In layman’s terms, the scapula is known as the wing bone. There are 2 in the normal human anatomy, and you can feel them on both sides of the upper back. There is a lot of soft tissue and muscle surrounding these bones, therefore, fractures of the scapula are fairly uncommon. Of all the broken bones around the shoulder, scapula fractures only account for about 5%. Typically, the fracture of the scapula is a result of a high-energy trauma such as a car accident. When a scapular fracture is seen, particular suspicion should be given to looking for additional injuries such as a lung injury, rib fractures, or other damage to the arm on the same side. These additional injuries are seen about 90% of the time. It would be unusual for a patient with a scapula fracture not to end up in the emergency room. This is not your typical “I fell on my arm and broke my wrist” scenario where the patient may try and sleep it off and then show up the next day in a doctor’s office. A fall from a building, or a car or motorcycle accident, etc is what is happening here. As mentioned, there are typically significant associated injuries, so a full neurologic and vascular examination is necessary. It may be difficult to do a full examination as typically it is a very painful injury and there is often a rib fracture which may prevent the arm or body from being moved as necessary to do the exam. Plain x-rays after this type of trauma can be very helpful and are necessary to obtain. However, the most important radiographic study is a CAT scan. This can show how much the bone is separated and what kind of an angle there is to the break. Scapular fractures are categorized according to where in the bone the break occurs. It is often determining where the break occurs that then determines if the fracture can be treated without surgery or will need an operation. Typically, a nonoperative approach to scapula fractures is the best method of treatment. If a fracture occurs in the body of the bone, nonsurgical results have been satisfactory. Studies have shown that with long-term follow-up, one fourth of the patients did have some slight disability with either mild pain or range of motion being affected. The area of the scapula that joins up with the shoulder needs to be evaluated carefully as to whether surgery should be performed. This is called the scapular neck. Fractures of this area are very close to the region where the shoulder joint connects with the scapula and there should be a much lower threshold for surgery than otherwise. Indications for surgery in this area of the scapula are poorly defined. Some go by the definition of if the fracture is displaced by over a centimeter or if there is over 40° of an angle to the fracture pieces then surgery should be performed. But this is not a black-and-white area. If you have been involved in a high-energy trauma is best to have a board-certified orthopedic surgeon working on your case. Dr. Sumit Dewanjee of FXRX Inc if the premier practice of orthopedic doctors in Phoenix AZ and also has Orthopedic Surgeons Scottsdale AZ. He specializes in the treatment of knee, shoulder and hip problems such as scapula fractures and other extremity problems. Call today at 480 449-3979 to make your appointment today.
This suprascapular nerve supplies two out of the 4 rotator cuff muscles in the shoulder. These muscles allow individuals to effectively rotate there arm outward and to lift their arm up sideways. This nerve can see an injury in athletes most commonly who participate in repetitive overhead throwing activities. For instance, a baseball pitcher may end up seeing injury to the suprascapular nerve because of the repetitive overhead throwing with extreme ranges of motion. This is called suprascapular neuropathy. The suprascapular nerve is placed in the position of most stress and compression when the arm is lifted sideways and rotated outward. The nerve may become compressed directly from a fluid cyst in the region. Or it may just be that simply the repetitive stress is putting too much traction on the nerve and irritating it. The fluid cyst is not something that develops typically all by itself, it is a side effect of a cartilage injury inside the shoulder known as a labral tear. When an athlete with a super scapular nerve injury is being seen by orthopedic surgeons Phoenix AZ, they report weakening of their shoulder and aching pain which is actually similar in nature to wonder patient has tendinitis of the rotator cuff. When the orthopedic sports medicine surgeon inspects the shoulder it will often reveal atrophy of those 2 muscles supplied by the suprascapular nerve. Those muscles are the suprascapular muscle along with the infraspinatus muscle. An MRI study within our program can show if a fluid system is compressing on the nerve and it can also show if there is a labral tear inside the shoulder most of the time. Along with the MRI, an electrodiagnostic study can confirm the diagnosis and let the physician know the severity of the injury. Suprascapular neuropathy treatment is typically conservative at the beginning. For the most part patients will improve without needing surgery. If however, the individual is having significant atrophy of the rotator cuff muscles and there is a focal compressive elements sitting on the nerve, then surgery may be a good idea to relieve the problem. A shoulder arthroscopy is the most common method of treating the injury. This allows the surgeon to fix the labral tear and let the fluid cyst resolve as a result of that. Going after the compressed nerve directly is by and large not the best idea. The risk profile of that surgery increases substantially and only if it is absolutely necessary should this be performed. FXRX Ince is the premier practice of orthopedic doctors in Phoenix AZ in the state and features Dr. Sumit Dewanjee, a Board Certified, Fellowship Trained Sports Medicine surgeon specializing in the treatment of knee, shoulder and hip problems. Call (480) 449-3979 to make your appointment Today.
