Shoulder

Specialist in upper limb surgery of the shoulder.

Fellowship at Sydney Shoulder Research Institute in Shoulder surgery.

Pain

Shoulder pain with movement, at rest or pain while sleeping.

Instability

Dislocation of your shoulder resulting in a Bankart & Hill Sachs lesion.

Weakness

Reduced strength in your shoulder compromising your overhead activity/sports.

Stiffness

Reduced shoulder movement with difficulty lifting or reaching behind your back.

Fracture

Trauma to the shoulder resulting in a break of the bones in and around your shoulder.

Pain

Shoulder pain with movement, at rest or pain while sleeping.

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Causes

Overuse: Repetitive overhead activities, such as throwing sports or heavy lifting, can lead to a SLAP tear.
Trauma: Direct injury to the shoulder, such as a fall on an outstretched arm, or a sudden pull on the arm can cause a SLAP tear.
Aging: The labrum can naturally degenerate with age, making it more susceptible to tears.

Symptoms

Pain in the shoulder, especially when lifting the arm overhead.
A feeling of instability or weakness in the shoulder.
Clicking, popping, or catching sensation in the shoulder joint.
Decreased range of motion.

Diagnosis

A SLAP tear is usually diagnosed through a combination of physical examination and imaging tests such as MRI, which can reveal the extent of the tear.

Treatment

Conservative Treatment: Rest, anti-inflammatory medications, and physical therapy can help manage symptoms and improve shoulder function.
Surgery: If conservative treatment fails, arthroscopic surgery may be necessary to repair the torn labrum.

SLAP Tears: Understanding
your Shoulder Injury

What is a SLAP Tear? A SLAP tear, or Superior Labrum Anterior to Posterior tear, is an injury to the shoulder’s labrum. The labrum is a ring of cartilage that surrounds the shoulder socket and helps stabilize the joint. A SLAP tear occurs when this cartilage is damaged, typically at the top part of the labrum, extending from the front (anterior) to the back (posterior) of the shoulder socket.

Prevention

Strengthening the shoulder muscles and maintaining good shoulder flexibility can help prevent SLAP tears, especially in athletes involved in overhead sports.

Treatment Options

Conservative Treatments:

Pain Relief: Over-the-counter NSAIDs like aspirin or ibuprofen can help manage pain and reduce inflammation
Physical Therapy: Exercises to improve range of motion and shoulder strength are often recommended. This approach is effective in up to 90% of patients
Corticosteroid Injections: These can be used to reduce pain and inflammation, particularly during the freezing stage.

Advanced Treatments:

Hydrodilatation: This involves injecting sterile water into the joint to stretch the capsule and improve movement.
Surgery: In severe cases where conservative treatments fail, arthroscopic surgery may be performed to remove adhesions and scar tissue.

Overview

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint. It typically develops gradually and can be categorized into three stages: freezing, frozen, and thawing. Understanding these stages is crucial for appropriate treatment.

Stages of Frozen Shoulder

Freezing Stage: This initial phase lasts from 10 to 36 weeks and is marked by increasing pain and gradual loss of shoulder movement.
Frozen Stage: Pain may begin to diminish during this stage, which can last from 4 to 6 months, but the shoulder remains stiff.
Thawing Stage: Shoulder movement gradually improves over a period of 6 months to 2 years.

Self-care:

Home Exercises: Regularly performing stretching exercises can aid recovery and maintain shoulder mobility.

Diagnosis

Diagnosis is typically made through a combination of physical examination and imaging studies, such as X-rays or ultrasound, which can reveal the presence of calcium.

Treatment

Conservative Treatment: The first line of treatment often includes rest, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy to manage symptoms and improve shoulder mobility.
Invasive Procedures: If conservative methods fail, treatments like shock wave therapy, ultrasound-guided needling, or in severe cases, surgery to remove the calcium deposits may be considered.

Calcific Tendinitis: An Overview

What is Calcific Tendinitis? Calcific tendinitis is a condition where calcium deposits form within the tendons, most commonly in the shoulder, leading to inflammation and severe pain. The exact cause is not fully understood, but it may be related to aging, genetics, or repetitive stress on the tendons.

