Shoulder Archives - New Mexico Orthopaedic Associates, P.C

Do I Need Surgery for a Rotator Cuff Problem?

July 13, 2021/in Rotator Cuff, Shoulder /by nmortho

Article featured on WebMD, Reviewed by Tyler Wheeler, MD on May 16, 2021

Some rotator cuff problems are easily treated at home. But if yours is severe, or lingers for more than a few months, you may need surgery.

What Causes Rotator Cuff Problems

Your rotator cuff is a group of tendons and muscles in your shoulder. It helps you lift and rotate your arm. It also helps keep your shoulder joint in place. But sometimes, the rotator cuff tendons tear or get pinched by the bones around them. An injury, like falling on your arm, can cause this to happen. But wear and tear over time can take its toll on your shoulder, too. The pain can be severe.

Treatment

Home care can treat many rotator cuff problems. Your doctor will tell you to rest your shoulder joint and ice the area. Over-the-counter pain relievers can help ease your pain and swelling while your rotator cuff heals. Physical therapy will help restore your shoulder strength.

What About Surgery?

If you’re not getting any relief with these steps, surgery may be the next option for you.

You may need surgery if:

Your shoulder hasn’t improved after 6 to 12 months
You’ve lost a lot of strength in your shoulder and find it painful to move
You have a tear in your rotator cuff tendon
You’re active and rely on your shoulder strength for your job or to play sports

What Type of Surgery Do I Need?

Surgery can relieve your pain and restore function to your shoulder. Some are done on an outpatient basis. For others, you may need to stay in a hospital.

The most common types are:

Arthroscopic repair. After making one or two very small cuts in your skin, a surgeon will insert a tiny camera called an arthroscope and special, thin tools into your shoulder. These will let them see which parts of your rotator cuff are damaged and how best to fix them.

Open tendon repair. This surgery has been around a long time. It was the first technique used to repair the rotator cuff. If you have a tear that’s very large or complex, your surgeon may choose this method.

A large incision is made in your shoulder, then your shoulder muscle is detached so the surgeon has direct access to your tendon. This is helpful if your tendon or shoulder joint needs to be replaced. Both of these surgeries can be done under general anesthesia, which allows you to sleep through the whole thing. They can also be done with a “regional block,” which allows you to stay awake while your arm and shoulder stay numb.You can talk to your doctor ahead of time about the type of anesthesia you prefer.

Recovery

Recovery from arthroscopic surgery is typically quicker than open tendon repair. Since open tendon repair is more involved, you may also have more pain right afterwards.

No matter which surgery you have, a full recovery will take time. You should expect to be in a sling for about 6 weeks. This protects your shoulder and gives your rotator cuff time to heal. Driving a car will be off limits for at least a month.

Most people don’t get instant pain relief from surgery. It may take a few months before your shoulder starts feeling better. Until then, your doctor will advise you to take over-the-counter pain relievers.

Physical therapy will be a key part of your recovery. Your doctor will give you exercises to do every day or you can work with a physical therapist. The movements you learn will help you regain your shoulder strength and range of motion.While the recovery from rotator cuff surgery can be a challenge, most people are back to their normal routine within 6 months.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Is Swimming Bad for Your Shoulders?

June 10, 2021/in Shoulder /by nmortho

Article from CORA

Even though exercising in water takes strain off joints, bad form or overuse can cause damage.

Water is extremely therapeutic for the body, and swimming provides many health benefits, such as weight control, improved muscle tone and strength, enhanced endurance, and cardiovascular fitness. Swimming can also be a great exercise for your shoulders, but take note: excessive swimming, poor body mechanics, and improper technique can aggravate any underlying shoulder issues. Learn the role of the shoulder in swimming and how to enjoy this sport while preventing injury.

The shoulder is a complex and extremely mobile joint, designed to obtain the greatest range of motion with the most freedom of any joint system in the body. Swimming requires the shoulder to perform several complex maneuvers: overhead, reaching, and repetitive movements in both clockwise and counterclockwise directions. Competitive swimmers can perform more than 4,000 strokes per shoulder in a single workout, making them susceptible to shoulder pain, so much so that the term “swimmer’s shoulder” was coined. Even amateur and recreational swimmers can experience shoulder problems due to improper form. Consequently, shoulder pain is a very common musculoskeletal complaint among swimmers.

Risks and Benefits of Swimming

Generally, swimming is very good for the shoulder because it allows muscles to be exercised without excessively loading the joint. It also provides effective aerobic training that won’t stress the hips, knees, and ankles. Many patients suffering from low back pain are advised to swim as a form of rehabilitation and exercise because of its low impact buoyancy.

While it is important to maintain correct biomechanics of the shoulder joint before, during, and after swimming, according to research published in the North American Journal of Sports Physical Therapy, many swimmers will inherently adjust their stroke to avoid painful movement patterns. So if you are tired or have strength or flexibility issues that lead to improper form, swimming can be harmful.

Repetitive shoulder can lead to overuse and trauma to the joints and ligaments that support the shoulder. If you are currently experiencing shoulder pain, you should get schedule an appointment with a physical therapist before performing any new physical activity, including swimming, to prevent permanent damage.

