FAQ Category: Shoulder

Corticosteroid injections are often used for back or joint pain and swelling from an inflammatory condition. The maximum number of steroid injections that can be given safely is a debatable topic.

Some doctors advise no more than two to three to the same joint in one year. The concern is for systemic side effects of the steroids. Steroids can also thin the skin and underlying layer of protective fat in the area of the injection.

Steroid injections have the best chances of helping patients when used early on in the condition. They are not as helpful in chronic conditions. They seem to work best when combined with pain relievers and physical therapy. The goal is to reduce pain, thereby increasing motion and function. The need for surgery can be avoided in some cases.

The specific cause can’t be determined without an exam by a physical therapist or medical doctor. There is a wide range of possibilities from posture to nerve damage to muscle tear. Shoulder injuries are almost always accompanied by changes in the posture and movement of the wing bone called the scapula.

Once the cause of the problem has been identified, a physical therapist can set up a rehab program. This will restore normal motion and posture.

Unfortunately, yes. The rotator cuff is made up of four muscles and the tendons that attach them to the shoulder joint. If the cuff is torn, early treatment and repair is best.

Untreated, a small tear can become a large tear. If the tendon is completely separated, scar tissue fills in. Again, early in the injury, repair is more likely. After a number of years, this isn’t possible.

Exercise to keep the joint stable and the remaining muscles strong is advised. Pain can be reduced and activity increased. However, the patient may always have some pain and less than normal motion.

The first place to start is with a medical exam. An orthopedic doctor is the specialist to see for this kind of problem. In some cases, medications and exercise may be all that’s needed. Muscle weakness can cause pain. A good rehab program can reduce pain, improve motion, and increase strength.

Sometimes, surgery to repair a torn tendon or muscle is advised. Many patients with shoulder pain have undiagnosed soft tissue damage. This could have happened years ago after a fall or other injury. A total joint replacement isn’t always the first answer to shoulder problems.

Your shoulder is at risk for damage until the bone, muscles, and other soft tissues heal. The minimum amount of time for this is about six to eight weeks.

If you have other health problems such as diabetes, heart disease, or thyroid problems, wound healing can be delayed. This is also true if you are a smoker or tobacco user.

Failure of a joint implant can occur at any time. A study from the Mayo Clinic reported shoulder dislocation after replacement anywhere from immediately to 11 years later. In any shoulder, a traumatic injury can cause damage. This could be caused by a car accident or falling on an outstretched arm.

In about one-third of all cases, implant failure occurs after some kind of trauma. In other patients, bone loss contributes to joint failure. This may occur as a combination of decreased bone density from osteoporosis and bone removal during the operation.

A recent study at the Mayo Clinic reports results after shoulder replacement. Failures were often caused by more than one factor. Muscle tears, improper position of the implant, and tension in the joint capsule were all listed as possible causes. Soft-tissue imbalance was present in all cases.

When the arm is lifted overhead, some of the soft tissues in the shoulder can get compressed or pinched. This is called shoulder impingement. Impingement can cause pain in the neck, shoulder, upper back, and even down the arm. There may be numbness and tingling in the arm and hand.

People who sleep at night with a hand under the pillow or with the arm overhead are at risk for impingement. Keeping the arm down by the side is one way to prevent these symptoms. Medical supply companies offer shoulder immobilizers that work for this problem. A simpler method is to place the arm against the body under a snug nightshirt.

A team of experts, including you, must make this decision. A physical therapist will test muscle strength. A doctor will assess the size, shape, and condition of the joint. The condition of the muscles and tendons is also reviewed.

Your general health, smoking and drinking habits, and overall nutrition will be part of the deciding factors. Slow or poor wound healing can occur from poor health, diet, and lifestyle choices.There is a greater risk of implant loosening in patients who rely heavily on the arms to operate a wheelchair.

A rehab program now is ideal. A physical therapist can help you increase and keep muscle strength in the arms. This will protect the joints. The use of a small-motorized scooter may be a good idea to save wear and tear on the joints.

No. In fact it’s so uncommon that the Mayo Clinic in Rochester, Minnesota reports only 13 cases in 25 years. And that’s out of 2,568 patients who had a shoulder replacement.

Many studies report this is more common in hips and knees. The reason for this difference is unknown.

Yes and no. Some doctors repair all types of rotator cuff tears that can be repaired. This depends on their location and if there’s enough tissue to cover the head of the humerus (upper arm bone). The decision is more complicated if more than one tendon is torn.

New surgical techniques using arthroscopy have changed things. The arthroscope is a long needle-like tool with a tiny TV camera on the end. It’s inserted into a joint and gives the doctor a view inside. The arthroscope has made it possible to repair tears that couldn’t be fixed in the past.

If a tear is left unrepaired for years, there may be too much damage to fix it later. This can happen when someone injures the shoulder, but recovers without seeing a doctor. If the joint needs replacing years later, the doctor may find the tear during the operation.

Doctors use different measures to define “massive” tears in the rotator cuff. In one study, the torn tendon was 5 cm (1¼ inches) wide after the shredded edges were removed. Another study defined “massive” as tears of two or more tendons. There are four tendons in the rotator cuff of the shoulder.

Not all tears of the same size are equal. Researchers believe that tears of the subscapularis tendons are worse than other tears. A torn subscapularis combined with another tendon in the rotator cuff often has a poor outcome.

There are many specific tests doctors can use to test each muscle of the shoulder. Each muscle attaches to the bone by its tendon. Just palpating or pressing on each tendon will give some information. The patient’s report of how the injury occurred and what the symptoms were at the time of the injury also help.

