapy, the doctor will consider your activity level, general health, age, and grade of tear you have. Treatment options include:

  • Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen will reduce swelling and pain. Narcotic analgesics can be prescribed short-term for severe pain.

 

  • Physical therapy – Special exercises are used to strengthen the shoulder and restore movement. The exercise program involves stretches that improve range of motion and flexibility, and strengthening exercises that enhance strength of muscles that support the shoulder to prevent further injury.

 

  • Corticosteroid injection – The doctor can inject the shoulder with a corticosteroid, with or without an anesthetic. This anti-inflammatory drug relieves irritation and swelling. In a review of several clinical trials comparing steroid injection to placebo injection, studies found significant benefit of steroid injections.

 

  • Suprascapular nerve block – This involves injecting a long-acting anesthetic agent near the affected nerve. The doctor will use x-ray guidance (fluoroscopy) to assure correct needle placement. In a large clinical study, patients receiving this block were followed for 12 weeks. Statistically significant improvements in disability and pain scores were observed, along with improved range of motion scores.

 

  • Surgery – If pain continues and does not improve with nonsurgical efforts, surgery may be required. Surgery is a good option if your symptoms have persisted for 6-12 months, you have a large tear, your tear was caused by a recent, acute injury, and/or you have significant loss of shoulder function. The tendon is reattached to the humeral head if possible. If the tear is severe, a graft may be used to replace the tendon.

Orthopedic and Sports Performance Institute offers comprehensive treatments for all types of shoulder conditions including arthritis, rotator cuff tears, labral tears and more. OSPI offers pain management, physical therapy and orthopedic surgeons in Gilbert AZ as well! Call us today.

What You Need to Know About Rotator Cuff Tears

A rotator cuff tear is a common cause of disability and pain among adults. According to 2008 statistics, around 2 million people in the United States visited a doctor with a rotator cuff problem. A rotator cuff tear can weaken the shoulder, and it limits ability to perform simple daily activities, such as brushing teeth or dressing.

What structures are affected by a rotator cuff tear?

The shoulder is made of three bones: the humerus (upper arm bone), the scapula (shoulder rotator cuffblade), and the clavicle (collarbone). The shoulder is a ball-and-socket joint that is kept stable by the rotator cuff. The rotator cuff is composed of four muscles that come together with tendons to cover the head of the humerus (ball of the joint). The rotator cuff helps you lift and rotate your arm. Between the rotator cuff and the shoulder bone (acromion) is a lubricating sac known as a bursa. This structure allows the arm bone to move freely in the socket.

What are the different types of rotator cuff tears?

When one or more rotator cuff tendons are torn, the structures no longer attach to the ball (head of the humerus). Tears can begin as partial frayed areas that progress to complete tears as the damage worsens. The types of rotator cuff tears are:

  • Partial tear – A slight tearing of the soft tissue, but it is not severed into two pieces.
  • Full-thickness tear – Also called a complete tear, this is where the structure is torn into two separate pieces.

What causes a rotator cuff tear?

There are two primary causes for tearing of the rotator cuff: acute injury and degeneration.

  • Acute injury – This occurs if you fall onto an outstretched arm, or when you lift something that is too heavy. An acute tear often occurs along with other shoulder injuries, such as a Rotator Cuff Teardislocated shoulder or broken collarbone.
  • Degeneration – A tear related to degeneration occurs from wearing down of the tendon over time. This type of tear occurs more in older adults. Rotator cuff tears are more common in the dominant arm, and you have an increased risk for tearing the opposite shoulder structure when you have a tear in the dominant arm rotator cuff.

What are the risk factors for a rotator cuff tear?

Several factors can contribute to chronic rotator cuff tears. These are:

  • Repetitive stress – Repeating the same shoulder movements over and over can put stress on your rotator cuff tendons and muscles. This occurs with certain sporting activities like baseball (throwing) rowing, tennis, and weight lifting.
  • Lack of adequate blood supply – As you age, the blood flow to the rotator cuff lessens. Without an adequate blood supply, the body’s ability to heal and repair damaged tendon and muscle decreases.
  • Bone spurs – Bony overgrowths develop on the lower aspect of the acromion bone. When you lift your arms, the spurs rub on the rotator cuff structures, which are called shoulder impingement. Over time, this rubbing weakens the tendon are makes it tear.
  • Being older – Because most rotator cuff tears are caused by wear-and-tear, aging and being over age 40 years is a risk factor.

