Shoulder Injuries & Treatment

Watch the video of Dr. Marc Pietropaoli  discussing some new advances to help shoulder injuries and healing. 

Introduction to the Shoulder:

 

The shoulder joint is a “ball and socket” joint. In the shoulder, unlike the hip, the socket is rather flat.  The advantage of a flatter/shallower socket in the shoulder is that it allows less restriction and more mobility.  Shoulders have a tremendous range of motion as compared to the deeper socket and more constrained hip joint. However, the extra mobility and range of motion comes at a price. The hip is a very stable joint and very rarely will pop out of socket (dislocate), whereas the shoulder is a much less stable joint and is the most commonly dislocated large joint in the body.

Most Common Shoulder Problems:

Labrum Tears & Biceps Tendonitis, Tears:

The “looseness” of the shoulder can lead to tears of the labrum, which is a rim of cartilage around the perimeter of the glenoid which is the socket. It can also lead to stretching out of the capsule which is like the “casing” around a joint. One or both of these can lead to instability in the otherwise “normal” shoulder.  Sometimes surgery is needed to repair the labrum back to the bone and/or tighten up the capsule so it is not loose anymore. Many times, this can be treated non-operatively with physical therapy by doing exercises that strengthen the muscles around the shoulder, particularly the rotator cuff.

Sometimes the biceps tendon in the front of the shoulder gets inflamed (biceps tendonitis), and we will inject the groove where the biceps tendon passes from the front (anterior) part of the shoulder. In the end, cortisone can lead to benefits of decreased pain and inflammation and increased ROM, allowing the patient to progress better with their exercise/P.T. program.

Non-Surgical Treatment Options:

What is the AC Joint?

The AC (acromioclavicular) joint is a joint in the shoulder where the collarbone (clavicle) meets the shoulder blade (scapula). The specific part of the scapula adjacent to the clavicle is called the acromion, hence the name AC joint.  This is in contrast to the glenohumeral joint, the main “ball and socket” shoulder joint

What kinds of problems occur at the AC Joint?

The most common problems that occur at the AC joint are arthritis, fractures, and “separations.” Arthritis is a condition characterized by loss of cartilage in the joint.  Like arthritis at other joints in the body, it is characterized by pain and swelling, especially with activity. Over time, the joint can wear out, leading to swelling and formation of spurs around the joint. These spurs are a symptom of arthritis and not the primary cause of the pain. Motions which aggravate arthritis at the AC joint include reaching across the body toward the other arm.  AC joint arthritis is common in weight lifters, especially with the bench press, and (to a lesser extent) military press. AC joint arthritis may also be present when there are rotator cuff problems

How do you treat arthritis of the AC Joint?

There is currently no way to replace the cartilage that is damaged by arthritis. As a result, the primary way to control the symptoms of arthritis is to modify your activities so as not to aggravate the condition.  Application of ice to the joint helps decrease pain and inflammation.Medication including aspirin, acetaminophen, and non-steroidal drugs anti-inflammatory drugs (NSAIDs) are also used commonly

What can be done if those treatments do not work?

If rest, ice, medication, and modifying your activity does not work, then the next step is a cortisone shot.One shot into the joint sometimes takes care of the pain and swelling permanently, although the effect is unpredictable and may be only transient.  Surgery may be indicated if nonsurgical measures fail. Since the pain is due to the ends of the bone making contact with each other, the treatment is removal of a portion of the end of the clavicle.  This outpatient surgery can be performed through a small incision about one inch long or arthroscopically using several small incisions. Regardless of the technique utilized, the recovery and results are about the same. Most patients have full motion by six weeks and return to sports by 12 weeks

What is an AC Separation?

When the AC joint is “separated” it means that the ligaments connecting the acromion and clavicle have been damaged, and the two structures no longer line up correctly. AC separations can be anywhere from mild to severe, and AC separations are “graded” depending upon which ligaments are torn and how badly they are torn

    • Grade I Injury- the least damage is done, and the AC joint still lines up
    • Grade II Injury-damage to the ligaments which reinforce the AC joint. In a grade II injury these ligaments are only stretched but not entirely torn.  When stressed, the AC joint becomes painful and unusable
    • Grade III Injury-AC and secondary ligaments are completely torn and the collarbone is no longer tethered to the shoulder blade, resulting in a visible deformity

What is Treatment for AC separation?

These can be very painful injuries, so the initial treatment is to decrease pain. This is best accomplished by immobilizing the arm in a sling, and placing an ice pack to the shoulder for 20-30 minutes every two hours as needed. Acetaminophen and non-steroidal anti-inflammatory drugs can also help the pain.As pain starts to subside, it is important to begin moving the fingers, wrist, and elbow, and eventually the shoulder in order to prevent a stiff or “frozen” shoulder.

Instruction on when and how much to move the shoulder should be provided by your physician, physical therapist, or certified athletic trainer.  The length of time needed to regain full motion and function depends on the severity or grade of the injury. Recovery for a Grade I AC separation usually takes 10 to 14 days, whereas a Grade III may take six to eight weeks.

When is surgery indicated?

Grade I and II separations very rarely require surgery. Even Grade III injuries usually allow return to full activity with few restrictions.  In some cases, a painful lump may persist, necessitating partial clavicle excision in selected individuals such as high caliber throwing in athletes.  Surgery can be very successful in these ways, but as always, the benefits must be weighed against the potential risks

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