Tag Archives: Painful Shoulder Injury

Common Shoulder Injuries and Conditions

By  aenriquez  published  March 21, 2018

Whether an injury occurs from paddling a canoe, throwing a ball, or lifting boxes, it does occur. We rely on our shoulders to do a number of activities, and with use of a shoulder, injury can occur. Normally, the shoulder has a wide range of motion, more than any other joint of the body. However, because it is this flexible, it is also not very stable and prone to injury.

The shoulder is made of two main bones: the shoulder blade (scapula) and the ball of the upper arm bone (humerus/humeral head). The humeral head is round, and it fits into the scapular socket. There are several muscles and ligaments that surround the shoulder, and they are called the rotator cuff. Tendons also connect the bones to the shoulder’s surrounding muscles. Injury to any or several of these shoulder structures can produce pain and disability.

Shoulder Instability and Separation

Shoulder instability affects mostly athletes and young people, but it can occur at any age. When ligaments and muscles are stretched beyond normal limits, the shoulder becomes unstable. This condition is often part of growth and development, and shoulders can stiffen and tighten with age. For athletes, shoulder instability is caused by repetitive motions, such as pitching or throwing. These motions put tremendous force on the shoulder, and the ligaments stretch out over time.

After years of having instability, or with persistent use, shoulder separation can occur. When the ligaments that hold the clavicle to the acromion bone of the scapula tear, it is considered separately. Sprains can also occur during a fall onto an outstretched hand/arm. A sprain causes severe pain and a misshapen shoulder, which also contributes to disability and decreased shoulder mobility.

Treatment for shoulder instability and sprain can involve medications, rest, and physical therapy. A sling is often used to limit movement while the shoulder heals. With severe instability and shoulder separation, surgery is often required to remedy the problem. Your treatment plan will be determined by the orthopedic specialist, who will collaborate with other professionals to develop the best course of therapy for you.

Shoulder Dislocation

When the ligaments that hold shoulder bones together tear, and they can no longer support the joint, the shoulder is dislocated. A shoulder dislocation can occur due to a fall onto the shoulder, a fall onto an outstretched hand, or from violent twisting. The main symptom of shoulder dislocation is a pain, and the discomfort becomes worse with movement.

To treat a shoulder dislocation, you should apply ice immediately and go see a doctor. Within 15 minutes of the injury, the joint becomes sore and painful. A dislocated shoulder often can be re-set using gentle traction, where the bones are put back in place. When the shoulder moves out of socket repeatedly, it is called recurrent instability, which requires surgery for correction.

Rotator Cuff Tear

A rotator cuff is a group of four muscles that support the shoulder. They allow a person to raise and rotate the arm. These muscles are attached to bones by tendons, which allow the muscle to strategically move the arm. When the tendons tear, the upper arm bone cannot move easily in the socket, which means you cannot move it away from the body in an upward motion. As people age, and they become less active, tendons start to lose strength and degenerate. Most rotator cuff injuries occur in older adults or middle-aged individuals.

The shoulder has a poor blood supply, which makes it harder for the tendons to repair and maintain themselves. Using the arms overhead puts pressure on the rotator cuff tendons, and repetitive movement and stress can lead to shoulder impingement. When the tissue or bone in the shoulder area becomes misaligned and rubs/chafes. The rotator cuff tendons are often injured or torn when someone lifts a heavy object with an extended arm.

Treatment of a rotator cuff tear depends on the severity of the injury. The doctor may recommend resting the extremity, using a sling to support the arm and medications. After the initial injury, swelling and inflammation are controlled with a nonsteroidal anti-inflammatory drug.

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When do you Need a Bankart Repair?

By  aenriquez  published  December 17, 2017

Painful Shoulder InjuryA Bankart lesion is a common shoulder injury. This type of shoulder injury often requires Bankart repair. This lesion is when the anterior and inferior portion of the labrum (band of cartilage) is torn away from the glenoid (portion of the joint socket. Bankart repair recovery ranges from six to nine weeks, and the procedure can be extensive, depending on the extent of the injury.

The shoulder joint is a combination of many joints that work together. The glenohumeral joint is where the humerus (upper arm bone) attaches to the scapula (shoulder blade) body. The area where the scapula meets the humerus is called the glenoid fossa. Along with this structure is the labrum, which is a tough band of cartilage. The role of the labrum is to deepen the socket to allow greater congruence between these structures.

 

Bankart Repair Success Rate

A Bankart lesion often occurs along with anterior shoulder dislocation. The shoulder may be continuously moved forward or anteriorly. The Bankart lesion can lead to further shoulder joint damage or injury to other areas of the shoulder. Bankart lesion repair is a surgery used to reconnect the torn labrum to the glenoid fossa, which repairs and stabilizes the joint to prevent further dislocations.

The most common surgical technique for the treatment of anterior shoulder instability is the arthroscopic Bankart repair or the open repair method. In a study evaluating the outcomes of these procedures, researchers reviewed 28 clinical trials. They also reviewed outcome measures, pain scores, dislocation rate, and other problems. The estimated re-dislocation rate was 15% following arthroscopic repair and only 7% following the open Bankart repair.

 

Bankart Repair Recovery

The rehabilitation process following a Bankart repair begins almost immediately. Within the first few days after surgery, passive range of motion starts through physical therapy. The physical therapist and doctor discuss what moves and measures to take for rapid recovery. A sling is only prescribed for use during showering and dressing changes. No internal rotation is allowed for several weeks. Other therapies used for pain control are massage and electrical stimulation.

For the first four weeks after the Bankart repair, the therapist focuses on helping you regain as much range of motion as possible. During this time, the shoulder strength will also improve and shoulder pain should decrease. After four weeks, the focus is on regaining shoulder strength and function. The patient must continue to work with the physical therapist to regain full function and range of motion of the shoulder.

 

Bankart Repair Protocol

Regardless of how the labrum was torn, the surgeon will work with you to decide on the best possible treatment. For many patients, Bankart tears are successfully treated with anti-inflammatory measures, rest, physical therapy, and activity modification. When conservative measures fail to restore function, the doctor may suggest Bankart repair. Labral repair involves re-anchoring, suturing, and/or trimming away torn pieces of cartilage. The procedure is most often performed arthroscopically, and most patients go home the same day as the surgery.

 

The time it takes to recover after a Bankart repair varies from person-to-person. It typically takes 4-6 months for full recovery. For some patients, it can take a full year to full recovery. People with desk jobs must take1-2 weeks off from work. For those who lift and do labor type jobs, plan on being out of work for up to 6 months. Postoperatively, you will see the doctor in 5-10 days, and physical therapy usually begins soon after your procedure. You can use ice 3-6 times each day for 20-minute intervals for pain and swelling and must wear a sling for the first 2 weeks.

 

Resources
Rollick NC, Ono Y, Kurji HM, et al. (2017). Long-term outcomes of the Bankart and Latarjet repairs: a systematic review. Ortho Surg, 8, 97-105.
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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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