Symptoms

Sudden, intense shoulder pain.
Stiffness and limited range of motion in the shoulder.
Pain that may worsen at night or with shoulder movement

Causes

Calcium Deposits: The buildup of calcium in the tendons is the primary cause of calcific tendinitis. This deposit irritates the surrounding tissues, causing inflammation and pain.
Age: It is more common in people aged 30 to 50.
Repetitive Motion: Activities that involve repetitive shoulder use may increase the risk.

Prognosis

Most patients respond well to conservative treatment, though the condition can be recurrent. Full recovery may take several weeks to months.

Biceps Pulley Lesion: An Overview

What is a Biceps Pulley Lesion? A biceps pulley lesion is an injury to the biceps pulley system, a complex structure in the shoulder that stabilizes the long head of the biceps tendon. This pulley system consists of ligaments and tendons, including parts of the subscapularis and supraspinatus tendons, which help to keep the biceps tendon in place as it moves through the shoulder joint.

Symptoms

Pain in the front or top of the shoulder.
Weakness or difficulty lifting the arm.
A sensation of catching or clicking during shoulder movement.

Diagnosis

Causes

Acute Trauma: Sudden injury, such as a fall or direct impact to the shoulder, can cause a biceps pulley lesion.
Degenerative Changes: Over time, wear and tear can lead to degeneration of the pulley system.
Repetitive Microtrauma: Repeated overhead activities, common in sports like baseball or tennis, can stress the pulley system, leading to injury.
Associated Injuries: Biceps pulley lesions are often associated with rotator cuff tears, particularly in the subscapularis and supraspinatus tendons, as well as subacromial impingement.

Treatment

Conservative Management: Includes rest, physical therapy, and anti-inflammatory medications.
Surgery: In cases of severe injury or when conservative treatment fails, surgical intervention may be required to repair the damaged structures.

Diagnosis typically involves clinical examination and imaging studies, such as MRI, which can reveal damage to the pulley system and any associated rotator cuff tears.

Biceps Tendinitis: What You Need to Know

What is Biceps Tendinitis? Biceps tendinitis is an inflammation of the tendon that connects your biceps muscle to the bones in your shoulder. This tendon helps stabilize the shoulder joint and allows you to perform movements like lifting or reaching overhead. When the tendon becomes irritated or inflamed, it can cause pain and discomfort, particularly in the front of the shoulder.

Causes

Repetitive overhead movements (common in sports like swimming, tennis, or baseball).
Age-related wear and tear.
Sudden injury or trauma to the shoulder

Symptoms

Pain in the front of the shoulder or upper arm.
Tenderness when touching the area.
Weakness when lifting or rotating your arm.
A clicking or popping sensation in the shoulder.

Prevention Tips

Warm up properly before engaging in physical activities.
Incorporate strength training exercises that focus on the shoulder and upper arm.
Avoid repetitive overhead motions when possible.

Treatment

Rest and Ice: Avoid activities that exacerbate the pain and apply ice to reduce inflammation.
Physical Therapy: Exercises to strengthen the shoulder muscles and improve flexibility can help alleviate symptoms.
Medications: Over-the-counter anti-inflammatory medications like ibuprofen can reduce pain and swelling.
Injections: Corticosteroid injections may be used in more severe cases to provide temporary relief.
Surgery: Rarely, if symptoms persist despite conservative treatment, surgical options might be considered.

Understanding Rotator Cuff Repair

Rotator cuff repair is a surgical procedure to fix a torn tendon in the shoulder. The rotator cuff consists of muscles and tendons that help lift and rotate the arm. Here are key points about rotator cuff repair:

Sources

Indications: Surgery is recommended when a tear in the rotator cuff causes pain and weakness that does not improve with conservative treatments like rest, physical therapy, or medication.
Surgical Techniques:

Open Repair: A traditional method involving a large incision to access the shoulder and repair the tendon

Arthroscopic Repair: A minimally invasive technique using small incisions and a camera to guide the repair. This method is associated with less pain and a faster recovery compared to open surgery

Recovery: Post-surgery recovery includes wearing a sling to immobilize the shoulder, followed by physical therapy to restore movement and strength. Full recovery can take several months
Outcomes: Most patients experience significant pain relief and improved shoulder function after surgery. However, recovery and outcomes can vary based on the size of the tear and the patient's overall health.