The clavicle is a bone that connects the upper extremity to the torso. It is not a bone with a huge tolerance for deformity, it usually breaks rather than bends under significant stress. The most common way to sustain a fracture of the clavicle is either a direct blow or from falling on an outstretched arm. While it is uncommon for a clavicle fracture to lead to injury to a nerve or blood vessel, there are some close by so with the fracture separates there can be injury to the structures. When a patient sustains a broken clavicle, there is often bruising around the injury and evidence of some bony deformity in the region. Skin abrasions may be present and the shoulder itself is very painful to move. Depending on the energy involved with the trauma, there may be associated injuries to the shoulder girdle or potentially nerves or blood vessels. If there is substantial associated injury, surgery right away may be necessary with a Phoenix orthopedic surgeon. Radiographs will typically show a clavicle fracture very nicely. It would be unnecessary for a patient to need an MRI to make this diagnosis. A CAT scan may help with a skeletally immature patient with an open growth plate or in a situation where there is a fracture dislocation. The majority of clavicle fractures are able to avoid surgery and be treated conservatively. Most fractures occur in the middle 3rd of the bone and healing occurs uneventfully without surgery. About 5% of these fractures do not heal and develop what is called a nonunion. There are also times when a fracture will heal but at an unsatisfactory angle. This is called a malunion. The best indicator of whether or not a patient is going to have future problems is if a broken bone is displaced and bony contact is not present. In addition, research has shown that if the fracture shortens over 2 cm outcomes tend to be worse. Those patients end up with less strength than otherwise. If surgery is necessary for a fracture of the middle 3rd of the clavicle, there are plating techniques available that allow for adequate healing. They do involve a scar obviously and there is also a procedure that involves fixation through the bone which is called intramedullary fixation. This can be accomplished with a screw or a threaded pin. Fractures of the distal 3rd of the clavicle, which is the end of the bone, involve 15% of these fractures. These fractures have various categories depending on how close to the end of the bone they occur and tend to be more complicated than those of the middle third. If the broken bones are displaced from one another, surgery is often a good idea. There is a high propensity for nonunion and residual disability when the bones are displaced and surgery is not performed. Fractures of the medial 3rd of the clavicle, which is the inside part of the bone, are rare. Two to 3% of clavicle fractures are in this region and when they do occur a patient’s airway and large vessel needs to be assessed promptly. Patients who have clavicle fractures should not simply assume surgery is unnecessary. They should seek treatment from an accomplished orthopedic surgeon such as Sumit Dewanjee MD at FXRX. Dr. Dewanjee is a Board Certified, Fellowship Trained orthopedic surgeons phoenix az seeing patients in the greater Phoenix Metropolitan area. Call 480 349-FXRX to make your appointment Today!