Swimming Best Practices

When beginning a swimming program, follow these best practices to avoid shoulder injury:

Start slowly and gradually increase the frequency and intensity of your workouts to allow time for your muscles to adapt to your new exercise regimen.
Always warm up and cool down by stretching your chest and shoulders for approximately five minutes before and after swimming.
Practice shoulder stabilization exercises to help avoid injury.
Alter your swimming strokes: perform the backstroke one day, the breaststroke the next, etc. Varying your strokes will lessen repetitive movements and help avoid cumulative trauma.
Incorporate drills into your routine that focus on kicking, stork technique, and alternating breathing.

If you are experiencing shoulder pain due to swimming, a physical therapist can help you restore normal strength and avoid aggravation of the injury. A physical therapist can not only determine the cause of the problem, but also help you choose the best treatment option. Therapist-administered treatments including manual therapy, stabilization, ultrasound, phonophoresis, iontophoresis, and electrical stimulation can help reduce or eliminate shoulder pain and inflammation and increase flexibility.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Frozen shoulder: What you need to know

May 28, 2021/in Shoulder /by nmortho

Article on MedicalNewsToday, medically reviewed by William Morrison, M.D. — Written by Caroline Gillott on December 5, 2017

Frozen shoulder is a common condition in which the shoulder stiffens, reducing its mobility. It is also known as adhesive capsulitis.

The term “frozen shoulder” is often used incorrectly for arthritis, but these two conditions are unrelated. Frozen shoulder refers specifically to the shoulder joint, while arthritis may refer to other or multiple joints. It commonly affects people aged between 40 and 60 years, and it is more likely in women than in men. It is estimated to affect about 3 percent of people. It can affect one or both shoulders.

Exercises

Frequent, gentle exercise can prevent and possibly reverse stiffness in the shoulder.

The American Association of Orthopaedic Surgeons (AAOS) suggest some simple exercises:

Crossover arm stretch: Holding the upper arm of the affected side, gently pull the arm across in front of you, under the chin. Hold for 30 seconds. Relax and repeat.

Exercises should be guided by a doctor, an osteopath, or a physical therapist. Anyone experiencing stiffness in the shoulder joint should seek medical attention sooner rather than later to prevent permanent stiffness.

Harvard Medical School suggest the following exercises for relieving a frozen shoulder:

Pendulum stretch

Stand with the shoulders relaxed. Lean forward with the hand of the unaffected arm resting on a table. Let the affected arm hang down vertically and swing in a small circle, around 1 foot in diameter. Increase the diameter over several days, as you gain strength.

Towel stretch

Grab both ends of a towel behind your back. With the good arm, pull the towel, and the affected arm, up toward the shoulder. Repeat 10 to 20 times a day.

Symptoms

A person with a frozen shoulder will have a persistently painful and stiff shoulder joint. Signs and symptoms develop gradually, and usually resolve on their own.

Causes

The shoulder is made up of three bones: The shoulder blade, the collarbone, and the upper arm bone, or humerus. The shoulder has a ball-and-socket joint. The round head of the upper arm bone fits into this socket. Connective tissue, known as the shoulder capsule, surrounds this joint. Synovial fluid enables the joint to move without friction.

Frozen shoulder is thought to happen when scar tissue forms in the shoulder. This causes the shoulder joint’s capsule to thicken and tighten, leaving less room for movement. Movement may become stiff and painful. The exact cause is not fully understood, and it cannot always be identified. However, most people with frozen shoulder have experienced immobility as a result of a recent injury or fracture. The condition is common in people with diabetes.

Risk factors

Common risk factors for frozen shoulder are:

Age: Being over 40 years of age.
Gender: 70 percent of people with frozen shoulder are women.
Recent trauma: Surgery or and arm fracture can lead to immobility during recovery, and this may cause the shoulder capsule to stiffen.
Diabetes: 10 to 20 percent of people with diabetes develop frozen shoulder, and symptoms may be more severe. The reasons are unclear.

Other conditions that can increase the risk are:

stroke
hyperthyroidism, or overactive thyroid
hypothyroidism, or underactive thyroid
cardiovascular disease
Parkinson’s disease

Stages

Symptoms are usually classified in three stages, as they worsen gradually and then resolve within a 2- to 3-year period.

The AAOS describe three stages:

Freezing, or painful stage: Pain increases gradually, making shoulder motion harder and harder. Pain tends to be worse at night. This stage can last from 6 weeks to 9 months.
Frozen: Pain does not worsen, and it may decrease at this stage. The shoulder remains stiff. It can last from 4 to 6 months, and movement may be restricted.
Thawing: Movement gets easier and may eventually return to normal. Pain may fade but occasionally recur. This takes between 6 months and 2 years.

Over 90 percent of people find that with simple exercises and pain control, symptoms improve. A frozen shoulder normally recovers, but it can take 3 years.

Diagnosis

Doctors will most likely diagnose frozen shoulder based on signs, symptoms, and a physical exam, paying close attention to the arms and shoulders. The severity of frozen shoulder is determined by a basic test in which a doctor presses and moves certain parts of the arm and shoulder. Structural problems can only be identified with the help of imaging tests, such as an X-ray or Magnetic Resonance Imaging (MRI).