Rotator cuff repair is generally successful in reducing pain and restoring function, allowing patients to return to their daily activities.

Overview

Subacromial impingement syndrome (SIS) is a common shoulder condition characterized by pain and reduced function due to the compression of structures within the subacromial space. This space, located between the acromion (a bony projection on the scapula) and the rotator cuff tendons, can become narrowed, leading to impingement.

Causes and Mechanism

Mechanical Compression: SIS occurs when the rotator cuff tendons and the subacromial bursa are compressed during shoulder movements, especially overhead activities
Anatomical Factors: Variations in the shape of the acromion, such as a hooked or curved acromion, can predispose individuals to impingement
Functional Factors: Muscle imbalances and poor posture, leading to anterior translation of the humeral head, can contribute to the condition.

Symptoms

Pain: Typically felt on the front or side of the shoulder, worsening with overhead activities.
Weakness: Especially in the shoulder's abduction and external rotation.
Reduced Range of Motion: Difficulty in lifting the arm above the head.

Diagnosis

Clinical Examination: Includes specific tests such as the Neer and Hawkins-Kennedy impingement signs.
Imaging: MRI or ultrasound can be used to visualize structural changes or inflammation.

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Treatment

Conservative Management: 1. Rest and Activity Modification: Avoiding activities that exacerbate symptoms. 2. Physical Therapy: Focused on stretching and strengthening exercises to restore normal shoulder mechanics. 3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): To reduce pain and inflammation
Injections: Corticosteroid injections can be administered to reduce inflammation in the subacromial space
Surgical Intervention: If conservative treatments fail, arthroscopic surgery may be performed to remove or repair damaged tissues and expand the subacromial space.

By understanding the underlying causes, symptoms, and treatment options for subacromial impingement, individuals can effectively manage and alleviate their symptoms, restoring shoulder function.

Symptoms

Persistent shoulder pain
Stiffness and limited range of motion
Swelling and tenderness around the joint
A feeling of grinding or catching within the shoulder

Understanding Shoulder Arthritis

Shoulder arthritis is a condition characterized by inflammation of the shoulder joint, leading to pain, stiffness, and reduced range of motion. It can significantly impact daily activities and overall quality of life.

Types of Shoulder Arthritis

1. Osteoarthritis:

Degenerative joint disease caused by the breakdown of cartilage.
Commonly affects older adults.
Symptoms include pain, swelling, and decreased range of motion.

2. Rheumatoid Arthritis:

An autoimmune disorder where the body's immune system attacks joint tissues.
Can affect people of any age.
Symptoms include pain, swelling, and stiffness, often in multiple joints.

3. Post-Traumatic Arthritis:

Diagnosis

Diagnosing shoulder arthritis typically involves a physical examination, patient history, and imaging tests such as X-rays or MRI to assess joint damage and cartilage loss.

Treatment

1. Non-Surgical Treatments:

Medications: Anti-inflammatory drugs to reduce pain and swelling.
Physical Therapy: Exercises to improve strength and flexibility, including range of motion and isometric strengthening exercises
Lifestyle Modifications: Avoiding activities that exacerbate symptoms and maintaining a healthy weight.

2. Surgical Treatments:

Arthroscopy: Minimally invasive procedure to clean out the joint.
Shoulder Replacement Surgery: Replacing damaged parts of the shoulder with artificial components, often considered for severe cases.

Exercise and Rehabilitation

Regular exercise is crucial for managing shoulder arthritis. It helps reduce pain, promote healthy cartilage, and improve range of motion and function. A structured home exercise program can be very beneficial.

Develops after an injury to the shoulder, such as a fracture or dislocation.
Symptoms include pain and stiffness, similar to osteoarthritis.

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Conclusion

Shoulder arthritis can be a challenging condition, but with the right treatment and management strategies, you can maintain a good quality of life. If you are experiencing symptoms of shoulder arthritis, please contact our office to schedule a consultation.

