Category Archives: Shoulder Treatment

Healing and Recovery for Shoulder Dislocations and Lesions

By  aenriquez  published  November 29, 2017

Recovery for Shoulder Dislocations The shoulder joint is extremely mobile enabling the upper arm to move in most directions with ease but, this also makes it an unstable joint and easy to injure. When a dislocation occurs, the pain can be significant and when the shoulder is severely injured, the nerves and tissues around the joint become damaged, resulting in ongoing weakness.

It is relatively easy to dislocate the shoulder joint:

  • Falling – in particular, landing directly on the shoulder on a hard surface.
  • Direct injury to the shoulder
  • Falling but the brunt of the weight is directed through an outstretched hand.
  • A sharp twist on the arm

Within the shoulder joint, the humerus head sits in the glenoid fossa, a shallow extension of the scapula, and, because of the shallowness of this area, the structures around the joint must maintain stability.  The labrum extends from the glenoid fossa and enables a deeper vessel for the head of the humerus. The tissues surrounding the joint also help to provide stability with tendons and rotator cuff muscles providing protection. When the head of the humerus is removed from its position in the socket, it is dislocated, and the type of dislocation is described by the positioning of where it is. Most dislocations are anterior dislocations – approximately 95%. This simply means that the humeral head moves in front of the joint. Posterior dislocations move towards the shoulder blade.

When the injury first happens, the shoulder can be immobilized by placing the arm in a sling and it can also be useful to apply an ice pack to the shoulder area. It is advisable to seek medical care so that a diagnosis can be made, and treatment given to repair the dislocated shoulder. The restricted movement to the upper arm and shoulder area and even some deformation of the shoulder is likely if it is dislocated. If the upper arm bone comes out of the shoulder socket, the force of this could tear the labrum, a ligament, causing a bankart lesion. It is common with dislocations to the shoulders and most connected to the instability of this joint. Initially, a doctor would be concerned with joint relocation and pain management, but to treat fully, they need to understand the circumstances of the injury and whether any dislocation has happened previously. Muscles spasms are likely and there will be various levels of pain.  Surgery, by way of a bankart repair, may be necessary.

The labrum – which is essentially a fibrous ring located within the shoulder socket, can be repaired following a small incision which enables the specialist to view the damage via a tiny camera. The damaged labrum and any other ligaments are re-attached and then, tightened using sutures or anchors. Surgery takes between 1.5 hours and 2.5 hours and a regional block are used to help numb the area. There is usually an overnight stay in the hospital, but the stitches must stay in place for up to 14-days.

Following surgery, the orthopedic surgeon may provide antibiotics and pain medication to ease pain and discomfort but also, as a preventative measure to prevent infection setting in. Ice packs are often recommended to help with any pain experienced. Physical therapy is also recommended during the recovery process to increase mobility. It is possible to recover completely from a shoulder dislocation although recovery may take some time, certainly, there are considerations to be made and older patients and those with diabetes could have a higher hospital admission rate.

 

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What is a Shoulder Labral Repair?

By  aenriquez  published  November 8, 2017

Shoulder Labral repairThis injury is common in the news as it keeps professionals athletes out of action for a long time. In 2017 Hyun-jin Ryu of the Dodgers, Andrew Luck of the Indianapolis Colts and Jimmy Nelson of the Milwaukee Brewers all spent extended periods of time watching from the sidelines as a result of a shoulder labral tear. But it’s not just professional athletes that are sidelined by the injury and many people need to undergo what is known as Arthroscopic Labral Repair of the Shoulder or SLAP for short.

Many people suffer from shoulder pain, either brought on suddenly by falling on the shoulder or an outstretched hand or slowly and over time by repetitive strain. Many of these injuries are painful because they cause damage to the labrum of the shoulder joint. The labrum is a portion of soft and fibrous tissue that sits in the glenoid (this is the area of the shoulder joint that joins the bone of the upper arm called the humerus with the shoulder blade and the collarbone). This labrum has a number of functions. Firstly, it allows the joint to move freely and easily without the burns rubbing together (which can be painful). It also acts as a sponge, absorbing shocks taken to the joint. Patients with damage the labrum experience pain when lifting the shoulder and they often have a decrease in the range of movement they are able to achieve. This can be very disabling as the shoulder joint is in constant use in day to day life.

How are should labral tears repaired?

