FAQ Category: Shoulder

Controlling pain after surgery is an important way to avoid complications. Uncontrolled pain is the most common reason patients have longer (overnight) stays in the hospital after surgery.

Many studies have shown that patient-controlled pain medications are safe and effective. It is very unlikely that anyone without previous drug addiction would develop problems during this short amount of time. Be sure to talk with your doctor about your concerns.

Regional anesthesia blocks sensation in a large area such as the entire shoulder or arm without putting the patient to sleep. With general anesthesia, the patient is not awake or aware during the operation. General anesthesia has been in use for a long time. Regional anesthesia is a newer technique.

The biggest difference between these two types of anesthesia is the amount of pain after surgery. During the first four hours after the operation, there is less pain with the regional anesthetic. This also means fewer pain medications.

Other advantages of regional anesthesia include less blood loss and less time in the recovery room. This means the patient often gets to go home sooner. In some cases, pain levels require overnight stays in the hospital. Longer stays are more common with general anesthesia because of greater postoperative pain.

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.

The button anchor is a relatively new device used in rotator cuff surgery. Studies have explored the concerns you describe. So far, there have been no cases of anchor pullout or loosening in the first year after surgery. Likewise, there have been no cases of bone infection from the anchor that could lead to weakening of the bone and pullout. The complications reported have been movement of the anchor or breakage of the suture where it’s tied to the anchor.

Several studies were done before these anchors were approved for human use. Doctors inserted the anchors into human cadavers (bodies preserved for study) and then into live pigs. In both groups, the anchors were stressed with thousands of repeated movements. Doctors do these kinds of tests to make sure a treatment is safe before using it on humans.

Some doctors are doing rotator cuff repair using an anchoring or fixation device. These devices can be made of biodegradable plastic or metal, or they can be made of bone that has been treated and shaped for this purpose.

The surgeon drills a hole through a large bump on the shoulder bone. The graft is threaded through the hole and then threaded sideways to lock against the bone. The frayed or torn edges of the rotator cuff are then attached to this anchor.

When the anchor is made of bone, it blends in with the natural bone within six months. Biodegradable materials gradually dissolve and become part of the bone over the same period of time.

You may be describing a problem called shoulder impingement. Impingement of a tendon causes pain for swimmers at the point of hand entry into the water. In this position, the arm is rotated inward with the hand turned palm and thumb down. The supraspinatus tendon of the shoulder rotator cuff may be getting pushed up against a ligament that crosses the tendon just above it.

Before starting any kind of exercise program, it is important to find out exactly what is causing your symptoms. There are a variety of specific tests that can be done by an orthopedic doctor. Early identification of the problem can help prevent small problems from getting worse. Treatment may involve anti-inflammatory medication, physical therapy, or surgery.

MRI (magnetic resonance imaging) is a very good tool for identifying many problems. However, in the case of small tendon tears in the shoulder, MRIs can be wrong. In fact, studies show that more than half of rotator cuff tears in the shoulder come out negative on MRI when in fact there is a problem. This is called a “false negative.”

MRIs are still widely used because they do not require surgery or injecting anything into the body. In other words, the test is noninvasive. But if the MRI is normal, there may still be a problem that needs to be identified.

The next step is often arthroscopic surgery. In this procedure, the doctor inserts a small camera into the joint. This allows the doctor to see inside the joint and carefully examine all of the surrounding structures. Even the tiniest tears of tendon, ligament, or cartilage can be seen with this device. Repairs are usually made at the same time.

The most common cause of shoulder pain when the arm is in a certain position is called impingement. This can occur in the front or back of the shoulder when something is getting pinched. Most often, a tendon or bursa (protective sac) gets pushed against a bone or ligament.

Based on what you describe, there are other possible causes that could be more serious, such as a tumor. Although this is uncommon, a medical doctor must make the diagnosis. Impingement is commonly treated with physical therapy, though sometimes surgery is required. Some tumors respond to radiation; others must be removed surgically.

Early diagnosis can help prevent the problem from getting worse. Small tears in the shoulder can become large tears without treatment. Call your doctor today for an evaluation.

X-rays have limited value in a case like this. Your doctor might have ordered an X-ray if she thought you could have fractured a bone.

MRI (magnetic resonance imaging) is a useful test to identify damaged shoulder tendons. However, it is not always necessary to perform these studies. MRIs are very expensive, and most tendon tears can be accurately identified with a careful physical examination and history.

An MRI is probably not necessary unless the doctor is considering surgery. If you do not get better after a program of physical therapy, the doctor may reconsider ordering an MRI. Getting a second opinion from another doctor may confirm the diagnosis at a lesser cost.

You are wise to be cautious about starting such an exercise program. Previous injuries and unknown conditions can show up suddenly with the start of a weight-lifting program. This is especially true for adults over 40 years of age. Make an appointment with your doctor for a physical examination. Your doctor can check your readiness for this type of program.

Besides checking your shoulder, the doctor will evaluate you for any possible heart or blood vessel problems. Family history and past medical problems can identify potential areas of concern. In the case of a new weight-lifting program for anyone over 40, the doctor will also rule out the presence of aneurysms.