How common are rotator cuff tears?

The frequency of full-thickness rotator cuff tears is 5-30%, with increasing incidence with advanced age.

What are the symptoms of a rotator cuff tear?

The most common symptoms of a rotator cuff tear are:Shoulder pain

  • Intense pain after an injury
  • Snapping sensation and immediate upper arm weakness
  • Pain when lifting or lowering the arm
  • Pain at rest, particularly when lying on the injured shoulder
  • Weakness when rotating the arm or lifting
  • Cracking sensation (crepitus) when moving the shoulder

How is a rotator cuff diagnosed?

The orthopedic doctor in Chandler and Gilbert will ask you questions about your injury, inquire about your usual activates, ask about your symptoms, and take a medical history. In addition, a thorough examination is done. The doctor will measure range of shoulder motion and test your arm strength.

X-rays are often done to assess for a dislocation, fracture, or bony deformity. X-rays do not show the soft tissue structures, so a magnetic resonance imaging (MRI) scan is done. This test confirms the tear and alerts the doctor to the significance of the injury.

How are rotator cuff tears treated?

The goal of treatment is to reduce pain and to restore full function. Treatment options vary, depending on the severity of the tear, the age of the patient, and the level of activities. Around 50% of people will not need surgery. Nonsurgical treatment options include:

  • Rest – The East Valley orthopedic doctor may suggest you rest the shoulder and limit Shoulder Arthroscopyoverhead activities. A sling can be worn to protect your shoulder while you rest it.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – This includes drugs such as naproxen and ibuprofen, which decrease pain and swelling.
  • Physical therapy – Specific exercises will improve strength and restore movement of the shoulder. Your exercise program involves stretches for range of motion and flexibility, as well as strengthening the muscles that support the shoulder. This will prevent future injury and relieve pain. The therapist can also use various pain relief measures, such as heat therapy, ultrasound, electrical stimulation, and massage.
  • Corticosteroid injection – If rest, NSAIDs, and physical therapy do not reduce pain and improve mobility, the doctor may recommend a corticosteroid injection. This medication is instilled into the joint to decrease inflammation.

How will the Gilbert orthopedic doctor determine if I need surgery?

Some patients with rotator cuff tears require surgery for repair. The East Valley shoulder specialist may suggest surgery if:

  • You are active and use your arms for sports and overhead work.
  • You have continued pain after conservative measures.
  • You have a large tear (greater than 3 cm).
  • You have symptoms that persist for more than 6 months.
  • You have significant loss of function and weakness in the shoulder.
  • Your tear was caused by a recent injury.

How is rotator cuff tear surgery done?

Repair of a torn rotator cuff with a Gilbert or Chandler shoulder specialist involves reattaching the torn tendon to the humeral head. If the tendon is destroyed, a graft may be used to make the repair. The arthroscopic surgery involves making a few incisions around the shoulder capsule and using a camera and small instruments to make the repair.

OSPI offers the top sports medicine treatment in the Valley, including nonoperative and operative therapies. This may include NSAIDS, PT, injections or surgical repair. Call today!

Resources

Baker CL, ed. Shoulder impingement and rotator cuff lesions. The Hughston Clinic Sports Medicine Book. Baltimore, Md: Lippincott Williams and Wilkins; 1995. 272-9.

What You Need to Know About Shoulder Separation

A shoulder separation involves separation of the clavicle (collarbone) and the acromion (end of the shoulder blade). This injury can be partial or complete, painless or painful, and mild or severe.

What body structures are involved in a shoulder separation?

The clavicle and scapula (shoulder blade) are connected by the acromioclavicular (AC) joint. Shoulder painThis joint is held together by the coraclavicular (CC) and acromioclavicular ligaments. With an acromioclavicular joint injury (shoulder separation), these ligaments are partially or completely torn.

How are shoulder separations classified?

A shoulder separation is classified by how severely the ligaments are injured. The classes are:

  • Type I injury – The AC ligament is partially torn, but the CC ligament remains intact.
  • Type II injury – The AC ligament is completely torn, and the CC ligament is partially torn or not injured.
  • Type III injury – Both the CC and AC ligaments are completely torn. The acromion and clavicle are separated.
  • Type IV – Involves tearing of deltoid and trapezius muscles as well as CC and AC ligament tearing.