This type of injury often requires surgery to fully recover. The surgery is done arthroscopically to reduce the risk of infection and to provide a faster healing time. Arthroscopic surgery refers to a procedure that is done with a tiny camera instead of opening the entire joint up. This means a much smaller cut is made into the shoulder joint and allows healing to occur a lot faster. The surgeon will then repair the shoulder using small instruments and the small camera inside the shoulder.

After the surgery is complete the shoulder will need to be placed in a sling so it can heal for three-six weeks. During this time the patient is told to perform a number of passive exercises (meaning they get somebody else to move their arm and do not do it under their own power). After the sling is removed the patient will be told to do a number of exercises every day to restore proper muscle power and tone. This is done before the patient returns to strenuous activities like sports.

In some individuals who play sports at a high level the repair is unsuccessful and they may experience some pain or loss of performance for years after. However, on a day to day activities carried out by most patients, an Arthroscopic Labrum repair of the shoulder is a highly successful procedure.

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Corticosteroid Shoulder Injection for Shoulder Pain

By  aenriquez  published  September 6, 2017

Shoulder Injection - Posterior ApproachShoulder pain affects thousands of U.S. adults. According to clinical studies, shoulder pain affects 4% of the general population, and 1% of people age 45 years and older consult their family doctor each year with a new presentation of shoulder pain. Many individuals suffer from mild-to-moderate osteoarthritis of the shoulder. While pain medicine and physical therapy may work for some, others suffer with long-term, recurring shoulder discomfort. A shoulder injection may be necessary to relieve the pain associated with many types of shoulder arthritis.

If pain medication does not provide relief, the pain management specialist may recommend an injection of medicine directly into the shoulder joint. Orthopedic and rheumatologic specialists often use ultrasound guidance to assure the medication goes directly into the joint. Injections for shoulder pain are safe and effective and offer longer pain relief than conservative measures.

Corticosteroid Injection for Shoulder Pain

Many shoulder conditions produce an inflammatory effect that leads to pain. Corticosteroids are anti-inflammatory medications that are injected into the shoulder joint. A corticosteroid will reduce inflammation, which is the body’s immune response. Inflammation leads to swelling, redness, warmth, and pain. Before the injection, the doctor will administer an anesthetic, either locally or into the skin. After numbing the area, the corticosteroid agent is injected directly into the joint.

The corticosteroid solution starts to work after 2-3 days. An anesthetic, such as bupivacaine or lidocaine, is added into the solution to offer immediate pain relief. For some people, a corticosteroid shoulder injection for pain can offer several months of pain relief. Doctors recommend no more than 3 corticosteroid injections into the shoulder joint during a time-span of 3-5 years.

Hyaluronic Acid Shoulder Injection

The shoulder joint contains a gel-like lubricating substance known as synovial fluid. Over time, and with age, the joint becomes depleted of this fluid. Synovial fluid cushions and lubricates the joint. Hyaluronic acid is a component of this fluid. A medication produced in the laboratory, hyaluronic acid, is now used to replace this lost fluid. Hyaluronic acid injections can increase the joint fluid’s viscosity, improving the gliding motion, and relieving symptoms of arthritis.

With chronic shoulder pain, the pain management specialist may recommend an injection of hyaluronic acid. The injection involves placing the medication into the joint under ultrasound guidance. After the injection, the joint may be tender for 24-76 hours, and maximum effects are noticed in 2-3 weeks. One hyaluronic acid shoulder joint injection can provide beneficial for up to 12 months.

Platelet-Rich Plasma for Chronic Shoulder Pain

Platelet-rich plasma (PRP) is a solution of the patient’s own blood components that is injected into a joint. The patient first has his/her blood drawn. The nurse processes the blood in the laboratory, where the platelets are separated from other blood components. The platelet solution is then injected into the painful shoulder joint using x-ray (real-time) guidance. For shoulder pain, the results are usually felt within 2 weeks, and benefits may last for up to a year.

In a recent study involving joint degeneration from osteoarthritis, researchers evaluated the safety and effectiveness of PRP joint injections. They found that PRP injections were beneficial for people with mild osteoarthritis, but only were somewhat effective for moderate arthritis. Because the patient goes through a mild exacerbation period after the injection, the shoulder joint may be tender for up to a week.

Resources

Jang SJ, Kim JD, and Cha SS (2013). Platelet-rich plasma injections as an effective treatment for early osteoarthritis. Eur J of Orth Surg & Traum, 23(5), 573-580.

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