Aneurysms are areas in the blood vessels that get thin and can burst, causing bleeding and even death. Aneurysms can occur anywhere in the body, but most are located just below the kidneys. Improper weight-lifting techniques, like forcefully holding your breath, can result in a ruptured aneurysm.    

When you are cleared medically, ask your doctor to refer you to a physical therapist. The therapist will teach you proper lifting techniques and prescribe the right program for you. This will help you avoid muscle and joint injuries.

If you still have full motion without pain or other symptoms, you are probably safe to begin tennis. There is a risk of future injury, but there is no way to predict this. Warming up before exercise or activity (including tennis) is always a good idea. Spend about five or 10 minutes stretching the muscles of both shoulders, and move your arms through various tennis motions gently and slowly.

Your therapist can retest the strength of your shoulder and prescribe a specific warm-up and exercise program for you. This may be a good way to prevent future injuries while still enjoying the fun of tennis.

Although most rotator cuff repairs have excellent outcomes, there are times when another surgery is required. The doctor may have to “revise” the repair that was done some time ago. People who have only had one previous surgery and can still lift the arm overhead are more likely to have a good result from the second surgery.

Before you worry much more about surgery, see your doctor. It may be that all you need is a rehabilitation program. Strengthening exercises to restore full motion can also help prevent future pain and problems with the rotator cuff.

The rotator cuff is made up of four muscles and their tendons that surround the top rim of the shoulder. These muscles are important for smooth and coordinated use of the upper arm. They help hold the upper arm bone in the socket while still allowing the arm to move overhead.

Muscle and joint stiffness is very common in older adults. It is not clear whether this occurs as a consequence of aging, inactivity, degenerative disease, adhesion (glue-like) molecules in the tissues, or a combination of all these things.

Having enough muscle bulk and strength is necessary for full joint motion. This requires healthy muscles and tendons with a good blood supply. Without these, raising the arms completely overhead becomes a challenge. Nutrition is important, and a strength-training program is recommended. Exercises will help offset the loss in muscle mass and strength typical of normal aging.

Discuss this situation with your doctor. It is important to make sure nothing more serious is causing these changes. Ask about seeing a physical therapist for a muscle-strengthening program. This can improve your movement and flexibility while preventing deconditioning. Taking these steps now can help prevent future injuries.

Arthroscopic techniques seem to do a good job of keeping shoulders stable and flexible. A recent study compared the results of patients who had arthroscopic treatment with those who had regular “open” surgery. Two to five years after surgery, patients who had arthroscopy had better range of movement in their shoulders. These shoulders had 10 degrees more flexibility in some movements than those that had open surgery.

This was the only difference between the two groups. Strength and function was the same. Also, both kinds of surgery resulted in stable shoulders for 85 to 90 percent of patients.

Talk with your doctor about his or her experiences with different kinds of surgery. Following a prescribed physical therapy program can help reduce stiffness no matter which surgery you choose.

Though there have been conflicting reports in the literature, it looks like the two kinds of surgery may have about the same success rate. A recent study compared the results of the two procedures in over a hundred patients. The patients were mostly men around age 27. They’d dislocated their shoulders an average of six to 10 times. Roughly three years after injury, they chose to have either arthroscopic or open surgery.

Two to five years after surgery, 15 percent of the patients in the arthroscopic group had had another dislocation. The same was true of 10 percent of patients who had open surgery. The difference between groups was felt to be slight.

Patients in the arthroscopic group seemed to have better movement in their shoulders than those in the open group. Other than that, there were no differences between the two groups in shoulder strength or function.

There were also no differences between groups in complications from surgery or need for more surgery. Both procedures seemed to have good results for most patients. The authors suggest that looseness in the shoulder joint may determine how effective surgery is in either case. They think that decisions about surgery should be based on patients’ preferences and doctors’ experiences with both types of surgery. Talk more with your doctor to decide which kind of surgery is best for you.

Not likely. There is general agreement that symptoms of frozen shoulder usually don’t go away by themselves. In addition to physical therapy, other treatment options may be suggested by your doctor. One option is to inject the shoulder joint with a steroid and/or painkiller. The shot can help ease pain and allow greater movement with the shoulder stretches used by your therapist.

If this doesn’t improve pain and movement, your doctor may recommend shoulder manipulation. Patients are given anesthesia for this treatment. While they sleep, the doctor forcefully stretches the tight shoulder. Manipulation helps break up scar tissue adhesions in the joint. Patients often show immediate improvements in shoulder motion. Many patients achieve full resolution of symptoms within four months of the procedure.

Age plays a big part in whether athletes have repeat shoulder injuries. Because you’re young, you’re at a high risk for re-injury. Research says that up to 94 percent of athletes under age 25 who dislocate their shoulders do it more than once.

What can you do about this? Surgery is one possibility. Doctors are now using an arthroscopic procedure to treat dislocated shoulders. This procedure is less invasive than regular open surgery and seems to prevent future injuries. In a recent study of West Point cadets, 88 percent of patients who had this surgery within 10 days of injury still had stable shoulders two to five years later. And they were able to return to all their sports activities.

Talk to your doctor about how to best protect your shoulders. He or she can tell you whether surgery is an option in your case.