FAQ Category: Shoulder

Studies show that the hands and knees position puts the least amount of stress on a recovering shoulder. The patient can strengthen muscles and “re-tune” the joint after surgery with less risk of re-injury in this position.

However, if the position causes other problems, something different must be done. The shoulder exercises can probably be changed to a standing position with weight through the hands and arms against a wall or table. This will depend on which muscle was torn and repaired. Some muscles are more active in one position compared to others.

Putting the least stress on recovering muscle is important in the rehab of healing tendons after surgery. Too much load or force against the muscle too soon can result in a failed operation.

Bring up your concerns with the therapist and give him or her a chance to modify the program to meet all your needs.

Right after surgery, you’ll probably be wearing a sling. This is kept on for a week to ten days according to your comfort level. You will be allowed to move your shoulder in two directions so long as it doesn’t hurt. The first is shoulder flexion (forward) and the second is outward rotation (elbow is held next to the body, hand moves away from the body).

By the end of the month, you may be given exercises using as much motion in all directions as pain will allow. Your full motion should be returned by 12 weeks. A recent study showed that patients who have a rotator cuff repair using only arthroscopic surgery regain motion faster. Patients who have an open incision get back their full motion, but it takes longer.

Four tendons around the shoulder joint make up what is called the rotator cuff. Overuse or trauma can lead to injury of one or more of these tendons. The tears can be graded from mild to moderate to severe. Another way to say this is “small,” “medium,” and “large.”

Doctors rely on magnetic resonance imaging (MRI) to make this decision. A small or mild tear is less than ¼ inch (less than one centimeter). A medium or moderate tear is from ¼ to ¾ inches long (one to three centimeters). A large or severe tear is longer than ¾ of an inch (three to five centimeters).

Another way to look at this is whether or not the tear goes all the way through the tendon. Using this method, there are two kinds of tears: partial-thickness and full-thickness. A small or medium tear goes through part, but not all, of the tendon. A severe tear extends through the entire (full-thickness) of the tendon.

The rotator cuff is a group of four muscles and their tendons around the shoulder. Pain and loss of motion occur when there’s a tear in one or more tendons of the rotator cuff. Sometimes, surgery to repair the tear is needed.

A loss of motion is normal right after the operation. Most patients stay in a sling for the first few weeks. Certain movements such as shoulder flexion or outward rotatin are allowed right away. By the end of 12 weeks, most patients can move the joint in all directions.

Fibrous ankylosis occurs when the shoulder can’t flex forward more than 120-degrees. This is about eye-level. It will allow you to reach the first or second shelf in most kitchens, but not the top shelf.

It’s unclear what causes this condition. It may be the result of the type of operation. A recent study showed that fibrous ankylosis occurs more often when the doctor uses a combination of open incision and arthroscopic surgery. This means the doctor makes a cut to open the shoulder and then uses a tool with a tiny TV camera on the end to see inside the joint.

Pain is a normal sign at certain points in the recovery process. This is most common during the early phase after an operation. Drugs to control pain and inflammation are used from one to three weeks after surgery.

At the same time, physical therapy to stretch and move the tissue is begun. The therapist will include exercises to retrain the muscles, restore normal posture, and begin motion. The program is progressed from three to six weeks postop.

Throughout this time, it’s best to complete the exercises without pain. Pain is a sign that something is wrong. Either the exercise is being done too soon or improperly. It’s better to do a little often than doing a lot occasionally.

Keep at it with the help of your therapist. Quality is more important than quantity. Good muscle control comes first before the ability to do many repetitions. Stop when the muscle gets tired. You’ll know you’ve reached this point when the muscle starts to shake or you can’t go through the same motion as during the first few repetitions.

Yes, actually it does make a difference as to which muscles are activated. In both positions, the chest muscles are the primary movers. However, with the elbows tucked into the sides, the triceps muscle behind the upper arm becomes more active. When the elbows are out, the deltoid muscle of the upper arm is more active.

You can actually test this for yourself by doing many repetitions of just one kind (elbows in versus elbows out). You’ll likely be sore within 24 to 48 hours. Repeat the exercise using the other method. Compare which muscles are more active by patterns of soreness.