Treatment

The aim is to alleviate pain and preserve mobility and flexibility in the shoulder. In time and with treatment, 9 out of 10 patients experience relief. However, recovery may be slow, and symptoms can persist for several years. There are several ways to relieve pain and alleviate the condition.

Painkillers: Nonsteroidal anti-inflammatory drugs (NSAIDs) are available to purchase over-the counter, and may reduce inflammation and alleviate mild pain. Not all painkillers are suitable for every patient, so it is important to review options with the doctor.

Hot or cold compression packs: These can help reduce pain and swelling. Alternating between the two may help.

Corticosteroid injections: However, repeated corticosteroid injections are discouraged as they can have adverse effects, including further damage to the shoulder.

Transcutaneous electrical nerve stimulation (TENS): This works by numbing the nerve endings in the spinal cord that control pain. The TENS machine sends small to electrodes, or small electric pads, that are applied to the skin on the affected shoulder. Various TENS machines from different brands are available to purchase online.

Physical therapy: This can provide training in exercises to maintain as much mobility and flexibility as possible without straining the shoulder or causing too much pain.

Shoulder manipulation: The shoulder joint is gently moved while the patient is under a general anesthetic.

Shoulder arthroscopy: A minimally invasive type of surgery used in a small percentage of cases. A small endoscope, or tube, is inserted through a small incision into the shoulder joint to remove any scar tissue or adhesions. The doctor will suggest a suitable option depending on the severity of signs and symptoms.

Prevention

Frozen shoulder can only be prevented if it is caused by an injury that makes shoulder movement difficult. Anyone who experiences such an injury should talk to a doctor about exercises for maintaining mobility and flexibility of the shoulder joint.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Shoulder Replacement Surgery: What to Know

May 12, 2021/in Joint Replacement, Shoulder /by nmortho

Medically Reviewed by Tyler Wheeler, MD on December 08, 2019 from WebMD

If your shoulder joint gets seriously damaged, you might need surgery to replace it. Before you have your procedure, you should know some things.

About Your Shoulder

The joint where your upper arm connects to your body is a ball-and-socket joint. The bone in your upper arm, called the humerus, has a round end that fits into the curved structure on the outside of your shoulder blade.

Ligaments and tendons hold it together. Ligaments connect the bones, while tendons connect muscles to the bone. A layer of tissue called cartilage keeps the bones apart, so they don’t rub against each other.

The ball and socket lets you move your arm up and down, back and forward, or in a circle.

Why You’d Need It Replaced

You may have to have it done if you have a condition that makes it painful and hard to use your arm, such as:

A serious shoulder injury like a broken bone
Severe arthritis
A torn rotator cuff

Your doctor will probably try to treat you with drugs or physical therapy first. If those don’t work, they may recommend surgery.

Shoulder replacement surgery is less common than hip or knee replacements. But more than 50,000 shoulder replacements are done in the U.S. each year.

What to Expect

An orthopedic surgeon will replace the natural bone in the ball and socket of your shoulder joint with a material that could be metal or plastic. It’s a major surgery that’ll keep you in the hospital for several days. You’ll also need several weeks of physical therapy afterward.

There are three types of shoulder replacement surgeries:

Total shoulder replacement: This is the most common type. It replaces the ball at the top of your humerus with a metal ball, which gets attached to the remaining bone. The socket gets covered with a new plastic surface.

Partial shoulder replacement: Only the ball gets replaced.

Reverse shoulder replacement: Usually, you’d get this if you have a torn rotator cuff. It’s also done when another shoulder replacement surgery didn’t work. The metal ball gets attached to your shoulder bones, and a socket is implanted at the top of your arm.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What to Know About Front Shoulder Pain

November 11, 2020/in Osteoarthritis, Rotator Cuff, Shoulder /by nmortho

From Medical News Today; Medically reviewed by William Morrison, M.D. — Written by Sunali Wadehraon January 22, 2019

Damage to the shoulder may result from repetitive movements, manual labor, sports, or aging. A person may also injure this part of the body due to a bad fall or accident. Many people visit the doctor with front, or anterior, shoulder pain.

Shoulder Injuries in the Throwing Athlete

January 15, 2020/in Shoulder, Sports Injuries, Sports Medicine /by nmortho

Article Featured on AAOS

Overhand throwing places extremely high stresses on the shoulder, specifically to the anatomy that keeps the shoulder stable. In throwing athletes, these high stresses are repeated many times and can lead to a wide range of overuse injuries.

Although throwing injuries in the shoulder most commonly occur in baseball pitchers, they can be seen in any athlete who participates in sports that require repetitive overhand motions, such as volleyball, tennis, and some track and field events.

Anatomy of the Shoulder

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. Surrounding the outside edge of the glenoid is a rim of strong, fibrous tissue called the labrum. The labrum helps to deepen the socket and stabilize the shoulder joint. It also serves as an attachment point for many of the ligaments of the shoulder, as well as one of the tendons from the biceps muscle in the arm.

Strong connective tissue, called the shoulder capsule, is the ligament system of the shoulder and keeps the head of the upper arm bone centered in the glenoid socket. This tissue covers the shoulder joint and attaches the upper end of the arm bone to the shoulder blade.

