FAQ Category: Shoulder

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.

Researchers think that more aggressive kinds of treatment may help. A group of researchers at West Point reported on a less invasive surgical treatment for dislocated shoulders. The procedure uses an arthroscope. This camera-like device lets surgeons see the joint without making big incisions. Surgeons then insert special tacks, to keep the shoulder in place.

A young, active group of patients had this surgery within 10 days of injury. Two to five years later, 88 percent of them still had stable shoulders. They’d returned to sports and other activities. They said their shoulders were basically normal.

Even after the arthroscopic procedure, 12 percent of the patients dislocated their shoulders. What determined whether or not the surgery worked? Patients’ history and condition had a lot to do with it. Patients who’d had problems in both shoulders were more likely to have another injury. So were those with more shoulder looseness and those who had poor tissue quality at the time of surgery. Playing collision sports may also put patients at risk for another injury.

Talk with your doctor to see whether surgery is an option for you.

Traditionally, doctors have treated dislocated shoulders with slings and physical rehabilitation. Unfortunately, this approach isn’t very effective in preventing repeat dislocations. This is especially true if you’re young. Studies show that athletes under age 25 re-injure their shoulders up to 94 percent of the time.

Surgery to stabilize the shoulder is a more aggressive approach. A new procedure uses an arthroscope— a camera-like device that lets doctors see inside the joint. With this instrument, doctors don’t have to make big incisions in the skin. This makes surgery less invasive. Doctors implant special tacks to hold the shoulder in place.

How effective is this procedure? It was recently tested on cadets at West Point. In this group of young, highly active patients, surgery resulted in stable shoulders 88 percent of the time. These patients had no complications from surgery. They were able to return to all their activities. Twelve percent of the patients had another injury within a year and a half of surgery. Still, this re-injury rate was felt to be small compared to that of patients who didn’t have surgery.

Talk to your doctor about your options for surgery, given your age and history.

In all likelihood, yes. This procedure was recently studied in 33 patients who had shoulder stiffness from surgery. The patients had tried physical therapy and manipulation under anesthesia without positive results.

Two years after arthroscopic release, patients had more movement in the treated shoulder. They had less pain and better shoulder function. They were also more satisfied with their treatment.

Only four patients weren’t helped by the procedure. They went on to have open surgery. Researchers note that, in general, gains made by patients with previous shoulder surgery may be smaller than those of other patients. This could be due to the original injury or surgery. Still, patients whose shoulder stiffness comes from surgery seem to benefit from arthroscopic treatment.

A recent study showed excellent results from arthroscopic release of frozen shoulders. There were no complications from treatment. Two years later, patients had much more movement in their shoulders. They had less pain and better shoulder function. And they were more satisfied with their treatment.

Patients saw improvements no matter what caused the stiffness–surgery, fracture, or no known cause. However, patients whose stiffness came from a previous surgery improved less. They had more pain and less function and satisfaction at follow-up than those whose stiffness was due to fractures or no known cause. Patients with prior surgery also had a little less movement in the treated shoulder. Researchers think the more modest improvements of this group were due to the original injury and/or surgery.

It used to be that people in your situation had to either live with the symptoms or have open surgery. Now there’s a new option. Doctors can release the stiff shoulder using an arthroscope, an instrument that works like a TV camera under the skin. This is less invasive than open surgery. And a recent study showed that it improves movement in the shoulder. Two years after surgery, patients had less pain and better shoulder function. They were also more satisfied with their treatment. This was true whether the stiffness came from surgery, fracture, or some other cause.

Doctors think that arthroscopic release is a safe way to restore movement in the shoulder when other treatments have failed. Ask your doctor whether arthroscopic treatment may be a good next step for you.

This question applies to young boys and girls who pitch. There are no Little League rules about pitching limits. Coaches use various guidelines. You can help by keeping track of your daughter’s pitches. The following guidelines are used by many coaches and apply to the child who has not reached full skeletal growth:

• Count pitches in practice as part of daily or weekly pitching time. Pitches in practice count for half as much as pitches in games. For example, throwing 30 to 40 pitches in practice counts the same as one inning of 15 to 20 pitches.


• Do not pitch more than the total of one game per week, including practice time. For example, do not exceed 100 total practice and game pitches in any one week.