Most people would prefer to avoid muscle soreness. There are ways to measure muscle activity. Studies of adults doing push ups against a force plate have measured muscle activity with this exercise. Besides the main muscle doing the action, other “helper” muscles are found this way.

Researchers at the Cleveland Clinic Foundation advise against it. A small study of 25 shoulders showed a high re-injury rate. This was especially true for patients with loose joints throughout the body. You may benefit from another, different operation.

Using the shoulder too much, too soon may be the cause of problems after laser treatment. The best treatment program after laser hasn’t been decided yet. Several studies have reported a problem with loss of tissue stiffness in the early days after laser treatment. Since many patients are pain free, they return to normal activities too soon. This stretches out the fibrous tissue around the joint and can lead to chronic dislocations.

The condition you’re describing is called positional cyanosis. Cyanosis means a “bluish discoloration.” It’s caused by a lack of oxygen to the tissues. This can occur if you sleep in one position too long or if you lay on the arm without moving for more than two hours.

Another possible cause of this problem is a condition called thoracic outlet syndrome (TOS). In the adult body, there’s a bundle of nerves and blood vessels that travel from the neck down the arm. These pass under the collarbone. If anything presses on the vessels, the blood supply can get cut off.

TOS can occur as a result of postural changes, bone spurs in the neck or shoulder, or problems with the muscles. A physical therapist can help you find the cause of the problem and solve it. If you don’t get relief from your symptoms in three months, see your doctor.

Using heat in the form of laser or radiofrequency has gained in popularity over the last 10 years. Uses for laser therapy in the shoulder are still limited. Research only supports its use for shoulder instability.

When the fibrous tissue surrounding a joint (the capsule) is torn or stretched, it’s causes joint laxity. This is another way to say “loose joint.” Joint laxity causes a joint to be unstable. In the case of the shoulder, this can lead to dislocation.

Currently, thermal devices are used to treat shoulder instability caused by damage to the capsule. Arthritis is a condition that primarily affects the bone and joint surfaces. Laser hasn’t been approved for use with arthritis at this time. More studies using laser are being done and may include arthritis in the future.

Shoulder impingement is a fairly common problem in adults. The soft tissues around the shoulder get pinched between two bones. This usually happens to a tendon or bursa. The bursa is the cushion that sits between the tendon and the bone.

When conservative treatment fails, surgery is an option to think about. The operation is called decompression. The doctor shaves away any bone spurs and cuts out part of the acromion. The acromion projects from the scapula (wing bone) to form the roof of the shoulder. By removing the end of this bone, pressure is taken off the soft tissues underneath.

This operation is usually very successful. Most patients regain motion and function. Pain is relieved allowing the patient to return to work and recreational activities.

Wear and tear on the shoulder over a long period of time can cause problems. Each time the arm is lifted up, tendons and the bursa can get squeezed. This is called shoulder impingement.

Over a period of years, this kind of friction can cause inflammation. When the bursa is affected, it’s called bursitis. Tendonitis is a similar problem of the tendon. Chronic bursitis or tendonitis usually responds well to surgery.

Each doctor will have his or her own follow-up plan. If there are no serious complications, an office worker may expect to return to work in four to six weeks. Patients who are required to lift or carry heavy objects return to work after three months. Following a rehab program can help ensure a safe return to work.

Tendons, ligaments, and muscles can “snap” or “pop” when injured or damaged. Often, this is a sign that the soft tissue has torn partially or completely. Immediate pain and swelling suggests a muscle may be involved.

A normal tendon/muscle unit is painless and strong. A first degree strain or tear will be painful and strong. If movement of the arm is painful and weak, suspect a serious strain or tear. In the case of a weak arm without pain, there may be a complete tear of the soft tissue structures.

Use ice, gentle motion, rest, and antiinflammatories for the first 24 to 48 hours. If painful symptoms persist, a medical exam is advised. Continuing to use the arm can cause further damage. It’s best to file an incident report, even if you don’t see a doctor right away.