The bones of the shoulder

The bones of the shoulder. Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

The ligaments of the shoulder

The ligaments of the shoulder. Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Your shoulder also relies on strong tendons and muscles to keep your shoulder stable. Some of these muscles are called the rotator cuff. The rotator cuff is made up of four muscles that come together as tendons to form a covering or cuff of tissue around the head of the humerus.

The biceps muscle in the upper arm has two tendons that attach it to the shoulder blade. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process. These attachments help to center the humeral head in the glenoid socket.

rotator cuff anatomy

This illustration shows the biceps tendons and the four muscles and their tendons that form the rotator cuff and stabilize the shoulder joint. Reproduced and adapted with permission from The Body Almanac. (c) American Academy of Orthopaedic Surgeons, 2003.

In addition to the ligaments and rotator cuff, muscles in the upper back play an important role in keeping the shoulder stable. These muscles include the trapezius, levator scapulae, rhomboids, and serratus anterior, and they are referred to as the scapular stabilizers. They control the scapula and clavicle bones — called the shoulder girdle — which functions as the foundation for the shoulder joint.

Muscles in the upper back

Muscles in the upper back help to keep the shoulder stable, particularly during overhead motions, like throwing. (Note: this illustration has been drawn in such a way to show the many layers of muscle in the back.) Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Cause

When athletes throw repeatedly at high speed, significant stresses are placed on the anatomical structures that keep the humeral head centered in the glenoid socket.

baseball pitching phases

The phases of pitching a baseball. Reproduced and adapted with permission from Poss R (ed): Orthopaedic Knowledge Update 3. Rosemont, IL. American Academy of Orthopaedic Surgeons, 1990, pp 293-302.

Of the five phases that make up the pitching motion, the late cocking and follow-through phases place the greatest forces on the shoulder.

Late-cocking phase. In order to generate maximum pitch speed, the thrower must bring the arm and hand up and behind the body during the late cocking phase. This arm position of extreme external rotation helps the thrower put speed on the ball, however, it also forces the head of the humerus forward which places significant stress on the ligaments in the front of the shoulder. Over time, the ligaments loosen, resulting in greater external rotation and greater pitching speed, but less shoulder stability.
Follow-through phase. During acceleration, the arm rapidly rotates internally. Once the ball is released, follow-through begins and the ligaments and rotator cuff tendons at the back of the shoulder must handle significant stresses to decelerate the arm and control the humeral head.

When one structure — such as the ligament system — becomes weakened due to repetitive stresses, other structures must handle the overload. As a result, a wide range of shoulder injuries can occur in the throwing athlete.

The rotator cuff and labrum are the shoulder structures most vulnerable to throwing injuries.

Common Throwing Injuries In the Shoulder

SLAP Tears (Superior Labrum Anterior to Posterior)

In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the long head of the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and in back (posterior) of this attachment point.

Typical symptoms are a catching or locking sensation, and pain with certain shoulder movements. Pain deep within the shoulder or with certain arm positions is also common.

shoulder labrum and SLAP tear

(Left) The labrum helps to deepen the shoulder socket.

(Right) This cross-section view of the shoulder socket shows a typical SLAP tear.

Bicep Tendinitis and Tendon Tears

Repetitive throwing can inflame and irritate the upper biceps tendon. This is called biceps tendinitis. Pain in the front of the shoulder and weakness are common symptoms of biceps tendinitis.

Occasionally, the damage to the tendon caused by tendinitis can result in a tear. A torn biceps tendon may cause a sudden, sharp pain in the upper arm. Some people will hear a popping or snapping noise when the tendon tears.

biceps tendinitis

(Left) The biceps tendon helps to keep the head of the humerus centered in the glenoid socket. (Right) Tendinitis causes the tendon to become red and swollen.

Rotator Cuff Tendinitis and Tears

When a muscle or tendon is overworked, it can become inflamed. The rotator cuff is frequently irritated in throwers, resulting in tendinitis.

Early symptoms include pain that radiates from the front of the shoulder to the side of the arm. Pain may be present during throwing, other activities, and at rest. As the problem progresses, pain may occur at night, and the athlete may experience a loss of strength and motion.

Rotator cuff tears often begin by fraying. As the damage worsens, the tendon can tear. When one or more of the rotator cuff tendons is torn, the tendon no longer fully attaches to the head of the humerus. Most tears in throwing athletes occur in the supraspinatus tendon.

rotator cuff tear

Rotator cuff tendon tears in throwers most often occur within the tendon. In some cases, the tendon can tear away from where it attaches to the humerus.

Problems with the rotator cuff often lead to shoulder bursitis. There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are injured or damaged, this bursa can also become inflamed and painful.

Internal Impingement

During the cocking phase of an overhand throw, the rotator cuff tendons at the back of the shoulder can get pinched between the humeral head and the glenoid. This is called internal impingement and may result in a partial tearing of the rotator cuff tendon. Internal impingement may also damage the labrum, causing part of it to peel off from the glenoid.

Internal impingement may be due to some looseness in the structures at the front of the joint, as well as tightness in the back of the shoulder.