Sources

Instability

Dislocation of your shoulder resulting in a Bankart & Hill Sachs lesion.

Overview

Sternoclavicular (SC) joint injuries are relatively rare, accounting for less than 3% of all traumatic joint injuries. The SC joint connects the sternum (breastbone) to the clavicle (collarbone) and is essential for shoulder movement and stability.

Causes

SC joint injuries can result from direct trauma to the shoulder, such as during contact sports, motor vehicle accidents, or falls. Non-traumatic causes include arthritis, infection, and degenerative changes due to aging.

Types of Injuries

Sprains: Mild injuries involving ligament stretching or partial tears.
Dislocations: More severe injuries where the clavicle is displaced from the sternum. These can be anterior (forward) or posterior (backward) dislocations, with posterior dislocations being more dangerous due to potential damage to vital structures like blood vessels and the trachea
Fractures: Less common but can occur due to high-impact trauma.

Symptoms

Pain and swelling at the SC joint.
Difficulty and pain with shoulder movement.
Visible deformity in case of dislocations.
Breathing difficulties or vascular issues in severe posterior dislocations.

Diagnosis

Diagnosis involves a thorough physical examination and imaging studies such as X-rays, CT scans, or MRI to assess the extent of the injury and rule out associated complications

Treatment

Non-Surgical: Rest, ice, anti-inflammatory medications, and physical therapy for mild injuries.
Surgical: Required for severe dislocations or fractures that cannot be managed conservatively. Surgery aims to realign the joint and repair any damaged structures.

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Classification

AC joint injuries are classified into six types based on the severity of the ligament damage:

Type I: Sprain or partial tear of the AC ligament, no injury to the coracoclavicular (CC) ligaments.
Type II: Complete tear of the AC ligament, sprain or partial tear of the CC ligaments.
Type III: Complete tear of both AC and CC ligaments, with displacement of the clavicle.
Type IV-VI: Increasing severity with greater displacement and associated damage to surrounding structures.

Symptoms

Pain at the top of the shoulder.
Swelling and bruising.
Visible bump or deformity at the AC joint.
Limited shoulder movement and strength.

Overview

Acromioclavicular (AC) joint injuries, also known as shoulder separations, are common injuries, particularly in contact sports. These injuries involve the ligaments that connect the acromion (part of the shoulder blade) and the clavicle (collarbone).

Causes

AC joint injuries typically result from a direct blow to the shoulder or a fall onto an outstretched arm. Common causes include sports injuries, falls, and accidents.

Diagnosis

Diagnosis is typically made through a physical examination and confirmed with imaging tests such as X-rays to assess the extent of ligament damage and joint displacement.

Treatment

Non-Surgical: Rest, ice, compression, and elevation (RICE); physical therapy; and anti-inflammatory medications for mild injuries (Type I and II)
Surgical: Required for more severe injuries (Type III-VI), involving repair or reconstruction of the damaged ligaments.

Glenoid Bone Loss: An Overview

What is Glenoid Bone Loss? Glenoid bone loss refers to the reduction or damage of bone in the glenoid cavity, which is the part of the shoulder blade that forms the socket of the shoulder joint. This condition is most commonly associated with recurrent shoulder dislocations and can significantly impact shoulder stability.

Diagnosis

Imaging: X-rays, CT scans, and MRIs are used to assess the extent of bone loss.
Physical Examination: Evaluating shoulder stability and range of motion helps in diagnosing the severity.

Treatment

Non-Surgical: Physical therapy to strengthen surrounding muscles may help in mild cases.
Surgical Options: In cases of significant bone loss, surgery may be necessary to reconstruct the glenoid or stabilize the joint. Procedures like the Latarjet or bone grafting are commonly performed.

Symptoms

Recurrent shoulder dislocations
Chronic shoulder pain and instability
Difficulty performing overhead activities or lifting objects

Causes

Recurrent Shoulder Dislocations: Multiple dislocations can wear down or fracture the glenoid rim.
Traumatic Injuries: High-energy trauma, such as a fall on an outstretched arm, can cause immediate bone loss.
Degenerative Conditions: Over time, wear and tear on the shoulder joint can lead to bone erosion

Prognosis

Most patients respond well to conservative treatment, though the condition can be recurrent. Full recovery may take several weeks to months.

