FAQ Category: Shoulder

It may be you are part of a long-term study to see what kind of results are possible with the surgery you had. Patients who don’t come back to the clinic are often sent a survey with questions to answer.

p>The data is entered into a computer and tracked over a period of 12 months, two years, five years, and longer. The information gathered can help doctors find out when an operation isn’t working well. Sometimes they are able to find factors that put a patient at risk for failure. This kind of information can help in future patient selection.

Keep filling out the paper work if you don’t mind being part of the ongoing research carried out by the Mayo Clinic. If it’s truly too much for you, contact the clinic directly and ask them to remove you from the follow-up mailings.

These days there’s a wide range of abilities and disabilities from age 20 to 100+. It’s no longer possible to predict what to expect by the decade.

Seniors are joining in the exercise craze lifting weights and running marathons. Folks are staying out in the work force longer, too. It’s not unusual to find an older adult who does physically demanding manual labor.

Most likely the answer you gave to the question helped the therapist get an idea of your daily activity level and functional abilities. Establishing a baseline of activity is important in order to know what goals to set and how to get there.

Not necessarily. It’s a new world out there even for doctors in sports medicine. Older adult athletes are new but becoming more common. Doctors, physical therapists, and chiropractors may just need a little reminder from time to time.

Bring the topic up yourself at your next appointment. Let your doctor (and any other members of your health care team) know of your interest and activities. It’s always a good idea to make your goals known.

Perhaps you want to get back to 18-holes of golf or compete in tennis tournaments. The treatment and rehab might differ if everyone knows what direction you’d like to head.

You both are! Success can be measured as many ways as there are people to measure it. The surgeon may look at the stability of the shoulder and status of the healing tissues and say, “It’s a success.”

Some patients may think pain relief is enough. Others, like you, want a higher level of function. You measure the results in terms of how much you can do and how well you can do it.

It’s also true that two patients with the same problem having the same operation can end up with different outcomes. This could be based on their level of activity before the operation. There could be complications or health issues for one patient but not the other.

Many patients today expect to get back to their previous level of activity after surgery. Most often this is possible but it does take time. Let your doctor know what you consider a “success” so he or she can help you get there.

Weakness or paralysis of the serratus anterior muscle causes the shoulder blade or scapula to “wing.” Nerve injury as you describe is one possible reason for this problem. Medical reports suggest that the nerve function will return in about nine months. It can take as much as two years before the nerve has recovered.

About 25 percent of the time, the patient doesn’t get full use of the shoulder blade back and the winging persists. Sometimes doctors can operate and help the problem. They can transfer another muscle to that spot to work in place of the serratus anterior. It’s also possible to fuse the shoulder blade to the rib cage. Surgery isn’t done until at least two years has gone by and it’s clear the nerve isn’t going to get any better.

It’s best to work with a physical therapist to keep the muscles around the scapula from freezing up. Of course, the patient is advised to avoid the movement that caused the problem in the first place.

You may have had a steroid injection into the shoulder or one of the nearby joints. This is an anti-inflammatory drug given locally right to the potential source of the problem.
It’s called diagnostic because the doctor is using it to figure out what’s wrong. This step can cure the problem for some patients and avoid expensive imaging studies such as MRIs.

If you got good pain relief from the injection, then it’s likely there was some swelling or inflammation in the joint pressing on soft tissues or a nerve causing the pain. If the pain relief was only temporary (an hour, several hours, a day up to a week), then more tests may be needed.

You may be describing an injury to the long thoracic nerve that controls the serratus anterior (SA) muscle. When there is weakness in the SA the shoulder blade or scapula can’t rotate and slide like it should when the arm is lifted up. The result is called scapular winging.

Mastectomy is one possible cause for this problem. During the surgery for the mastectomy, the nerve can get stretched from the position of the arm. There are many other possible reasons such as a viral illness, working with the arms overhead, or lifting a heavy weight.

The best way to know for sure what’s going on is to have some testing done. Electromyography or EMG studies can find out for sure which muscles are involved. Nerve conduction velocity (NCV) tests can be done to see if the nerve is damaged. Talk to your doctor about these symptoms and see what he or she suggests.

Studies show that magnetic resonance arthrography (MRA) does add to what an MRI (magnetic resonance imaging) can show.