What causes a shoulder separation?

Traumatic acromioclavicular joint dislocations can occur during athletic events. A direct blow to the shoulder or a fall onto the shoulder can cause shoulder separation. The injury requires excessive force. Shoulder separations are common injuries in sporting activities.

How common are shoulder separations?

According to a recent study of shoulder problems, intra-articular injuries were found in 18% of patients, and co-occuring injuries to the shoulder girdle occur frequently.

What are the symptoms of shoulder separation?

The symptoms and signs of a separated shoulder include:

Pain at the time of injuryAC Joint Injuries

  • Limited shoulder movement related to pain
  • Swelling
  • Bruising
  • Tenderness over the AC joint
  • Possible deformity with the clavicle appearing out of place

How is a shoulder separation diagnosed?

The doctor will inquire about your injury, take a medical history, and conduct a clinical examination. The doctor will check for a bump or deformity, the shoulder range of motion, blood flow, and muscle strength. In addition, he will perform certain test to assess nerve function. X-rays are taken to assess fractures and dislocation.

How is a shoulder separation treated?

Treatment of a shoulder separation depends on the extent of injury. For type II and II injuries, AC Joint Injurythe shoulder is rested and supported with a sling, and the patient must undergo physical therapy. The therapist helps the patient strengthen the shoulder and regain range of motion. This is important for prevention of frozen shoulder syndrome.

Surgery is reserved for patients with type III and IV injuries. Surgery is performed on type I and II injuries that do not respond to non-surgical treatment, or when pain continues after 2-3 months. Surgery involves reconstruction of the CC and AC ligaments using screws or sutures to stabilize the joint. The procedure may be performed using the arthroscopic technique, where the surgeon makes several small incisions around the joint, and inserts a tiny camera to view the structures. Small instruments are also inserted to make necessary repairs.

OSPI offers top orthopedic surgeons in the East Valley serving Gilbert, Chandler, Mesa, Queen Creek and surrounding areas. All types of sports injuries such as shoulder separations are treated, including all levels of AC joint injury. For the top Arizona sports medicine surgeons, call OSPI today!

Resources

Tischer T1, Salzmann GM, El-Azab H, Vogt S, & Imhoff AB (2009). Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med, 37(1):136-9. doi: 10.1177/0363546508322891.

What Does Research Show on Arthroscopic Shoulder Instability Repair

Shoulder instability is represented by labral tears that are traumatic and involve the inferior, posterior, and the anterior aspects of the labrum, which represent a unique population of the glenoid fossa. A recent clinical study evaluated the clinical results of the patients who had to undergo arthroscopic repair for at least a 270 degree labral tear.

Study finds that Arthroscopic Repair is Effective

The researchers analyzed prospective outcomes of patients who went for stabilization arthroscopically for a labral tear that measured 270 degrees. Traumatic injury patients were included, as well as those with antero-inferior instability and those with posterior instability. Labral injury was extensive, as Shoulder Arthroscopyrevealed by imaging, in all these patients. Indications for further repairs were labral lesions and arthroscopic confirmation extending inferiorly, anteriorly, and midglenoid posteriorly. Nontraumatic injuries, SLAP lesions, and revisions were exclusive criteria. Modern sutures of the anchor technique were used to perform arthroscopic repair.

The results showed that 23 of these 270 degrees repairs of the labral were performed by a single surgeon in 21 of the patients. Of these, 92 percent (which was 19 patients) were involved in a follow up after a 28 month-period. The range of which was 14 to 47 months, and this was postoperative. There were significant statistical improvements on both the postoperative and preoperative mean scores. Three participants (which represented 15 percent failure rate) had episodes of subsequent instability. The revision rate was 5 percent, representing one shoulder, which presented a need for a second procedure due to instability. Postoperatively, two patients managed to develop adhesive capsulitis, and one required a further arthroscopic arthrolysis.

The researchers concluded that arthroscopic repair, in the case of the glenoid fossa having labral injuries of 270 degrees, was indeed the most effective surgical treatment. This surgical technique managed the restoration of the mechanical stability back to the shoulder. Also, complete visualization was allowed by the arthroscopic approach for the repair of all the labral pathology.

Patients with Shoulder Instability Benefit from Grafting of Glenoid Bone

In another clinical study, patients with non-rigid fixation from grafting of glenoid bone with shoulder instability, as well as being recurrently anterior, demonstrated unknown healing rates and clinical outcomes. Satisfactory results can be obtained through the use of non-rigid fixation employing glenoid bone grafting for the patients who experienced instability in the anterior shoulder.