The muscles and tendons of the rotator cuff

The muscles and tendons of the rotator cuff. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

shoulder impingement

This illustration shows the infraspinatus tendon caught between the humeral head and the glenoid. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Instability

Shoulder instability occurs when the head of the humerus slips out of the shoulder socket (dislocation). When the shoulder is loose and moves out of place repeatedly, it is called chronic shoulder instability.

In throwers, instability develops gradually over years from repetitive throwing that stretches the ligaments and creates increased laxity (looseness). If the rotator cuff structures are not able to control the laxity, then the shoulder will slip slightly off-center (subluxation) during the throwing motion.

Pain and loss of throwing velocity will be the initial symptoms, rather than a sensation of the shoulder “slipping out of place.” Occasionally, the thrower may feel the arm “go dead.” A common term for instability many years ago was “dead arm syndrome.”

Glenohumeral Internal Rotation Deficit (GIRD)

As mentioned above, the extreme external rotation required to throw at high speeds typically causes the ligaments at the front of the shoulder to stretch and loosen. A natural and common result is that the soft tissues in the back of the shoulder tighten, leading to loss of internal rotation.

This loss of internal rotation puts throwers at greater risk for labral and rotator cuff tears.

Scapular Rotation Dysfunction (SICK Scapula)

abnormal positioning of the scapula

This photograph shows abnormal positioning of the scapula on the right side. Reproduced with permission from Kibler B, Sciascia A, Wilkes T: Scapular Dyskinesis and Its Relation to Shoulder Injury. J Am Acad Orthop Surg 2012; 20:364-372.

Proper movement and rotation of the scapula over the chest wall is important during the throwing motion. The scapula (shoulder blade) connects to only one other bone: the clavicle. As a result, the scapula relies on several muscles in the upper back to keep it in position to support healthy shoulder movement.

During throwing, repetitive use of scapular muscles creates changes in the muscles that affect the position of the scapula and increase the risk of shoulder injury.

Scapular rotation dysfunction is characterized by drooping of the affected shoulder. The most common symptom is pain at the front of the shoulder, near the collarbone.

In many throwing athletes with SICK scapula, the chest muscles tighten in response to changes in the upper back muscles. Lifting weights and chest strengthening exercises can aggravate this condition.

Doctor Examination

Medical History and Physical Examination

The medical history portion of the initial doctor visit includes discussion about your general medical health, symptoms and when they first began, and the nature and frequency of athletic participation

During the physicial examination, your doctor will check the range of motion, strength, and stability of your shoulder. He or she may perform specific tests by placing your arm in different positions to reproduce your symptoms.

The results of these tests help the doctor decide if additional testing or imaging of the shoulder is necessary.

Imaging Tests

Your doctor may order tests to confirm your diagnosis and identify any associated problems.

X-rays. This imaging test creates clear pictures of dense structures, like bone. X-rays will show any problems within the bones of your shoulder, such as arthritis or fractures.

Magnetic resonance imaging (MRI). This imaging study shows better images of soft tissues. It may help your doctor identify injuries to the labrum, ligaments, and tendons surrounding your shoulder joint.

Computed tomography (CT) scan. This test combines x-rays with computer technology to produce a very detailed view of the bones in the shoulder area.

Ultrasound. Real time images of muscles, tendons, ligaments, joints, and soft tissues can be produced using ultrasound. This test is typically used to diagnose rotator cuff tears in individuals who are not able to have MRI scans.

Treatment

Left untreated, throwing injuries in the shoulder can become complicated conditions.

Nonsurgical Treatment

In many cases, the initial treatment for a throwing injury in the shoulder is nonsurgical. Treatment options may include:

Activity modification. Your doctor may first recommend simply changing your daily routine and avoiding activities that cause symptoms.
Ice. Applying icepacks to the shoulder can reduce any swelling.
Anti-inflammatory medication. Drugs like ibuprofen and naproxen can relieve pain and inflammation. They can also be provided in prescription-strength form.
Physical therapy. In order to improve the range of motion in your shoulder and strengthen the muscles that support the joint, your doctor may recommend specific exercises. Physical therapy can focus on muscles and ligament tightness in the back of the shoulder and help to strengthen the structures in the front of the shoulder. This can relieve some stress on any injured structures, such as the labrum or rotator cuff tendon.
Change of position. Throwing mechanics can be evaluated in order to correct body positioning that puts excessive stress on injured shoulder structures. Although a change of position or even a change in sport can eliminate repetitive stresses on the shoulder and provide lasting relief, this is often undesirable, especially in high level athletes.
Cortisone injection— If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can provide long-term pain relief for tears or other structural damage.

cortisone injection in shoulder

A cortisone injection may relieve painful symptoms. Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Your doctor may recommend surgery based on your history, physical examination, and imaging studies, or if your symptoms are not relieved by nonsurgical treatment.The type of surgery performed will depend on several factors, such as your injury, age, and anatomy. Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs.

Arthroscopy. Most throwing injuries can be treated with arthroscopic surgery. During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the shoulder joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.