With MRA, a contrast dye is injected into the joint. Since there’s already some synovial fluid in the joint, the added fluid pushes against the joint capsule.

The colored fluid then moves into every nook and cranny of the joint. It outlines the structures and leaks into any areas of damage. MRA can show any changes in the normal structure of the shoulder. It shows tears in the capsule, cartilage, ligaments, and tendons.

If you’re thinking about having shoulder surgery, the MRA will help the surgeon plan the best surgical method for the problem.

Your surgeon will know the best tests to order based on your history and the examination. MRIs give good contrast of the soft tissues. It’s an ideal way to see inside the joint without actually opening it up.

MRIs are only 84 to 96 percent accurate in finding rotator cuff tears (RCT). Magnetic Resonance Arthrography (MRA) may be a better choice if a RCT is suspected.

MRA uses the natural fluid in the joint as a way to look for “holes” in the capsule from a RCT. A contrasting agent is injected into the joint. Any fluid that shows up outside the capsule must have moved through the defect.

MRA isn’t available everywhere. Ask your surgeon if it’s available in your area and if it’s recommended for your situation.

MRIs (magnetic resonance imaging) give good information about the shoulder, which is a very complex joint. However it’s not accurate 100 per cent of the time. In fact it may be only about 86 to 90 percent accurate.

The magnetic resonance arthrography (MRA) is more sensitive and more reliable for rotator cuff tears. It has been shown to be 100 percent accurate in some studies. The MRA is more expensive, takes a little longer, and does require a needle injection into the shoulder.

Most patients report it doesn’t hurt as much as they expected. The MRA doesn’t offer any advantage in diagnosis if there’s damage outside the joint capsule. It does give the surgeon more information about the type, direction, and size of rotator cuff tears.

Removing and replacing the entire shoulder joint is done 10,000 times each year in the United States. The most common reason for shoulder replacement is advanced osteoarthritis.

Whether to replace part or all of the joint remains a hotly debated topic among orthopedic surgeons. Long-term studies (10 to 20 years) aren’t available yet. Short-term studies (two to five years) show good results for both.

Most often the surgeon makes the decision during the surgery. The joint and surrounding soft tissues are examined. The type and amount of damage helps the surgeon decide what’s best. Then the correct size of implant is chosen and implanted.

Don’t worry…it’s not as serious as it might sound. The patient hasn’t crossed over from this life into the next. It refers to a second surgery to remove a partial shoulder replacement and put in a total shoulder replacement.

A partial joint replacement is called a hemiarthroplasty. With a partial implant only half of the shoulder joint is removed and replaced. Usually the socket is the side replaced. Sometimes the head of the humerus is more the problem.

Complications and problems after a hemiarthroplasty may lead the surgeon to suggest a total joint replacement. There could be a crack or fracture in the implant, an infection, or continued severe pain.

It’s true that the number of hip and knee replacements far out pace the number of shoulder replacements. The number of shoulder replacements is increasing every year. Last year more than 10,000 were done in the United States.

Long-term studies 20 years down the road aren’t available yet. But short- to mid-term results are in. Most patients have a good result with decreased pain and improved movement. These two results also mean better function and higher quality of life for most people.

As with any surgery, problems can occur. In a small number of patients blood clots, infection, or fracture can cause death or delay recovery. The risk of technical difficulties is greater with shoulder replacement surgery compared to hip and knee.

Overall, patients report improved quality-of-life with a shoulder replacement. If they had to do it over again, they would have the same operation.

The choice of anesthesia depends on several factors. The Bankart repair can be done as an open incision or closed (arthroscopic) surgery. It’s a specific repair to the labrum or rim of cartilage around the shoulder socket.

Patients who have the open repair often receive general anesthesia. The patient is asleep for the entire operation.

A regional anesthesia is possible with an arthroscopic repair. The shoulder, arm, and upper quarter of the body are numb. General anesthesia can be added if this isn’t enough anesthesia.

Check with your surgeon and the anesthesiologist to find out what’s planned. Alert them to your prior difficulties. This will help avoid any problems this time.

There are plusses and minuses for both operations. Closed surgery with an arthroscope is less invasive. There’s a reduced risk of getting osteoarthritis in that shoulder later.

