FAQ Category: Shoulder

Heat via laser light or adiofrequency electrical current can be applied to the capsular tissues around the shoulder to “tighten up” the tissue. This helps hold the shoulder stable and prevents further dislocations.

It works by causing an inflammatory response in the tissue. The tissue fibers called collagen is stimulated to heal, a process that takes at least six weeks. Sometimes
healing takes as much as three to four months.

The patient can expect to see changes around that time. You must be careful to follow your doctor’s counsel. Most patients are told to keep the shoulder immobile for at least two weeks and sometimes longer. Returning to sports or athletic activities too soon can
be a problem.

Pretty close. In both cases sound waves are projected through the skin and soft tissues and bounce back. The result is an image of the structures underneath the skin. Ultrasound can be used to look at unborn babies, heart defects, tumors, and gallstones.

The frequency of the sound wave varies depending on its use and the tissue being examined. A broad-bandwidth frequency between five and 13 MHz (mega-hertz) is used to look at the rotator cuff around the shoulder. Extremely high frequency cleans dental and surgical tools.

Technology is changing and improving everyday. Rotator cuff sonography
(ultrasound) is an imaging study that can be done in the doctor’s office. It doesn’t require radiation, dyes, or lying inside a machine.

Doctors like it because it’s easy to use and portable. A round head (transducer) is moved over the surface of the shoulder. Sound waves are passed through the body and bounce off
the bone. This forms a picture of the soft tissue structures in question.

The patient can see what’s wrong as the test is being done. The doctor can ask you to
move your arm in positions that make the pain better or worse. This helps identify exactly which tissue is torn or damaged.

Ultrasound doesn’t work well to show tears of the cartilage in or around the shoulder. Likewise problems with the joint surface aren’t clear enough for a diagnosis. MRI may still be needed for these types of injuries.

Many things can affect the outcome of rotator cuff repairs. First, the severity of the tendon tear is important. A full tear can require a more complicated operation. A partial
tear with a small repair may heal faster and rehab sooner.

Second the type of surgery makes a difference. Did the doctor use an arthroscope and go into the joint with a special tool to make the repair? Or was a full cut needed to open the joint up? Arthroscopy usually means faster recovery.

Third, what’s the general health of the patient? Anyone with other health problems may be facing some extra complications. For example the client who has diabetes, high blood
pressure, or lung or heart problems may have some special problems after the operation. There’s always a concern about infection, poor wound healing, and blood clots after an operation of any kind. Patients with any of the problems listed here can be at increased
risk for these complications.

Research shows patients with other health problems often have more shoulder pain and less function. Overall, they rate their health as lower compared to patients without these extra problems. When a patient has two or more health problems at the same time, they are said to have comorbidities.

It’s important for the doctor to have a complete medical history. Past and current problems must be considered when planning an operation. The patient is often at increased risk for poor outcome after surgery when other illness and diseases are present. The doctor who is prepared can help patients avoid these additional problems.

Ultrasound can show many aspects of the soft tissues around the shoulder. It will show if there’s any fluid within the tendons, the size and shape of bursae, and any tears in the
tendons. By moving the arm during the test, the doctor can see if a tendon is partially or fully torn.

The image also shows if a torn tendon has drawn back into the muscle belly, called retraction. Knowing this helps the doctor plan treatment. The condition of the joint isn’t as clear. Ultrasound doesn’t show tears in the joint cartilage or the rim around
the shoulder joint. MRI may be needed to see this kind of damage. X-ray may be better for seeing arthritic changes in the joint.

Joint proprioception is the sense of joint position. Proprioception tells us if the joint is flexed forward or raised overhead. Joint position sense tells the person where the joint is in relation to the body and the other joints.

Like many things, proprioception does decline with age but usually in small amounts. Most people aren’t really aware of the change. Many different things can cause loss of motion. Arthritis is the number one problem in aging adults. Inactivity can lead to decreased
motion and even a frozen shoulder.

Sometimes people with heart disease become breathless when their arms are raised overhead so they stop using this motion. Forgetting how to do simple tasks such as raising the arms overhead can be a part of Alzheimer’s. This isn’t an early sign, though. It usually
happens later on as the disease progresses. If your mother doesn’t have any other signs of Alzheimer’s, this loss of motion is likely caused by something else.

Make an appointment with her doctor for an evaluation. Early identification and treatment of some problems can help prevent long-term complications.