• Do not pitch more than 75 pitches in a game. There are usually 15 to 20 pitches per inning.


• Young pitchers should not throw more than 600 pitches during the season. It is best if the training and practices help them build up to at least 300 pitches per season.


• Young pitchers should avoid using the curveball and slider pitches until the arm is more fully developed. These pitches have greater risk for injury. The change-up pitch is generally safe for younger pitchers.


• If the arm starts to show fatigue, stop pitching and/or remove the pitcher from the game.

You’ll need to see a doctor to find out for sure. The doctor will want to do a thorough physical exam of the shoulder to check for muscle weakness or tenderness. He or she may also order tests such as magnetic resonance imaging (MRI) to identify the cause of your symptoms.

Your symptoms may be coming from a tear in the rotator cuff or inflammation of the tendons that make up the rotator cuff (tendinitis). When your doctor finds the source of the problem, you can move forward with treatment.

Someone with a rotator cuff tear usually has pain and difficulty moving the arm. Daily activities are difficult and sleep at night is often interrupted by pain. After surgery, the doctor may have your mother use a sling for up to six weeks to help support the arm when she is not using it. A physical therapist will show her how to take her arm out of the sling and carefully move it frequently during the day. The physical therapist will also give her exercises to do every day to gradually help increase her movement and decrease her pain.

At the end of six weeks (often much sooner), people who have this operation are no longer using the sling and can reach overhead. By this time, your mother should also be able to sleep on that side for several hours at a time. Exercises with light weights are added between four and six weeks after the operation. Most people regain full motion of the arm and shoulder by the end of four months.

There are four muscles that make up the rotator cuff. The tendons from each muscle encircle the top of the shoulder, much like the cuff of a sleeve goes around the entire wrist. The rotator cuff holds the humerus in the socket of the shoulder joint while still allowing it to turn, or rotate (hence the word “rotator”).

Usually only one or two tendons of the rotator cuff are torn. The tear commonly occurs close to where the tendon attaches to the bone. It is rare for all four tendons to be injured at the same time.

Surgery to repair the rotator cuff is fairly quick and simple these days. The doctor may use an arthroscope to enter the joint through a small hole instead of using a large incision. The torn tendon is sewn together. If the tendon was pulled from the bone, the surgeon will reattach it.

After any operation, there is a risk of infection either in the joint or on the skin. This does not happen very often and can be treated with antibiotics. Rarely, there may be numbness in the hand on the operated side. This may last up to 48 hours and is usually caused by the traction or pull used on the arm during the operation.

It is best to talk with your doctor before any operation about your concerns.

A nonsurgical treatment was recently reported. The patient was a 33-year-old male with a cyst like the one you describe and mild rotator cuff tendinitis. Instead of opening the shoulder or doing arthroscopy, the doctors aspirated or “deflated” the cyst using suction. While the shoulder was numb from anesthesia, the doctors used ultrasound to find the cyst. They then inserted a large needle that sucked the contents out.

Within six months of the procedure, the patient regained full shoulder strength. He had pain relief in overhead shoulder activities, such as playing tennis. Up to a year after the procedure, the cyst had not come back.

This procedure seems to be an effective, minimally invasive treatment for patients who don’t want to have surgery for cysts compressing the nerve over the shoulder blade. Ask your doctor whether this treatment is an option in your case.

It’s possible that the size of the tear will make a difference in the surgery’s success. A recent study followed patients who had this kind of surgery at age 55. Ten years after surgery, researchers checked on patients’ pain, level of function, and shoulder strength.

All of the patients who had small or medium-sized tears had excellent results from surgery ten years later. Patients who had large tears also had good or excellent results. These numbers changed somewhat for the 11 patients with massive tears. There were seven excellent results, one good result, and three unsatisfactory results.

From this study, it looks like the chance of having an unsatisfactory result goes up slightly as the tear gets bigger. However, there’s still a good chance of having a positive result. Ask your doctor what kind of results you can expect, given your age and condition.

In all likelihood, yes. A recent study looked at 33 patients about your age who had this kind of surgery. Two and ten years after surgery, patients completed questionnaires about their pain and ability to do daily activities. This information, along with patients’ shoulder strength, went into a “grade” for each patient.

