In a recent study of people under 30 years old with a shoulder dislocation, arthroscopy surgery was compared to the more traditional approach of slinging the shoulder. Nearly everyone who chose surgery had an excellent return to strength and movement without having a future dislocation. Most of the sling-only patients had another dislocation within the year. Share your concerns with your orthopedist.
Unfortunately, no. The chance of another shoulder dislocation in people under 30 years old who participate in sports is high. That chance goes down with age. The amount of time in a sling does not seem to lower the chances. Arthroscopy surgery is another treatment approach to consider that may keep you from dislocating the shoulder again. Talk to your orthopedist about the treatment plan that is best for you.
The surgery you are talking about is arthroscopy surgery, and it’s not all that new. However, it is being looked at more closely as an improvement over the traditional approach of simply placing the shoulder in a sling. Physical therapy is an integral part of the recovery process, regardless of the treatment approach. Since it’s your body, you need to have a say in how it is cared for. That said, many surgeons prefer not to operate if the plan for rehabilitation afterward can’t be agreed upon. Discuss your concerns with your surgeon.
The most common reason total shoulder arthroplasties fail is loosening of the glenoid, or socket, component. Sometimes the new socket doesn’t line up right, or it may loosen, move, or even dislocate. Loosening occurs in about 10 percent of cases.
A bone graft of the glenoid, or shoulder socket, may improve the outcome of total shoulder arthroplasty. A bone graft is used for cases in which the socket is worn away significantly or unevenly. In one recent study, nine of 17 cases of glenoid bone grafting showed good results in long-term follow-up. The procedure is complicated, however.
This problem you describe sometimes happens in athletes who do repeated overhand motions as part of their sport. The action of throwing forces the arm out and back in order to “cock” the arm to throw. This can potentially squeeze the ball of the upper arm bone (humerus) against the underside of the rotator cuff tendons, a condition called “internal impingement.”
As this condition develops, the feeling of stiffness initially goes away once you’ve warmed up, and pain felt during the wind up is generally vague. In time, the problem may worsen, causing the shoulder to feel stiff even after a longer warm up. Feelings of vague pain usually become more noticeable around the back part of the shoulder.
Treatment in the early stages involves resting the shoulder for one month followed with a strengthening program for the muscles of the rotator cuff and shoulder blade. Surgery is usually reserved for athletes who’ve had the problem for at least four months and who haven’t gotten better after trying nonsurgical treatments.
Snapping scapula syndrome is a fairly rare condition where the shoulder blade thumps, grates, or snaps as it moves along the chest wall. It can happen when the bursa between the shoulder blade and chest wall becomes inflamed. (A bursa is a lubricated sac that cuts down on friction between muscles, tendons, and bones during movement.) People who have had a fractured rib or shoulder blade sometimes feel grating because the bones may have healed out of alignment. Weak muscles under the shoulder blade can increase the chances of having snapping scapula syndrome because there is less muscle padding between the shoulder blade and chest wall.
Chances are good that the two problems are related. The thumping noise is a pretty good indication that the problem relates to the bones rather than the soft tissues. A condition called snapping scapula syndrome can start from problems in the bones of the scapula or rib cage, or from the soft tissues between. Sometimes snapping scapula can after a scapula fracture. This may occur because the bones on each side of the fracture don’t line up smoothly, or it could be from irritation, swelling, or wasting (atrophy) of the muscles under the scapula.
It depends why you are having symptoms. If your symptoms are caused by an inflamed bursa under the shoulder blade, a physical therapist can give you heat or ultrasound treatments to calm pain and inflammation. If you have problems with posture, a therapist can give you exercises to help you learn better body alignment and to strengthen the muscles that support healthy posture. Therapy can also involve exercises to target specific muscles that control the alignment and movement of the shoulder blade.
The exercise you’ve described is a standard push-up with a plus. The “plus” is the part where you hunch your shoulders forward. This part of the exercise is designed to strengthen the serratus anterior muscle, which attaches to the edge of the scapula nearest the spine. This muscle passes in front of the scapula, wraps around the chest wall, and connects to the ribs on the front part of the chest. Working this important muscle helps align the shoulder blade and can add some extra cushion between the shoulder blade and the rib cage.
After the corner of the scapula is surgically removed, the muscles have to be reattached to the scapula. The extra time is needed to make sure the muscles heal solidly to the bone. Active exercise too soon after this type of surgery make the new muscle attachments more likely to pull loose. Be sure to follow your doctor’s advice about exercise or activity after surgery.
Doctors generally want to try all other options before resorting to surgery. And snapping scapula responds well to non-operative treatments, especially if the problem is coming from the soft tissues around the shoulder blade. However, if the problem is caused by bony abnormalities, or if non-operative treatments clearly aren’t helping, surgery may be necessary.
Chances are good that the two problems are related. It is possible that the jerk on your arm injured the long thoracic nerve. This nerve activates the serratus anterior muscle, which helps hold the shoulder blade snuggly against the chest wall. When this muscle isn’t working right, the shoulder blade can tilt like you’ve mentioned. Also, the muscle may have started to atrophy (shrink) from the nerve injury.
Both of these problems can cause the shoulder blade to pop and grate with movement of the shoulder blade. You may need to work with a physical or occupational therapist to help get the shoulder blade into better alignment. Bulking up the muscles under the shoulder blade may add just enough padding and space between the shoulder blade and chest wall to make the popping and snapping go away.
The extra training may have caused the bursa under the tip of the scapula to become inflamed. This condition is called scapulothoracic bursitis. A bursa is a lubricated sac that helps decrease friction between tendons and muscles when they move. The repeated arm motions of baseball pitching can irritate the bursa underneath the scapula. It becomes inflamed and painful. It also begins to pop during the windup, as the arm is cocked back and gains speed for the throw. The first method of treatment is to rest your sore shoulder. Talk to the team doctor or a family physician for other suggestions.
It depends on where and when you feel the popping. If it is in the back part of the shoulder blade, the popping might be coming from a problem called snapping scapula. Snapping scapula causes feelings of grating, grinding, or snapping under the back part of the shoulder blade when you move your shoulder.
Popping felt during shoulder movement can also happen when a tendon rolls over a bony bump. The acromioclavicular joint is formed where the shoulder blade meets the collarbone. This joint tends to wear out earlier than other joints and can also start to pop and click with shoulder movement.
Most cases of popping or snapping in the shoulder are not serious. They often can be helped by a well-rounded exercise program designed by a physical or occupational therapist.