There are a few ways to operate on rotator cuff tears. The most extensive surgery is open repair of the rotator cuff. With this procedure, surgeons use a large incision to operate. During surgery, they suture the tear to help the shoulder function properly. This approach is the best option for severe tears, or those that affect more than half of the rotator cuff tendon.

An alternative for minor tears is called acromioplasty. With this procedure, surgeons shave part of the acromion bone on the point of the shoulder. A ligament over the top of the shoulder is cut, and injured tissues are removed. This takes pressure off the injured rotator cuff and promotes healing. For patients with tears that affect less than half of the tendon, this procedure usually has good, lasting results.

For patients whose tears go through about 50 percent of the tendon, repair of the rotator cuff may offer better results than acromioplasty. This choice also depends on where the tear is located. Ask your doctor which surgery is best, given the size and location of your injury.

With acromioplasty, surgeons shave part of the acromion bone on the point of the shoulder. A ligament over the top of the shoulder is cut, and injured tissues are removed. This procedure is sometimes done to treat pinched tissues in the shoulder (called shoulder impingement). It is also used to treat tears in the rotator cuff. Acromioplasty can be done using an arthroscope. This slender instrument has a camera on the end that allows surgeons to work without making big incisions in the skin.

Athroscopic acromioplasty is a less invasive procedure than open shoulder repairs, which require large incisions. For shoulder impingement and minor rotator cuff tears, acromioplasty has good results. Five years later, most patients have pain relief. They also have normal strength and motion in the shoulder.

For rotator cuff tears, acromioplasty works best on minor tears and those on the undersurface of the tendon. Talk with your doctor about how this procedure may help in your case.

If the tear affects less than half of the rotator cuff tendon (grade 1 or 2 tear), you’ll probably have good results. Ninety percent of patients with minor tears show immediate improvement from this procedure. And the results seem to last. In a recent study, most patients continued to be pain free when rechecked up to five years after surgery. Patients showed good shoulder strength and motion and were able to do all their activities. Patients followed for up to 10 years didn’t show any worsening in the shoulder area.

When this treatment fails, it fails right away, and the results do not get better over time. Failure is more likely for larger tears and those located on the top surface of the rotator cuff.

Not likely. Most metals used in orthopedic surgery are made of titanium. This is an alloy or mixture of two or more metals that dissolve in each other when heated to a high temperature.

As far as the security system goes, these alloys are no different than the amalgam in dental fillings. They do not trigger the security system. Most doctors will give their patients a letter or prescription with the necessary medical information. This can be shown if there are any questions during the security checks.

Probably not, but she will be trading a bump for a scar. In terms of improving her physical or cosmetic appearance, your daughter may not be happy with the results. Have her talk to a surgeon about this decision. The surgeon may have photos of other shoulders to help your daughter see the final outcome.

About 80 percent of people who separate their shoulders but do not completely dislocate the joint regain pain-free motion and strength by the end of a year. For the remaining 20 percent, there may be pain, stiffness, and weakness when lifting overhead. Results may be different for young athletes.

As your doctor has said, it’s impossible to know who will do well without surgery. It is also unknown how often shoulders without surgery have a second (usually worse) separation. For a young athlete interested in getting back into the game, surgery may be the best option. Follow your doctor’s advice on this.

There are many parts to the shoulder complex. Most people think of the shoulder as the upper arm bone in a socket. That’s technically correct, but the “socket” is just a small part where the arm moves and turns. Above the socket, the collarbone attaches to the shoulder blade as it comes around from behind. A band of strong ligament holds these two bones together. Where these two bones meet is called the acromioclavicular or AC joint.

A shoulder separation occurs when the ligaments at the AC joint are torn or damaged, and these two bones are disrupted. Shoulder separations are graded as I, II, or III depending on the seriousness of the tear. An X-ray determines this. For example, if the ligaments are completely ruptured, the collarbone becomes dislocated. This is a grade III shoulder separation. A grade I is a minor ligament tear, and the bones stay in place. Grades II is in between these two extremes.

This may actually be a sign of injury to the structures around the front of your shoulder. This type of excess motion can persist even after rehabilitation. It may indicate the need for surgery, especially if the shoulder continues to dislocate or cause extra pain. You should see your doctor for a follow-up evaluation.