Symptoms

Shoulder instability
Pain, particularly with overhead activities
Sensation of the shoulder "slipping" or "catching"
Reduced range of motion in the shoulder

Diagnosis

Hill-Sachs Lesion: An Overview

What is a Hill-Sachs Lesion? A Hill-Sachs lesion is a specific type of injury that occurs in the shoulder joint, specifically affecting the humeral head (the upper part of the arm bone). It is a posterolateral humeral head depression fracture that typically results from an anterior shoulder dislocation, where the humeral head impacts against the edge of the glenoid (the socket part of the shoulder blade).

Causes

The lesion occurs when the shoulder dislocates forward (anterior dislocation), causing the humeral head to collide with the glenoid rim. This collision creates a dent or fracture on the humeral head, known as the Hill-Sachs lesion. Repeated dislocations can exacerbate the size and severity of the lesion.

Treatment

Non-Surgical: Physical therapy to strengthen shoulder muscles and improve stability. This approach is often used for mild cases.
Surgical: In cases of significant bone loss or recurrent dislocations, surgical options such as remplissage (filling the lesion with tendon tissue) or bone grafting may be considered to restore stability and function.

Imaging Tests: X-rays, CT scans, and MRIs are used to confirm the presence and extent of the lesion.
Physical Examination: Doctors may assess shoulder stability and pain response during movement.

Symptoms

Feeling of looseness or weakness in the shoulder.
Pain or discomfort during activities, especially when moving the arm in certain directions.
Recurrent shoulder dislocations or subluxations (partial dislocations).

Treatment

Multidirectional Shoulder Instability (MDI): What You Need to Know

What is MDI? Multidirectional Instability (MDI) of the shoulder is a condition where the shoulder joint becomes unstable in multiple directions—typically anterior (front), posterior (back), and inferior (downward). This instability can lead to frequent dislocations or a sensation of the shoulder "giving way."

Causes

Laxity of Ligaments: Some individuals naturally have looser ligaments, which can predispose them to MDI.
Overuse Injuries: Repeated stress on the shoulder joint, especially in activities like swimming or throwing sports, can contribute to the development of MDI.
Trauma: Although less common, a traumatic injury can lead to the development of MDI.

Prevention Tips

Warm up properly before engaging in physical activities.
Incorporate strength training exercises that focus on the shoulder and upper arm.
Avoid repetitive overhead motions when possible.

Non-Surgical Management: Physical therapy is the first line of treatment, focusing on strengthening the muscles around the shoulder to improve stability.
Surgery: In cases where conservative treatment fails, surgery may be recommended to tighten the loose ligaments and improve shoulder stability.

Understanding AC joint stabilisation

AC (acromioclavicular) joint stabilisation is a surgical procedure to correct instability or dislocation of the AC joint, which connects the clavicle (collarbone) to the scapula (shoulder blade).

Here are key aspects of AC joint stabilisation:

Indications: This surgery is typically performed for patients with severe AC joint dislocations or chronic instability that causes pain and functional impairment.

Procedure:

A small incision is made over the AC joint.
The torn ligaments are repaired or reconstructed, often using a graft.
Sometimes, the clavicle is secured to the coracoid process of the scapula using screws or a button system to maintain joint stability.

Techniques:

Open Surgery: Traditional method with a larger incision.
Arthroscopic Surgery: Minimally invasive method using small incisions and a camera for guidance.

Recovery: Post-surgery, patients typically wear a sling for a few weeks to immobilize the shoulder. Physical therapy follows to restore range of motion and strength. Full recovery can take several months.

Outcomes: Successful AC joint stabilisation can significantly reduce pain and improve shoulder function, allowing patients to return to their daily activities and sports.

Sources

Posterior Shoulder Dislocation: Overview

What is it? A posterior shoulder dislocation occurs when the humeral head (the top of the arm bone) dislocates backward from the glenoid (the shoulder socket). This type of dislocation is less common than the anterior dislocation but can be more challenging to diagnose and treat.