Of course it’s possible some minor damage occurred in the right shoulder at the time of the accident. Perhaps an injury is present but undiagnosed. Be sure and ask your doctor to check this for you.

It is possible that you are experiencing a change in the joint position sense. This is the ability of the joint to tell where it is in relation to the body. It’s called proprioception. Proprioception also tells the joint where it is as it moves.

Proprioception is regulated centrally by the nervous system. If one side is injured, the other side is also affected. Usually patients aren’t aware of any difference, but testing
reveals the change.

A recent study from Germany suggests the shoulder is able to regain its own sense of joint position after surgery to repair the injury. In fact, even the proprioception in the uninjured arm improves. Researchers aren’t sure why this happens, but future studies
are planned.

In simple terms, joint proprioception means joint position sense. In other words, where is the joint in relation to the body?

Proprioception is really more complex than just one function. Besides joint position, proprioception also helps the joint tell how fast it’s moving and in what direction. There’s also an ability to sense resistance to the muscles around the joint.

Active motion (you move your arm) and passive motion (someone else moves your arm) are two separate types of joint position sense. Kinesthesia is also a part of proprioception. This is the ability to feel the joint position as you move through space.

Being able to match one arm’s movements to the other, called movement replication, is another form of proprioception.

The surgeon was most likely doing arthroscopic surgery. This means a special tool (an arthroscope) was inserted into the joint to allow the doctor to look inside.

The drive-through sign refers to the ability to pass the arthroscope easily
between the humeral head (round ball at the top of the upper arm) and the glenoid cavity. The glenoid cavity is the shallow cup the humeral head fits into. Together the humeral head inside the glenoid cavity forms the shoulder joint.

The location of a positive drive-through is at the bottom of the joint. This is where the lowest part of the glenohumeral ligament is located.

If the arthroscopic probe can move easily through the joint from back to front it’s a positive drive through sign. This sign tells the doctor the shoulder is loose or unstable. After treating the shoulder, the doctor looks to see if the drive-through sign
is gone. If it is, this is means the shoulder is tight enough.

A Hill-Sachs lesion occurs with an injury that causes damage to the head of the humerus (the round ball at the end of the upper arm bone). This type of lesion is linked with a shoulder dislocation. When the shoulder dislocates, the smooth cartilage surface
of the humeral head hits against the shallow socket (the glenoid cavity). An X-ray confirms the diagnosis.

The SLAP lesion is an injury to the labrum. The labrum is a rim of cartilage that forms a cup for the head of the humerus to move within. A SLAP lesion is a specific type of labral tear. This describes a Superior Labral tear from Anterior (front) to Posterior
(back). The SLAP lesion occurs at the point where the top of the biceps tendon connects to the labrum. The injury is seen most often after a fall onto an outstretched arm.

Slap injuries don’t show up well with imaging studies (X-rays, CT scans, or MRIs). Surgery may be needed to find the problem.

There are many factors in the outcome of this operation. Your age and general health are very important. Healing can be delayed by smoking, diabetes, poor nutrition, and stress.

The type of surgery done is also important. An open incision takes longer to heal than a mini-incision or arthroscopic surgery. Likewise, the type of repair done will make a
difference. Rehab takes longer if the rotator cuff is repaired at the same time as the biceps tendon repair. The same is true if the doctor has to remove a piece of bone to make room for the soft tissues.

Most patients are immobilized in a sling for seven to 10 days no matter which operation
is done. Physical therapy is usually started two weeks after the operation. The therapist will start with motion exercises and slowly move you toward strengthening exercises.

Lifting will be added sometime after six weeks. Only small items with minimal weight are allowed at first. This restriction is taken away 12 weeks after the operation. You will continue to build strength from there.

If you don’t have any neurologic problems like multiple sclerosis, stroke, or cerebral palsy and you just have muscle weakness, the exercises are ranked like this:

Paxinos test is named for Anastasios Paxinos from the University of New South Wales in Sydney Australia. It’s used by doctors, physical therapists, and athletic trainers to test for injury of the acromioclavicular (AC) joint.

The examiner presses two bones together: the clavicle (collarbone) and the acromion. The acromion is a bony projection that comes off the back of the shoulder blade. It curves
around to the front over and above the shoulder joint and meets the clavicle in front of the shoulder.

The test is done with the patient sitting and the involved arm down at the side. The examiner places his or her hand over the top of the shoulder. The thumb presses against the back of the acromion. The index finger of the same hand presses against the clavicle.
The pressure from the front and back of the shoulder is directed in toward the body.