Should you have your ACL reconstructed? When a person is in middle-age, such as in his or her 40s or 50s, it is not uncommon to tear the anterior cruciate ligament. This is especially true if the person is participating in athletic activities such as basketball, soccer, or even baseball. If you care your ACL in your 20s or 30s, is not really difficult decision about whether or not to have the ACL reconstruction surgery. But what should you do if your middle-age and you have an ACL tear? It is not always an easy decision. Years ago surgeons used to think that without an intact anterior cruciate ligament the patient would be predisposed to premature arthritis. Numerous studies have now looked at this and have shown patients are not predisposed to arthritis without an ACL reconstruction. So what should be done? If degenerative arthritis is not necessarily going to result from not having the surgery, what should be the deciding factors in the decision process? The 1st is looking at the individuals activity level. If the person participates in those athletic activities such as skiing or soccer, it typically is a good idea to have the ligament reconstructed. The reason is that notwithstanding the risk of arthritis, there is a risk of further injury from having the instability and not being able to perform the twisting and cutting maneuvers necessary in the sporting events. Without having an intact ACL, it can make the knee feel very unstable and give out during athletic activity. The person may then suffer further injury as a result. In making the decision, it would be prudent to seek out an orthopedic sports medicine doctor who has a lot of experience in ACL reconstruction. Dr. Sumit Dewanjee with FXRX has this experience as a Board Certified, Fellowship Trained Sports surgeon specializing in knee, shoulder and hip problems along with fracture treatment and orthopedic bracing. FXRX is the premier practice of knee surgeons in Phoenix in the state and also has the best
The Anterior Cruciate Ligament, known as the ACL for short, is an extremely important piece of anatomy for individuals participating in those sports that require a lot of cutting and twisting activities. These sports include the likes of soccer, gymnastics, baseball, and basketball. Decades ago surgeons tried to suture the torn ligament back together, but that didn’t work because the healing potential is minimal. So the current standard of care involves actually replacing the ACL. There are 2 main options for performing an ACL reconstruction. One includes utilizing a patient’s own tissue which is referred to as an autograft. The 2nd option is referred to as an allograft and this is using tissue from a cadaver. When a patient’s own patellar tendon or hamstring tendon is used, those are autograft options. The same tissue is used in allograft situations if that is the chosen route. Studies have shown that both allograft and autograft options work well in allowing patients to return to high level athletic activities similar to those performed pre-injury. The Anterior Cruciate Ligament reconstruction surgery replaces the ligament in the knee with either tissue from the patient him or herself or tissue from a cadaver. The ACL is a ligament connecting the thighbone to the shinbone and assist patients with the ability to successfully perform twisting activities. The procedure itself is performed by making an incision vertically over the front part of the knee. If the individual’s own patellar tendon is being used as the new anterior cruciate ligament, the initial part procedure involves removing part of this tendon. The tendon itself is partially removed along with bony elements on either and where it comes out of the kneecap as well as from the tibia. This will end up becoming the new ACL. Most of the surgery is then performed through an arthroscopic camera. This is a tiny little camera that fiber optical he allows the surgeon to see inside the knee and the image shows up on the video screen. This allows the surgeon to properly configure the ACL and position it to anatomically replace the one that was torn. While the knee is bent, the damaged ACL is removed and shaved away, and the me is then cleaned of fraying that remains from the injury. The surgeon then inserts a pin in a diagonal manner through the tibia, which is the shinbone, and then through the femur, which is the thigh bone. This pin then becomes a guide for placing the new ACL reconstruction graft. Additional holes are drilled by the surgeon and then the graft is attached to this pin and pulled through and into proper position. Special screws are placed to secure the bony ends of the graft of both the femur and the tibia. The knee is then put through a full range of motion to make sure that there is no impingement. The procedure is then completed. If you have a torn ACL and are wondering whether surgery it is appropriate for you, Dr. Sumit Dewanjee at FXRX is a board certified, fellowship trained orthopedic surgeons Phoenix AZ. FXRX is the premier practice of Phoenix orthopedic surgeons in the state. Dr. Dewanjee specializes in the treatment of knee, shoulder and hip problems including such procedures as < href="">ACL reconstruction surgery. FXRX also specializes in fracture treatment and orthopedic bracing, treating each patient as if he or she were part of their own family! Call (480) 449-3979 to make your appointment TODAY!
There are 3 basic types of shoulder instability. These include anterior, posterior, and then there is multidirectional instability. Let’s review in this article Anterior Shoulder Instability.