During arthroscopy, your doctor can repair damage to soft tissues, such as the labrum, ligaments, or rotator cuff.

shoulder arthroscopy

During arthroscopy, your surgeon inserts the arthroscope and small instruments into your shoulder joint.

Open surgery. A traditional open surgical incision (several centimeters long) is often required if the injury is large or complex.

Rehabilitation. After surgery, the repair needs to be protected while the injury heals. To keep your arm from moving, you will most likely use a sling for for a short period of time. How long you require a sling depends upon the severity of your injury.

As soon as your comfort allows, your doctor may remove the sling to begin a physical therapy program.

In general, a therapy program focuses first on flexibility. Gentle stretches will improve your range of motion and prevent stiffness in your shoulder. As healing progresses, exercises to strengthen the shoulder muscles and the rotator cuff will gradually be added to your program. This typically occurs 4 to 6 weeks after surgery.

Your doctor will discuss with you when it is safe to return to sports activity. If your goal is to return to overhead sports activities, your doctor or physical therapist will direct a therapy program that includes a gradual return to throwing.

It typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year to return to your sports activities.

Prevention

In recent years, there has been a great deal of attention on preventing throwing injuries of the shoulder.

Proper conditioning, technique, and recovery time can help to prevent throwing injuries. Throwers should strive to maintain good shoulder girdle function with proper stretches and upper back and torso strengthening.

In the case of younger athletes, pitching guidelines regarding number of pitches per game and week, as well as type of pitches thrown, have been developed to protect children from injury.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Rotator Cuff and Shoulder Conditioning Program

November 19, 2019/in Shoulder, Surgery Recovery /by nmortho

Article Featured on AAOS

After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Following a well-structured conditioning program will also help you return to sports and other recreational activities.This is a general conditioning program that provides a wide range of exercises. To ensure that the program is safe and effective for you, it should be performed under your doctor’s supervision. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals.Strength: Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Keeping these muscles strong can relieve shoulder pain and prevent further injury.Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness and keep your muscles long and flexible.Target Muscles: The muscle groups targeted in this conditioning program include:

Deltoids (front, back and over the shoulder)
Trapezius muscles (upper back)
Rhomboid muscles (upper back)
Teres muscles (supporting the shoulder joint)
Supraspinatus (supporting the shoulder joint)
Infraspinatus (supporting the shoulder joint)
Subscapularis (front of shoulder)
Biceps (front of upper arm)
Triceps (back of upper arm)

Length of program: This shoulder conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your shoulders. Performing the exercises two to three days a week will maintain strength and range of motion in your shoulders.

Getting Started

Warmup:Stretch: After the warm-up, do the stretching exercises shown on Page 1 before moving on to the strengthening exercises. When you have completeds the strengthening exercises, repeat the stretching exercises to end the program.

Do not ignore pain: You should not feel pain during an exercise. Talk to your doctor or physical therapist if you have any pain while exercising.

Ask questions: If you are not sure how to do an exercise, or how often to do it, contact your doctor or physical therapist.

1. Pendulum

Main muscles worked: Deltoids, supraspinatus, infraspinatus, subscapularis

Equipment needed: None

Repetitions: 2 sets of 10
Days Per Week: 5 to 6

Step-by-step directions

Lean forward and place one hand on a counter or table for support. Let your other arm hang freely at your side.
Gently swing your arm forward and back. Repeat the exercise moving your arm side-to-side, and repeat again in a circular motion.
Repeat the entire sequence with the other arm.

Tip: Do not round your back or lock your knees.

2. Crossover Arm Stretch

Main muscles worked: Posterior deltoid
You should feel this stretch at the back of your shoulderEquipment needed: NoneRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

Relax your shoulders and gently pull one arm across your chest as far as possible, holding at your upper arm.
Hold the stretch for 30 seconds and then relax for 30 seconds.
Repeat with the other arm.

Tip: Do not pull or put pressure on your elbow.

3. Passive Internal Rotation

Main muscles worked: Subscapularis
You should feel this stretch at the front of your shoulderEquipment needed: Light stick, such as a yardstickRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

Hold a stick behind your back with one hand, and lightly grasp the other end of the stick with your other hand.
Pull the stick horizontally as shown so that your shoulder is passively stretched to the point of feeling a pull without pain.
Hold for 30 seconds and then relax for 30 seconds.
Repeat on the other side.

Tip: Do not lean over or twist to side while pulling the stick.

4. Passive External Rotation

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in the back of your shoulderEquipment needed: Light stick, such as a yardstickRepetitions: 4 each side
Days Per Week: 5 to 6Step-by-step directions

Grasp the stick with one hand and cup the other end of the stick with the other hand.
Keep the elbow of the shoulder you are stretching against the side of your body and push the stick horizontally as shown to the point of feeling a pull without pain.
Hold for 30 seconds and then relax for 30 seconds.
Repeat on the other side.

Tip: Keep your hips facing forward and do not twist.

5. Sleeper Stretch

Main muscles worked: Infraspinatus, teres minor
You should feel this stretch in your outer upper back, behind your shoulderEquipment needed: NoneRepetitions: 4 reps, 3x a day
Days Per Week: DailyStep-by-step directions

Lie on your side on a firm, flat surface with the affected shoulder under you and your arm bent, as shown. You can place your head on a pillow for comfort, if needed.
Use your unaffected arm to push your other arm down. Stop pressing down when you feel a stretch in the back of your affected shoulder.
Hold this position for 30 seconds, then relax your arm for 30 seconds.