Symptoms

Severe pain in the shoulder
Limited range of motion
Shoulder appears to be pushed backward
Muscle spasms around the shoulde

Diagnosis

Physical Examination: Check for deformity, swelling, and pain.
Imaging: X-rays or CT scans are used to confirm the dislocation and assess any associated damage. Posterior dislocations may not always be visible on standard X-rays and might require special views.

Causes and Mechanism

Trauma: Often caused by a direct blow to the shoulder or a fall on an outstretched arm.
Seizures: Intense muscle contractions during seizures can force the shoulder out of its socket.
Electrical Shock: Can lead to dislocation due to muscle contractions

Treatment

Reduction: The primary treatment is to reposition the humeral head back into the glenoid. This may be done manually under sedation or anesthesia.
Rehabilitation: After reduction, physical therapy is essential to restore function and strengthen the shoulder muscles.
Surgery: In severe cases or if there are repeated dislocations, surgical intervention might be necessary.

By understanding the underlying causes, symptoms, and treatment options for subacromial impingement, individuals can effectively manage and alleviate their symptoms, restoring shoulder function.

Understanding Shoulder Dislocation

A shoulder dislocation occurs when the upper arm bone (humerus) pops out of the shoulder socket (glenoid). This injury can result from a fall, sports injury, or other trauma, and it is essential to seek immediate medical attention.

Symptoms

Deformity: Visible deformity or out-of-place shoulder.
Pain: Severe pain, often accompanied by muscle spasms.
Swelling and Bruising: Around the shoulder area.
Numbness and Weakness: Possible loss of sensation or strength in the arm.
Limited Mobility: Difficulty moving the arm.

Diagnosis

Diagnosis is typically confirmed through a physical examination and imaging tests, such as X-rays or MRI, to determine the extent of the dislocation and any associated damage to ligaments or bones.

Types of Shoulder Dislocations

Anterior Dislocation:
The most common type, where the humerus is displaced forward.
Posterior Dislocation:
Less common, occurring when the humerus is pushed backward.
Inferior Dislocation:
Rare, where the humerus is displaced downward.

Prevention

Strength Training: Strengthen shoulder muscles to provide better joint stability.
Protective Gear: Use appropriate gear during sports and activities to protect the shoulder.
Avoid High-Risk Activities: Be cautious in activities that increase the risk of falls or shoulder injuries.

Treatment

Reduction:
The process of repositioning the bone into the socket. This is often done under sedation or anesthesia.
Immobilization:
Using a sling or splint to keep the shoulder stable and allow healing.
Medications:
Pain relievers and anti-inflammatory drugs to manage pain and swelling.
Physical Therapy:
Exercises to restore range of motion, strengthen the shoulder muscles, and prevent future dislocations.

Weakness

Reduced strength in your shoulder compromising your overhead activity/sports.

Symptoms

Sudden pain in the chest or shoulder.
Swelling and bruising.
Weakness in the shoulder or inability to lift objects.

Diagnosis

Typically involves physical examination and imaging techniques like MRI or ultrasound to assess the extent of the tear.

Overview

A pectoralis major rupture is a rare injury involving a tear in the pectoralis major muscle, which is responsible for moving the shoulder and arm. This injury often occurs during activities that involve heavy lifting or explosive movements, such as weightlifting.

Treatment

Non-surgical: Rest, ice, and physical therapy may be sufficient for partial tears.
Surgical: Repair is often required for complete tears, especially if the muscle is significantly detached. This involves reattaching the muscle to the bone through surgery.

Rehabilitation

Post-surgery, rehabilitation focuses on restoring strength and flexibility, starting with gentle range-of-motion exercises and progressing to strengthening exercises as healing allows.

Symptoms

A sudden, sharp pain in the upper arm or shoulder.
A “pop” sound or sensation at the time of injury.
Visible bulge in the upper arm (often referred to as a "Popeye muscle").
Bruising, weakness, and difficulty with shoulder movements like lifting or rotating the arm.

Overview

A proximal biceps rupture occurs when the tendon of the long head of the biceps muscle tears near its attachment at the shoulder. This injury typically happens during activities involving heavy lifting or sudden forceful movements of the arm.