Anterior instability involves an issue where the shoulder will potentially dislocate out the front. This dislocation or just instability can occur because of repetitive overhead throwing or trauma like a car accident. If a pitcher throws a lot continuously and repetitively it may lead to a slow, gradual soft tissue elongation in the front of the shoulder. As this gets worse, the humeral head may start to displace from the glenoid (the ball coming out of the socket), especially if the rotator cuff muscles get fatigued. It would be unusual to frankly dislocate as a result of this chronic situation without some additional trauma like an athletic collision or fall. The end result of this could be if an athlete is involved in a collision or trauma then a Bankart lesion may take place and one may need orthopedic surgeons phoenix az to surgically repair it. In an overhead thrower such as a pitcher in baseball who is suffering from instability of the anterior type, there’s often symptoms of feelings of looseness of the shoulder when the arm is in the cocked position of throwing. Rather than having frank instability, the pitcher will typically note severe and sudden pain with arm control loss. In addtion, the athlete can experience arm tingling or possibly a dead arm feeling. There are a few different types of physical examination tests to evaluate for anterior instability, which are performed in a controlled setting by a sports medicine doctor to prevent actual dislocation (thankfully). Treatment for anterior instability is treated by Phoenix orthopedic surgeons depending on the instability severity. If the athlete has a lax shoulder from repetitive trauma such as throwing a baseball 95 miles an hour twice a week in games, Phoenix physical therapy can be attempted which will work on strengthening the rotator cuff muscles to prevent the instability and pain. As the therapy moves along, the athlete can start sports participation as long as a successful throwing program is completed with emphasis on proper mechanics. In those who have a traumatic history of anterior instability such as a car accident, there is often a Bankart lesion. This is a situation that occurs after a dislocated shoulder that comes out the front part. As the humeral head dislocates out the front, the glenoid labrum (shoulder cartilage) is damaged and there could also be some bony injury too. This is damage to the ball and socket part of the joint. The labrum is a cartilaginous part that forms a cup where the humorous moves. This allows for stability of the shoulder and a large range of motion. When a shoulder dislocation damages the shoulder, it often does not heal by itself. The actual portion of the labrum which experiences damage is called the inferior glenohumeral ligament. After a patient has sustained a traumatic dislocation with a Bankart lesion, symptoms that the individual may feel include a catching sensations, sense of instability, aching of the shoulder, or unfortunately repeat dislocations. Along with this, the person often says that they simply cannot “trust” their shoulder because they think it may dislocate at any time. When an individual sustains a shoulder dislocation with a labral injury, statistically the chances of re-dislocating are over eightly percent if the person is younger than thirty years. This grows a lot if the person is over age thirty. Along with the physical exam tests looking at shoulder instability, the best test to look at this injury is an MRI. The orthopedic surgeon Phoenix AZ may order the test with contrast injection which may allow better visualization of the injury. Surgery is only for for those individuals who fail considerable nonoperative treatment or who potentially have a history of traumatic shoulder dislocation. In the vast majority of patients no true indication exists to have immediate surgery for this injury type. However, if the injury is a high-level athlete who wants to get back for the next season as a professional, they will need to understand that healing from a labrum repair can take six months or even more. Contemporary arthroscopic shoulder surgery involves reattaching the labrum to the shoulder’s socket. Successful outcomes have been reported in about ninety percent of athletes who are overhead throwing athletes. When it comes to returning to full competition though, the percent of success drop down to 68%.
FXRX is the premier practice of orthopedic surgeons Phoenix AZ in the state and also has Orthopedic Surgeons Mesa AZ. FXRX has Sumit Dewanjee MD who is a Board Certified, Fellowship Trained Sports Medicine surgeon. Call (480) 449-3979 to make your appointment TODAY!
The SLAP lesion is a shoulder injury that is short for Superior Labral Anterior Posterior. It is an injury to the cartilaginous labrum in the shoulder joint, which is a structure that provides enhanced stability to the joint. It helps the shoulder to have its incredible range of motion that it enjoys. Without the labrum intact, the patient’s shoulder would be significantly unstable analogous to a golf ball on a tee. It has minimal coverage! In conjunction with muscles of the rotator cuff, stability is provided by the labrum which allows the shoulder to maintain an immense range of motion. If the injury happens to the labrum, it involves detachment of the top part (superior) labrum along with part of the biceps tendon. A lot of people don’t realize that part of the biceps tendon originates right off of the shoulder capsule. These injuries typically occur in overhead throwing athletes because of the exceptional motion extremes seen in these repetitive activities. There are several proposed theories of how these injuries happen, but what is known for certain is that the greatest strain on the superior labrum occurs during the late cocking phase of throwing. When it comes to the biceps tendon, the