Shoulder painThe group of researchers evaluated 52 patients who were having anterior shoulder instability on a continual basis who underwent bony Bankart repair and arthroscopic glenoid bone grafting. Firm fixation was not used; rather, the grafts were placed using anchors on the glenoid surface, and sutures were used to attach them to the glenoid. After periods of 3, 6, 12, and 24 months follow-ups were made, and MRI and CT examinations were conducted immediately after surgery. These diagnostic tests were again performed at each follow-up in order for the graft healing and capsule-labrum structure repair to be evaluated.

The results of the study showed that at 3 or 6 months the grafts had healed to glenoid. The glenoid remodelling in the period of 12 months was complete. A robust structure of the bone-capsule was observed to form, in most cases, on the glenoid’s anterior side. Comparing the final surface area of the glenoid to the presumed and normal glenoid, an increase of 94 percent was recorded. The glenoid width in the final stage showed an increase in 96 percent of patients.

Re-dislocation was experienced by only one patient, and an instability sensation was experienced by 2 other patients. In conclusion, this study was successful in proving that grafting of the glenoid bone arthroscopically in a non-rigid fixation, used in combination with Bankart repair, helped to restore shoulder stability satisfactorily and the graft healed by 100 percent.

Cadaver Study Finds Arthroscopic Technique Good for Shoulder Repair

Cadavers were used a research study where scientists sought to determine the effect of a stepwise arthroscopic anterior plication and arthroscopic-equivalent rotator interval closure on the range of motion and kinematics of the glenohumeral structure of the shoulder. The researchers stretched six cadaveric shoulders to 10 percent beyond maximum capacity, which created anterior shoulder instability.

The researchers concluded that the range of motion was reduced back to the original intact state and resulted in additional tightness with the anterior capsular plication procedure. Therefore, care needs to be taken in the performance of anterior placation and repairs that are combined in order to prevent over tightening. When debating type of closure in patients, intraoperative translations could be useful with the unidirectional instability of the anterior glenohumeral.

The Board Certified shoulder surgeons at OSPI are experts in minimally invasive arthroscopic procedures for instability, rotator cuff repair and labral injuries. Procedures are performed as an outpatient, with most insurance being accepted. Call OSPI today for treatment with the top orthopedic surgeons in Gilbert, Mesa, Chandler and Queen Creek!

Resources

Mazzocca ADCote MPSolovyova ORizvi SHMostofi AArciero RA.

http://www.ncbi.nlm.nih.gov/21566068

Zhao JHuangfu XYang XXie GXu C.

http://www.ncbi.nlm.nih.gov/24510068

Sodl JFMcGarry MHCampbell STTibone JELee TQ

http://www.ncbi.nlm.nih.gov/24509881

Shoulder Arthroscopy and Debridement with Top Arizona Orthopedic MDs

Shoulder arthroscopic debridement is a procedure used to relieve pain and restore function to the shoulder joint. This surgery is best for patients who have rotator cuff tears that cannot be fully repaired. The procedure is followed by a long course of physical therapy.Shoulder Surgeon Mesa AZ

What is debridement?

Debridement is the process of removing damaged tissue and debris from the shoulder joint. Considered a minimally invasive procedure, shoulder joint debridement involves use of small tools to surgically clean the area.

Who is a candidate for shoulder arthroscopic debridement?

Tissue damage of the shoulder joint occurs due to various reasons. The most common reason for tissue damage is degeneration from osteoarthritis. However, damage can also occur due to trauma or injury. As the tissue of the joint deteriorates with normal wear-and-tear as the body ages, debris and loose tissues form in the joint. This can lead to impaired shoulder range of motion and significant pain.

What is the success rate of shoulder arthroscopy and debridement?

Based on clinical studies, shoulder arthroscopic debridement has over a 70% success rate with orthopedic surgeons in Gilbert and Chandler AZ. This success rate is based on reduction in pain and return to normal activities.

What type of anesthesia is involved?

Shoulder ArthroscopyShoulder arthroscopy and debridement is usually done using general anesthesia, and the total procedure takes approximately one hour. For pain relief after the procedure, a local anesthetic and or regional anesthetic (nerve block) may be used. Regional anesthesia is used for patients who have certain medical conditions and those who wish to avoid post-operative side effects.