How the shoulder moves and when pain occurs adds another piece of information. For example, if a specific shoulder motion is painful but strong, a minor tear is suspected. A painful and weak response suggests a partial tear of the muscle or tendon. A completely torn muscle/tendon is painless and weak.

The biceps muscle has two parts: the long head and the short head. With complete rupture of the long head of the biceps, the patient has no pain and there is a bulging of the muscle.

Imaging studies such as X-rays and MRIs also offer useful information in making the diagnosis. The final diagnosis is made (or confirmed) when the doctor uses an arthroscope to look inside the joint. Partial or complete tears can be seen during this test.

A recent study from the Orthopedic Biomechanics Laboratory at the Mayo Clinic in Rochester, Minnesota, offers some new information. The role of the deltoid muscle as a shoulder stabilizer was reported.

The deltoid is a muscle that makes up most of the bulk of your outer, upper arm. It’s divided into three parts: anterior, middle, and posterior. The deltoid lifts the arm up. It also holds the head of the humerus (upper arm bone) against the glenoid (shoulder socket).

The researchers found that all three parts of the deltoid work equally to hold the shoulder and keep it from dislocating forwards. You’re probably already strengthening the rotator cuff and biceps muscle. It may be adviseable to now strengthening exercises for the deltoid muscle.

There are at least four items that hold the shoulder joint steady and keep it from dislocating. The first is the bulk of the surrounding muscles, which provides some passive tension to hold the joint. The second is muscle contraction. When the muscle contracts, it presses the joint together. Bringing the joint surfaces closer increases stability. Third is joint motion. When the shoulder moves, some of the ligaments tighten up. This is called passive constraint. One other factor is the barrier provided by the muscles. This keeps the head of the humerus from coming out of the socket. Injury or damage to any of these structures can cause the joint to become unstable.

A Bankart lesion occurs in the shoulder joint when there is a tear in the lower front portion of the glenoid labrum. The glenoid is the “ocket” half of the shoulder joint. The labrum is a ring of fibrous cartilage around this opening.

Often in a Bankart lesion, the ligaments that attach to the labrum are torn. An osseus Bankart defect tells us that along with the tendon a piece of bone has been torn off the edge of the socket.

A Bankart lesion suggests shoulder instability. The shoulder may dislocate in a forward direction. Surgery to repair the damage can now be done arthroscopically without cutting the joint open. The doctor inserts a slender instrument into the joint. A tiny TV camera on the end allows the surgeon to see inside the joint. A separate incision allows the surgeon to work insert surgical tools to make necessary repairs.

Maybe not. Untreated rotator cuff tears can lead to wear and tear on the shoulder joint. A chronic tear with arthritis often results in restricted and sore shoulder motions. Severe pain is reported with daily activities and at night.

Doctors offer several methods of treatment for this problem. The joint can be cleaned out, fused, or replaced. Removing fragments of tissue, scraping off bone spurs, and opening the joint space can help. Fusion eliminates pain, but also restricts motion.

Replacing the joint is a third option. One or both sides of the joint is removed and replaced. If both sides are involved, it’s called a total joint arthroplasty. If only one side is altered, it’s a hemiarthroplasty.</i

Just five or 10 years ago, surgery was followed by a hospital stay. This would be several days to a week or more, depending on the type of operation done. Today, many operations are completed and the patient sent home on the same day or within 23 hours. Costs are reduced when an overnight stay is avoided.

Some operations are more invasive and more technical and require closer supervision. Patients are recovering from anesthesia and pain management is an issue. They aren’t considered ‘safe’ to go home on their own or with family help. In some cases, the risk of postoperative complications requires a longer hospital stay.

A shoulder joint replacement is major surgery. Physical therapy on the first day is needed. Most patients require help getting back to daily activities. Some patients go home more quickly than others. Those with complications such as fever, blood clots, or wound infection may have to stay longer.

This is a very good question and a problem that researchers have to deal with everyday. Electromyography (EMG) is the tool used to measure electrical activity in muscles. EMG tells researchers a lot about how muscles work.

There are two ways to hear and record the electrical signals of muscles. Small patches or electrodes can be placed on the skin over the muscle. The electrodes are placed over the middle section of each muscle. This method gets the best signal without picking up signals from other muscles.

A second method uses fine-wire electrodes. Fine needles are inserted in to the belly of the muscle. The wires are taped down to keep them from moving when the muscle contracts. Fewer muscle fibers are recorded with wires compared to electrodes.

Scientists know that cross-talk is a problem with EMG studies. They take this into account when looking at their findings.

Yes. Military physical therapists have a special program worked out for soldiers with this problem. Rehab begins with range of motion exercises and works toward getting back full motion. Stretching and resistive exercises are slowly added.

Push-ups are also added slowly and start with a modified form. Modified push-ups include wall push-ups, then push-ups done from a high table top. Before going to regular push-ups, the exercise is done from a low table. When the patient is ready, wide arm, “diamond,” and single-arm push-ups can be included.

It’s not advised without checking with your doctor and therapist first. Rehab programs for shoulder injuries must progress at a rate that recovering tissues can handle. Usually, this is from low- to high-demand exercises.

Some muscles are more active than others in different positions. The therapist starts patients out in positions that are easy on the healing tissue. For example, being on hands and knees puts the least stress on shoulder muscles. Push-ups against the floor put the most stress on the shoulder. There’s a wide range of positions and exercises in between.

Early rehab exercises must put a low demand on the recovering muscles. Higher loads should be put off until the tissues and muscles can accept greater demands. The load on the joint and muscles may be greater than you think. The therapist knows how to balance how much load the shoulder can accept without dislocating or causing reinjury to the muscles.