Two years after surgery, 88 percent of the patients got “good” or “excellent” grades for surgery results. At ten years, 91 percent were graded as “good” or “excellent.” From this study, it looks like the results of this surgery don’t deteriorate over time. They may even get better.

The authors pointed out that patients’ activity levels went down between the two follow-ups. Also, many patients retired. Surgery results may seem better as patients get older because shoulders get less of a workout. Whatever the reason, you can probably look forward to ongoing good results in the coming years.

According to a recent study, there’s an excellent chance that surgery can help your mother to do daily tasks. This study looked at patients who had surgery to repair their rotator cuffs around age 55. The patients had tried other kinds of treatment before surgery, and their pain had lasted more than three months.

Two years after surgery, 88 percent of the patients had good or excellent results. These patients had less pain, more shoulder strength, and were better able to do everyday activities.

Ten years after surgery, the results were even better. Ninety-one percent of patients had good or excellent results. And they had less disability than they’d had at two years. This may be because many of the patients were retired and less active overall. In other words, their lifestyles had changed in ways that put fewer demands on their shoulders. Your mother may want to talk to her doctor about what surgery could do for her, based on her condition and lifestyle.

The arthrogram is an older test. It is based on the idea that a special dye will leak out if the rotator cuff is torn. If a scar forms over the tear or if the dye can’t leak out for some other reason, the test will appear negative. This is known as a “false negative” result, meaning the test appears normal even though the tendon is actually torn. 

A “false positive” is when a test shows there’s a problem where there isn’t one. For example, because the MRI scan is so sensitive, it can sometimes show what looks like a tear. Yet when surgery is performed to fix the tear, the surgeon may find that the tendon is not torn.

The most accurate test of all is surgical exploration. However, because surgery is costly and has certain risks, doctors prefer to use tests like MRI first to try to confirm the presence of a tear.

Doctors generally prefer to try conservative treatments before using more aggressive forms of treatment. When symptoms don’t improve with physical therapy, doctors may recommend an injection into the shoulder joint. The injection is typically a steroid medicine, a painkiller, or both. Filling the joint with medicine helps with inflammation and pain. It also stretches the tight joint capsule. Resuming physical therapy soon after the injection enhances the benefits of the shoulder stretches you do in therapy.

If symptoms continue and shoulder motion still does not improve, your doctor may recommend a treatment called manipulation under anesthesia. This procedure is done by forcefully stretching the tight shoulder of a patient who is asleep from anesthesia.

Adhesive capsulitis, also called “frozen shoulder,” is a condition in which the shoulder becomes tight and painful, making it difficult to do daily activities.

With frozen shoulder, inflammation in the joint causes the lining surrounding the joint to stick together. This causes the shoulder to “freeze” and seriously limits movement.

It’s hard to say how you got a frozen shoulder. Most cases can’t be traced to one event. One theory is that this condition is caused by an auto-immune reaction. An auto-immune reaction happens when the body’s defense system, which normally protects it from infection, mistakenly begins to attack the tissues of the body.

A frozen shoulder may arise gradually, with no injury or warning. It sometimes happens to people who’ve had past shoulder problems, such as rotator cuff tendonitis or bursitis. Others are affected after surgeries unrelated to the shoulder–even after heart attacks. The condition likely results when pain or inflammation in the shoulder causes a person to start using the shoulder less, setting the stage for a frozen shoulder.

Most likely. Most surgeons will suggest surgery when this problem keeps happening over and over. You can damage the joint if it is left untreated and it continues to dislocate. If dislocation only happens once or twice, it is possible that a series of physical therapy sessions could help ease pain and restore movement. However, a significant dislocation stretches out the ligaments that hold the joint steady. Once these have been injured, it is questionable whether the joint will stay in place without surgery.

A group of researchers studied injuries in Major League Baseball over five years. They looked specifically at what kinds of injuries kept players from the sport. Twenty-eight percent of these were shoulder injuries. Twenty-two percent were elbow injuries.

Injuries to the knee, wrist, hand, and back were also reported. However, these injuries weren’t as common. And they were less likely to keep players from the game.

Elbow injuries seemed to be on the rise. But injuries to other areas stayed about the same over the five-year period.