A positive Paxinos test should be followed up by a bone scan. Dr. Paxinos’s studies show when both tests are positive in a patient with shoulder pain, the diagnosis of AC joint
pain is virtually certain.

Ultrasound (US) is a form of energy that can be applied to the body through the skin. High frequency sound waves absorbed by tissues causes a vibration that’s turned into heat energy. US raises the tissue temperature to around 100 to 110 degrees Fahrenheit.

Since the effect is deep in the tissues, no sense of heat is felt over the skin. You may feel some burning pain at the bone. This signifies the US is too high or being applied improperly.

Pain relief occurs with US as increased blood flow to the area sweeps away toxins and damaged cells. It also has a beneficial effect on irritated nerves.

You may be a candidate for surgery. Doctors have been using a special operation to repair torn or ruptured biceps tendons. They use an arthroscope combined with a small incision to get to the tendon easily.

An arthroscope is a long, thin tool with a tiny TV camera on the end. It’s inserted into the area of damage and allows the doctor to see what has happened. The surgeon will be able to see if the tendon is torn, frayed, or pulled back away from the bone. This information helps guide treatment.

The tendon can be sewn together and reattached to the bone. Doctors report good results with full return of function.

This is a nerve block used to numb an area for surgery. It’s used most often for operations to the shoulder, arm, and hand. Interscalene brachial plexus describes which nerve and its location.

A needle is inserted into the skin around the sixth neck vertebrae on the same side as the involved shoulder. The doctor makes sure the needle is in the right place and begins to slowly and carefully inject a local numbing agent into the area.

Usually operations on the upper arm and hand are done under general anesthesia with the patient fully asleep. The cost and problems with this method have resulted in the use of regional anesthesia. There’s an added benefit, too. Pain after the operation is much less with a local block.

You can, but it can take years of daily exercises to make a difference. Often the joint just doesn’t move properly or fully as it should even after a serious rehab program. If the problem is severe enough, chronic pain and loss of motion can lead to shoulder stiffness that gets in the way of doing daily activities.

A doctor at Washington University in St. Louis reports a new, safe, and effective treatment for frozen shoulder. It’s called translation manipulation. It’s meant to replace traditional joint manipulation done under anesthesia.

TM requires a local nerve block that numbs the entire area, but doesn’t require the patient to be fully sedated or asleep. The doctor applies a force through the joint to restore normal sliding and gliding of the shoulder.

This treatment method helps open up space in and around the joint and reduces pressure through the joint. Only one joint is moved at a time. The force of TM does not hurt the nearby soft tissues and other nearby joints.

You didn’t say what treatment you’ve already tried. Sometimes conservative care can make a difference. Anti-inflammatory drugs and physical therapy are the first treatment options. The physical therapist can help restore a balance in the soft tissues. Special techniques can be used to help the nerve move freely and smoothly.

If that doesn’t work, then manipulating the shoulder while under anesthesia may be tried. The doctor grasps the arm and moves it through all its motions. This is called a traditional manipulation.

There are some problems with this method, so a new technique has been reported. This is called translational manipulation (TM). In this method, the patient only needs a
local nerve block instead of a full anesthesia. The doctor has more control over the force and direction of the manipulation. This way there’s less damage to other structures.

TM has been shown safe and effective in use with patients who have a shoulder and a neck problem. There’s less stress on the nerves when TM is done with the head bent toward the affected arm while keeping the elbow slightly bent.

The acromioclavicular (AC) joint is located just above the shoulder joint. The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm
bone), and the clavicle (collarbone). The part of the scapula that makes up the roof of the shoulder and connects with the clavicle is called the acromion. The joint where the
acromion and the clavicle join is known as the AC joint.

At first treatment for AC joint injury is often rest and anti-inflammatory drugs such as
aspirin or ibuprofen. A rehab program with a physical or occupational therapist may be needed. If the pain doesn’t go away, an injection of cortisone into the joint may help.
Cortisone is a drug that decreases inflammation and reduces pain. Cortisone’s effects are only temporary. The short-term relief can be very helpful.

For the AC joint, injection may be used for diagnosis. If painful symptoms are relieved by the injection, the AC joint is the most likely cause. In making this decision, ask your doctor if the injection is to diagnose or to treat the problem?

Joint injection should be used after other more conservative treatment is tried. This may include nonsteroidal anti-inflammatory drugs, physical therapy, and changing activities.