The down side of the closed repair is a higher rate of recurrent dislocations or subluxations (partial dislocation). Researchers report about seven to 17 percent of the closed cases have this problem. Only three to five percent of the open repairs partially or fully dislocate.

Many surgeons advise using the closed repair for young patients or extremely active patients. It sounds like you might be in this group. Your surgeon will probably make a recommendation for you based on your age, the injury, and your goals for rehab.

You’ll want to bring this up with your surgeon. Perhaps your injury can be treated with a more conservative, less expensive approach. If not, then you may want to look at the differences in cost for an open versus closed operation.

ith an open repair, the patient has general anesthesia. The surgeon makes an open incision to make the repairs. The operation is done in the hospital. There is often an overnight stay required.

With the closed (arthroscopic) method, regional anesthesia is used. The patient goes home the same day. There is usually a charge associated with pain relievers used for a few days.

All of these decisions are based on the type of problem you have and what your surgeon can do.

Bike accidents and sports collisions are common causes of shoulder dislocation. The most common position of the shoulder when dislocation occurs is out away from the body (abduction) and rotated outward (external rotation).

The doctor must test the shoulder for stability. It’s important to see if the shoulder will dislocate again. This position is called the shoulder apprehension test. A positive test shows on the patient’s face by pain and fear of another dislocation. The doctor may feel the head of the humerus slide forward during the test, too.

The apprehension test is an important part of the diagnosis and helps the doctor plan the best treatment. Does the patient need surgery? Or is a rehab program the best choice? It’s better to know the extent of the damage from the first shoulder dislocation before a
second one occurs.

The shoulder joint is a ball-and-socket joint. The socket is fairly shallow. This puts the joint at risk for dislocation. To help deepen the socket, the shoulder joint has a rim of cartilage called a labrum. The labrum forms a cup for the end of the arm bone (humerus) to rest and move inside.

A Bankart lesion is an injury to the labrum caused by forward (anterior) shoulder dislocation. The force of the head of the humerus (upper arm bone) as it dislocates, tears the labrum and the ligaments attached to it. The shoulder joint is unstable when the labrum is torn. There isn’t anything to keep the head of the humerus from slipping forward out of the socket again. Surgery to repair the damage is usually needed.

A Hill-Sachs lesion is an injury that causes damage to the head of the humerus. It also occurs with shoulder dislocation. When the shoulder dislocates, the smooth surface of the humerus hits against the bony edge of the socket (called the glenoid). The collision causes a dent in the bone of the humerus. This is also called an impaction fracture.

The Hill-Sachs lesion can usually be seen on a normal shoulder x-ray. Surgery may not be needed. Treatment is designed to prevent further damage (and later arthritis) to the surface of the humerus.

The Bankart lesion describes the type of damage to the shoulder. It occurs after forward (anterior) dislocation of the joint. The labrum is a rim of fibrous cartilage around part of the shoulder socket. There are ligaments that attach to the labrum.

When the shoulder is dislocated anteriorly, the labrum along the front of the shoulder is torn away from the bone. The injury is called a Bankart lesion. It was named after the doctor who first described it in the early 1900s.

The operation you described allows the doctor to pass sutures through the ligaments and repair the labrum while still allowing shoulder motion. Overhead throwing athletes may need a special rehab program to restore full motion and function needed for their sport.

Studies show it takes longer for overhead athletes to recover from shoulder surgery. There are greater demands on overhead athletes compared to nonoverhead players. Greater precision and endurance are needed. More external rotation is needed for some sports.

Muscles in the arms and legs can heal after injury but it’s very slow. Recovery usually takes four to six weeks and may not be complete. You may have some loss of strength. Re-injury is common after these types of muscle strains.

Healing occurs in several steps or phases. First there’s bleeding at the site of injury. A bruise or bleeding into the muscle called a hematoma may occur. Some muscle cells will die, then inflammation occurs. Special cells called phagocytes clean up
any damage or debris. Scar tissue forms to fill in the damaged area. Small blood vessels also form to supply the new tissue with blood.

The final result depends in large part on how severe the injury is. Good nutrition and rest are important to promote healing. The right amount and kind of movement can also help muscles heal at the right length-tension ratio needed for normal range of motion. In some cases, surgery is an option to reattach the tendon and muscle unit.