Tip: Do not bend your wrist or press down on your wrist.

6. Standing Row

Main muscles worked: Middle and lower trapezius
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
Stand holding the band with your elbow bent and at your side, as shown in the start position.
Keep your arm close to your side and slowly pull your elbow straight back.
Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together as you pull.

7. External Rotation With Arm Abducted 90°

Main muscles worked: Infraspinatus and teres minor
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
Stand holding the band with your elbow bent 90° and raised to shoulder-height, as shown in the start position.
Keeping your shoulder and elbow level, slowly raise your hand until it is in line with your head.
Slowly return to the start position and repeat.

Tip: Make sure your elbow stays in line with your shoulder.

8. Internal Rotation

Main muscles worked: Pectoralis, subscapularis
You should feel this exercise at your chest and shoulderEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

Make a 3-foot-long loop with the elastic band and tie the ends together. Attach the loop to a doorknob or other stable object.
Stand holding the band with your elbow bent and at your side, as shown in the start position.
Keep your elbow close to your side and bring your arm across your body.
Slowly return to the start position and repeat.

Tip: Keep your elbow pressed into your side.

9. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper backEquipment needed: Use an elastic stretch band of comfortable resistance. As the exercise becomes easier to perform, progress to 3 sets of 12 repetitions. If you have access to a fitness center, this exercise can also be performed on a weight machine. A fitness assistant at your gym can instruct you on how to use the machines safely.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

Make a 3-foot-long loop with the elastic band and tie the ends together.
Attach the loop to a doorknob or other stable object.
Stand holding the band with your elbow bent and at your side, as shown in the start position.
Keeping your elbow close to your side, slowly rotate your arm outward.
Slowly return to the start position and repeat.

Tip: Squeeze your shoulder blades together when you pull your elbow back.

10. Elbow Flexion

Main muscles worked: Biceps
You should feel this exercise at the front of your upper armEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

Stand tall with your weight evenly distributed over both feet.
Keep your elbow close to your side and slowly bring the weight up toward your shoulder as shown.
Hold for 2 seconds.
Slowly return to the starting position and repeat.

Tip: Do not do the exercise too quickly or swing your arm.

11. Elbow Extension

Main muscles worked: Triceps
You should feel this exercise at the back of your upper armEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

Stand tall with your weight evenly distributed over both feet.
Raise your arm and bend your elbow with the weight behind your head.
Support your arm by placing your opposite hand on your upper arm.
Slowly straighten your elbow and bring the weight overhead.
Hold for 2 seconds.
Slowly lower your arm back down behind your head and repeat.

Tip: Keep your abdominal muscles tight and do not arch your back.

12. Trapezius Strengthening

Main muscles worked: Middle and posterior deltoid, supraspinatus, middle trapezius
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.Repetitions: 3 sets of 20
Days Per Week: 3 to 5Step-by-step directions

Place your knee on a bench or chair and lean forward so that your hand reaches the bench and helps support your weight. Your other hand is at your side, palm facing your body.
Slowly raise your arm, rotating your hand to the thumbs-up position and stopping when your hand is shoulder height, with your arm parallel to the floor.
Slowly lower your arm to the original position to a count of 5.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

13. Scapula Setting

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back, at your shoulder bladeEquipment needed: NoneRepetitions: 10
Days Per Week: 3Step-by-step directions

Lie on your stomach with your arms by your sides.
Place a pillow under your forehead for comfort, if required.
Gently draw your shoulder blades together and down your back as far as possible.
Ease about halfway off from this position and hold for 10 seconds.
Relax and repeat 10 times.

Tip: Do not tense up in your neck.

14. Scapular Retraction/Protraction

Main muscles worked: Middle trapezius, serratus
You should feel this exercise in your upper back at your shoulder bladeEquipment needed: Begin with a weight that allows 2 sets of 8 to 10 repetitions and progress to 3 sets of 15 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

Lie on your stomach on a table or bed with your injured arm hanging over the side.
Keep your elbow straight and lift the weight slowly by squeezing your shoulder blade toward the opposite side as far as possible.
Return slowly to the starting position and repeat.

Tip: Do not shrug your shoulder toward your ear.

15. Bent-Over Horizontal Abduction

Main muscles worked: Middle and lower trapezius, Infraspinatus, teres minor, posterior deltoid
You should feel this exercise at the back of your shoulder and into your upper backEquipment needed: Begin with a weight that allows 3 sets of 8 repetitions and progress to 3 sets of 12 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 3 sets of 8 repetitions.Repetitions: 3 sets of 8
Days Per Week: 3Step-by-step directions

Lie on your stomach on a table or bed with your injured arm hanging over the side.
Keep your arm straight and slowly raise it up to eye level.
Slowly lower it back to the starting position and repeat.

Tip: Control the movement as you lower the weight.