largest stress occurs during the throwing deceleration phase once the ball is released secondary to the large forces seen. Unfortunately, making the diagnosis of a SLAP tear may be tough due to the individual having non-specific pain. Throwing athletes will typically tell their Phoenix orthopedic surgeon that they have deep seated shoulder pain during throwing and the pitching velocity may be reduced. There are several physical examination tests used by Scottsdale orthopedic surgeons to test for SLAP lesions. The most accurate method of diagnosing a SLAP lesion is arthroscopy, which is obviously not the primary step. MRI may show the tear, and it may necessitate contrast material with the MRI to see the tear best. The initial treatment prescribed by Arizona orthopedic surgeons focuses on Phoenix physical therapy and rest. The physical therapy should consist of muscle strengthening around the shoulder, referred to as the dynamic stabilizers. If this treatment is failing and a SLAP tear is highly suspected, an arthroscopic surgery is in order. There are 4 different variants of SLAP tears, which involve labral tears/fraying along with either a stable biceps tendon or biceps tendon tearing. If the labrum and biceps are completely unattached, they can be surgically reattached with suture anchors. After an operation, physical therapy involves restoring range of motion but allowing 6-8 wks for healing of the tissues while avoidaning extreme rotational movements. At the three to four month point, sport specific training can be started but not throwing just yet. Progression of throwing is avoided until the five to six month post-operative time frame, at which point it can be started. The results of SLAP repair with an arthroscopic shoulder surgery has shown good to excellent results in 85-90% of cases. After the shoulder surgery, three fourths of individuals are able to return to their pre-tear level of competitive sports. FXRX is the premier practice of orthopedic surgeons Phoenix AZ in the state and also has Arizona Orthopedic Surgeons. FXRX has Sumit Dewanjee, MD, Board Certified, Fellowship Trained Sports Medicine surgeon specializing in the treatment of shoulder, knee, and hip disorders. FXRX also specializes in treating fractures along with orthopedic bracing, treating each patient like family! Call (480) 449-3979 to make your appointment TODAY!
Elbow overuse injuries may cause pain and other problems in the forearm, wrist and hand and obviously the elbow itself. These issues typcially affect athletes along with those individuals who perform repetitive motions with their arms. It doesn’t have to be just athletes, but that’s what is mostly seen by a Phoenix orthopedic surgeon. Adolescents and children whose bones have not fully formed along with those working in factories are typically susceptible to these injuries. Overhand throwing and other overhand motions can place harmful stresses on the forearm, elbow, and shoulder, elbow. This stress may eventually cause pain, damage,and even scarring. This may also cause tendonitis and since these tendons do not maintain a great blood supply healing may take quite a bit of time. Some of the activities which lead to overuse injuries are named after the activities which incite them such as golfer’s elbow, tennis elbow, litte league elbow, or student’s elbow. Symptoms resulting from the overuse will vary considerably and may include loss of mobility, tenderness, pain, swelling, numbness, weakness, tingling, or clicking and popping sounds. Treatment options may include cold compresses, rest, anti-inflammatories, physical therapy, bracing, or as a last resort a surgical procedure by orthopedic surgeons phoenix az. Repetitive throwing stretches tendons ligaments on the inner side of the elbow and compresses those on the elbow’s outer side. Over time this can be harmful to bone and tissue in adolescents who are not quite skeletally mature. In medial epicondylitis, which is commonly called golfer’s elbow, there is overuse of the flexor forearm muscles which attach to the inside area of the elbow. This can eventually deteriorate the tendon somewhat, and is often able to be treated nonsurgically by an orthopedic doctors in phoenix az. Repetitive throwing may completely tear or hopefully just strain a vital ligament, the medial ulnar collateral ligament (MUCL). This ligament spans the area between the humerus and the ulna and then causes pain on the elbow’s inner side. If the injury has led to a complete tear may need a reconstructive surgery by a Scottsdale orthopedic surgeon commonly known as Tommy John surgery. Little leaguer’s elbow is the layman’s term for medial apophysitis. This condition typically occurs in children before they reach the age of puberty. These elbow areas have growth plates that have not quite completed their growth and repetitive throwing can lead to stress and permanent damage of these areas. Rest of the elbow and pitching limitations typically will help it get better if initiated soon enough and long enough. Repetitive throwing may disrupt the elbow’s blood supply to the cartilage that cushions the bony ends. This may lead to sections of cartilage to then pull away from its normal area or even break off. This is referred to as osteochondritis dissecans and commonly causes pain on the elbow’s outer side. Surgery may be necessary to remove loose bone or cartilage fragments if they exist. FXRX is the premier practice of orthopedic doctors in Phoenix AZ and also has AZ Orthopedic Surgeons. FXRX has a Board Certified, Fellowship Trained Sports Medicine surgeon, Sumit Dewanjee, MD specializing in the treatment of knee, shoulder and hip problems. FXRX also specializes in fracture treatment and orthopedic bracing, treating each patient as if he or she were part of their own family! Call 480-449-FXRX Today to make your appointment.