Causes

Degeneration due to ageing or repetitive shoulder activity.
Sudden traumatic events such as lifting heavy objects or a fall.

Treatment

Conservative: Rest, ice, physical therapy, and possibly anti-inflammatory medications are recommended for many patients.
Surgical: Surgery may be considered in younger, more active individuals, or those who require full strength and endurance in their arm for work or sports.

While a proximal biceps rupture may result in a cosmetic deformity, it often does not significantly impact shoulder function in most people, especially if treated promptly.

Diagnosis

Physical examination to assess the appearance and function of the shoulder and arm.
Imaging studies, such as MRI or ultrasound, to confirm the extent of the rupture.

Overview

A rotator cuff tear involves damage to the group of muscles and tendons that stabilize the shoulder. This injury can be caused by acute trauma or gradual wear and tear. Here are key points about rotator cuff tears:

Symptoms: Common symptoms include pain, weakness, and reduced range of motion in the shoulder. Pain often worsens at night or with activities that involve overhead movements.
Causes: Tears can result from repetitive stress or sudden injury. Activities that involve heavy lifting or overhead movements are common culprits.
Diagnosis: Diagnosis typically involves a physical exam and imaging tests such as an MRI or ultrasound to assess the extent of the tear.
Treatment: Treatment options range from physical therapy and medications to surgical intervention, depending on the severity of the tear and the impact on daily activities

Arthroscopic rotator cuff repair

Arthroscopic rotator cuff repair is a minimally invasive surgical procedure used to treat tears in the rotator cuff. Here are the key aspects of this procedure:

Procedure: The surgery involves making small incisions around the shoulder, through which an arthroscope (a small camera) and specialized surgical instruments are inserted. This allows the surgeon to view and repair the damaged tendons without a large open incision.
Duration: The operation typically takes about 2 hours.
Recovery: Post-surgery, patients often experience some pain and swelling. The recovery process includes physical therapy to restore strength and mobility. Most patients see significant improvement in shoulder function within a few months.
Risks: As with any surgery, there are risks such as infection or nerve damage, which can cause temporary numbness around the shoulder

Post-operative recovery from arthroscopic rotator cuff repair

Post-operative recovery from arthroscopic rotator cuff repair involves several stages and requires careful management to ensure optimal healing:

Immediate Post-Operative Care:
1. Dressings: Keep initial dressings clean and dry. They can be removed 24-48 hours after surgery, depending on your surgeon's advice. Waterproof bandages can be used for showering afterward.
2. Pain Management: Expect some pain and swelling. Pain medication and ice packs can help manage discomfort.
Rehabilitation:
1. Initial Phase (0-6 Weeks): Focus on reducing pain and inflammation while protecting the repair. Physical therapy typically begins with gentle range-of-motion exercises.
2. Intermediate Phase (6-12 Weeks): As healing progresses, strengthening exercises are introduced. Avoid heavy lifting and strenuous activities during this phase.
3. Full Recovery (3-6 Months): Gradual return to full activity, including sport-specific exercises if needed. Complete recovery may take several months.
Precautions:
Avoid driving for about 6 weeks if it involves the affected shoulder. Follow all post-operative instructions and attend scheduled follow-up appointments to monitor recovery.

Overview

A subscapularis tear involves damage to the subscapularis tendon, one of the four tendons that make up the rotator cuff in the shoulder. This type of tear can be caused by acute trauma or chronic wear and tear, particularly in athletes or individuals engaged in repetitive overhead activities.

Diagnosis:

Physical examination tests, such as the lift-off test or belly-press test, can help identify subscapularis weakness or pain.
Imaging studies like MRI or ultrasound are used to confirm the extent of the tear.

Treatment:

Non-surgical: Physical therapy, rest, and anti-inflammatory medications may be recommended for partial tears.
Surgical: Complete tears, especially in active individuals, may require surgical repair to restore full function and strength.

Early diagnosis and treatment are essential to prevent further damage and restore normal shoulder function.

Key Points:

Causes:

Acute trauma, such as a fall or lifting heavy objects.
Chronic overuse, often related to repetitive overhead movements or degeneration due to aging.

Symptoms:

Pain in the front of the shoulder.
Weakness when rotating the arm inward or lifting the arm overhead.