16. Internal and External Rotation

Main muscles worked: Internal rotation: anterior deltoid, pectoralis, subscapularis, latissimus.
External rotation: posterior deltoid, infraspinatus, teres minor
You should feel this exercise in the front and back of your shoulder, your chest, and upper backEquipment needed: Begin with a light enough weight to allow 3 to 4 sets of 20 repetitions without pain. As the exercise becomes easier to perform, add 2 to 3 pounds of weight, but do fewer repetitions. Progress to 3 sets of 15 repetitions at each weight increment, with the maximum weight approximately 5 to 7 pounds.Repetitions: 3 to 4 sets of 20
Days Per Week: 3 to 5Step-by-step directions

Lie on your back on a flat surface.
Extend your arm straight out from the shoulder and bend the elbow 90° so that your fingers are pointed up.
Keeping your elbow bent and on the floor, slowly move your arm in the arc shown. Bring your elbow down to a 45° angle if you experience pain at 90°.

Tip: Use a weight that makes the last few repetitions difficult, but pain-free.

17. External Rotation

Main muscles worked: Infraspinatus, teres minor, posterior deltoid
You should feel this stretch in the back of your shoulder and upper backEquipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

Lie on your side on a firm, flat surface with your unaffected arm under you, cradling your head.
Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.
Keep your elbow against your side and slowly rotate your arm at the shoulder, raising the weight to a vertical position.
Slowly lower the weight to the starting position to a count of 5.

Tip: Do not let your body roll back as you raise the weight.

18. Internal Rotation

Main muscles worked: Subscapularis, teres major
You should feel this stretch in the front of your shoulderEquipment needed: Begin with weights that allow 2 sets of 8 to 10 repetitions (approximately 1 to 2 pounds), and progress to 3 sets of 5 repetitions. As the exercise becomes easier, add weight in 1-pound increments to a maximum of 5 pounds. Each time you increase the weight, start again at 2 sets of 8 to 10 repetitions.Repetitions: 2 sets of 10
Days Per Week: 3Step-by-step directions

Lie on a firm, flat surface on the side of your affected arm.
Place a pillow or folded cloth under your head to keep your spine straight.
Hold your injured arm against your side as shown, with your elbow bent at a 90° angle.
Keep your elbow bent and against your body and slowly rotate your arm at the shoulder, raising the weight to a vertical position.
Slowly lower the weight to the starting position.

Tip: Do not let your body roll back as you raise the weight.

Biceps Tendon Tear at the Shoulder

November 8, 2019/in Shoulder /by nmortho

Tendons attach muscles to bones. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. If you tear the biceps tendon at the shoulder, you may lose some strength in your arm and have pain when you forcefully turn your arm from palm down to palm up.

Many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms. If symptoms cannot be relieved by nonsurgical treatments, or if a patient requires complete recovery of strength, surgery to repair the torn tendon may be required.

Anatomy

Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

There are two attachments of the biceps tendon at the shoulder joint.

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

The upper end of the biceps muscle has two tendons that attach it to bones in the shoulder. The long head attaches to the top of the shoulder socket (glenoid). The short head attaches to a bump on the shoulder blade called the coracoid process.

Description

Biceps tendon tears can be either partial or complete.

Partial tears. Many tears do not completely sever the tendon.
Complete tears. A complete tear will split the tendon into two pieces.

In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes when lifting a heavy object.

Illustration shows a complete tear of the long head at its attachment point in the glenoid.

The long head of the biceps tendon is more likely to be injured. This is because it is vulnerable as it travels through the shoulder joint to its attachment point in the socket. Fortunately, the biceps has two attachments at the shoulder. The short head of the biceps rarely tears. Because of this second attachment, many people can still use their biceps even after a complete tear of the long head.

When you tear your biceps tendon, you can also damage other parts of your shoulder, such as the rotator cuff tendons.

Cause

There are two main causes of biceps tendon tears: injury and overuse.

Injury

If you fall hard on an outstretched arm or lift something too heavy, you can tear your biceps tendon.

Overuse

Many tears are the result of a wearing down and fraying of the tendon that occurs slowly over time. This naturally occurs as we age. It can be worsened by overuse – repeating the same shoulder motions again and again.

Overuse can cause a range of shoulder problems, including tendinitis, shoulder impingement, and rotator cuff injuries. Having any of these conditions puts more stress on the biceps tendon, making it more likely to weaken or tear.

Risk Factors

Your risk for a tendon tear increases with:

Age. Older people have put more years of wear and tear on their tendons than younger people.
Heavy overhead activities. Too much load during weightlifting is a prime example of this risk, but many jobs require heavy overhead lifting and put excess wear and tear on the tendons.
Shoulder overuse. Repetitive overhead sports, such as swimming or tennis, can cause more tendon wear and tear.
Smoking. Nicotine use can affect nutrition in the tendon.
Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.

Symptoms

Sudden, sharp pain in the upper arm
Sometimes an audible pop or snap
Cramping of the biceps muscle with strenuous use of the arm
Bruising from the middle of the upper arm down toward the elbow
Pain or tenderness at the shoulder and the elbow
Weakness in the shoulder and the elbow
Difficulty turning the arm palm up or palm down
Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow (“Popeye Muscle”) may appear, with a dent closer to the shoulder.