How do I prepare for the shoulder debridement procedure?

Two weeks before your scheduled surgery, make the Chandler orthopedic surgeon aware of all your medications, and assure that he has copies of your medical records. Don’t smoke, avoid alcohol, and pass on over-the-counter medications. Do not eat or drink the night before the procedure, and leave valuables at home. Arrange to have someone to drive you home from the hospital. When you arrive, a nurse will have you sign a consent form, change into a gown, and place an IV in your arm to administer necessary medications.

How is the surgery done?

The sports medicine surgeon first makes several small incisions around the shoulder. The arthroscope is inserted so the doctor can see inside on a monitor. The first part of the procedure involves evaluating the shoulder for damaged tendons and arthritis of the joint. When shoulder ospi_smallmovement is restricted, the ligaments are released.

If the biceps tendon is trapped or painful when the arm is lifted, the tendon is also released. In order for the tendon to move adequately, a small portion of bone may need to be removed as well. After all debridement is done, the incisions are closed with sutures, and the area is covered with bandages. Then, the shoulder is placed in a sling.

What does recovery involve?

After the procedure, you are moved to a recovery room where a nurse monitors your condition for several minutes. Most patients will stay overnight in the hospital. The next day, a physical therapist works with you to teach necessary exercises for regaining strength and joint function. The sling is worn for 2-3 weeks, and at this time, you may use your hand as needed. After the sling comes off, you can drive and gradually return to usual activities over the next 3-6 weeks.

All about Partial Shoulder Replacement Surgery

The shoulder essentially comprises of a ball and socket joint, where the round end of one bone fits into the socket at the end of another bone. This is the joint which is responsible for both, arm and shoulder movement.

When it comes to replacing an arthritic or injured shoulder, the rate is highly uncommon as compared to knee or hip replacements. This means that the surgery rate is also very low. However, this doesn’t mean that an injured or arthritic shoulder cannot be treated by surgery.

Partial replacement surgery is generally recommended by Gilbert orthopedic surgeons to patients suffering from pain accompanied by arthritis or a traumatic injury to the shoulder. Exceptional care should therefore, be taken by athletes, because their shoulder joints are subjected to a lot of wear and tear, which over time, can lead to a problem.

That being said, the benefits that can be derived from other joint replacement procedures are the same as that of a shoulder replacement, i.e. restoration of normal joint movement and relief from joint pain.

What Is Included In A Partial Shoulder Replacement Procedure?

This procedure is normally used when the glenoid socket doesn’t need to be replaced because it’s still intact. Instead; in a partial shoulder replacement, the humerus is operated upon, replacing the head and implanting the humeral component.    

This means that, during the procedure, there is no need for a plastic socket, less bone is removed as compared to other surgical procedures, and it requires a smaller incision.

Because every shoulder is unique, the very first step that you should take if experiencing shoulder pain is to consult with an orthopedic surgeon in Chandler and ask for an assessment. Then the surgeon will perform an examination to find out what the condition of your shoulder is. Some common shoulder problems that require surgery are:

  • Instability of the Shoulder
  • Shoulder Tendinitis
  • Fractured Collarbone
  • Full Thickness Rotator Cuff Tear

Orthopedic Evaluation: What to Expect

The evaluation and assessment of the shoulder covers 3 essential components:

A Medical History: Typically about current complaints, the duration of symptoms, pain and limitations faced by the patient, any injuries and past surgical or non-surgical treatments.

A Physical Examination: This is done to assess the tenderness, swelling, range of motion, weakness or strength, instability, and/or deformity of the affected shoulder.

Diagnostic Tests: X-rays of the shoulder are taken in various positions and in a series of movements. An MRI scan can also be helpful in effectively making an assessment of soft tissues in the shoulder. A CT scan is sometimes used to evaluate the various bones within the shoulder.

At the end of the evaluation and assessment, your orthopedic surgeon will review the results and discuss the best treatment options with you, both surgical and non-surgical. If you opt for the surgical option of treatment, the doctor will then inform you regarding all the risks and complications that may occur, during and after surgery.

OSPI offers the top shoulder surgeons in the East Valley including Gilbert, Chandler and Mesa AZ. These shoulder specialists are Board Certified and Fellowship Trained. Call today for help with all your shoulder pain needs!

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