Difficulty with activities like reaching behind the back or tucking in a shirt.

Suprascapular Nerve Compression

Suprascapular nerve compression, also known as suprascapular neuropathy, occurs when the suprascapular nerve is pinched or compressed, often at the suprascapular or spinoglenoid notch. This condition can lead to shoulder pain, weakness, and dysfunction, particularly affecting the muscles that stabilize and move the shoulder.

Symptoms

Shoulder pain and weakness, particularly during overhead movements.
Atrophy of the supraspinatus and infraspinatus muscles.
Difficulty with shoulder abduction and external rotation.

Causes

Repetitive overhead activities.
Traumatic injuries.
Ganglion cysts or other space-occupying lesions

Treatment

Non-Surgical Management: Physical therapy is the first line of treatment, focusing on strengthening the muscles around the shoulder to improve stability.
Surgery: In cases where conservative treatment fails, surgery may be recommended to tighten the loose ligaments and improve shoulder stability.

Stiffness

Reduced shoulder movement with difficulty lifting or reaching behind your back.

Glenohumeral Internal
Rotation Deficit (GIRD)

Glenohumeral Internal Rotation Deficit (GIRD) is a condition commonly seen in throwing athletes, characterized by a significant loss of internal rotation in the shoulder joint compared to the non-dominant side.

Key Points

Causes:
Repetitive overhead throwing motions lead to tightening and thickening of the posterior shoulder capsule and posterior rotator cuff muscles, particularly in athletes like baseball pitchers.
Symptoms:

Limited internal rotation of the shoulder.
Pain, especially during overhead activities.
Compensatory movements that can lead to other shoulder or elbow injuries.

Diagnosis:

Physical examination including the measurement of internal and external rotation while the patient is lying on their back.
A difference of 18° to 20° or more in internal rotation between the throwing and non-throwing shoulders is often considered indicative of GIRD.

Treatment:

Stretching and strengthening exercises to improve shoulder flexibility and balance.
Physical therapy focused on restoring normal range of motion.
In severe cases, surgical intervention may be necessary if conservative treatments fail.

Proper management of GIRD is essential to prevent further injury and maintain shoulder function, particularly in athletes.

Symptoms

A sudden, sharp pain in the upper arm or shoulder.
A “pop” sound or sensation at the time of injury.
Visible bulge in the upper arm (often referred to as a "Popeye muscle").
Bruising, weakness, and difficulty with shoulder movements like lifting or rotating the arm.

Overview

Causes

Diagnosis

Physical examination to assess the appearance and function of the shoulder and arm.
Imaging studies, such as MRI or ultrasound, to confirm the extent of the rupture.

Degeneration due to ageing or repetitive shoulder activity.
Sudden traumatic events such as lifting heavy objects or a fall.

Treatment

Conservative: Rest, ice, physical therapy, and possibly anti-inflammatory medications are recommended for many patients.
Surgical: Surgery may be considered in younger, more active individuals, or those who require full strength and endurance in their arm for work or sports.

While a proximal biceps rupture may result in a cosmetic deformity, it often does not significantly impact shoulder function in most people, especially if treated promptly.

Arthroscopic rotator cuff repair

Arthroscopic rotator cuff repair is a minimally invasive surgical procedure used to treat tears in the rotator cuff. Here are the key aspects of this procedure:

Post-operative recovery from arthroscopic rotator cuff repair

Overview

Post-operative recovery from arthroscopic rotator cuff repair involves several stages and requires careful management to ensure optimal healing:

Immediate Post-Operative Care:
1. Dressings: Keep initial dressings clean and dry. They can be removed 24-48 hours after surgery, depending on your surgeon's advice. Waterproof bandages can be used for showering afterward.
2. Pain Management: Expect some pain and swelling. Pain medication and ice packs can help manage discomfort.
Rehabilitation:
1. Initial Phase (0-6 Weeks): Focus on reducing pain and inflammation while protecting the repair. Physical therapy typically begins with gentle range-of-motion exercises.
2. Intermediate Phase (6-12 Weeks): As healing progresses, strengthening exercises are introduced. Avoid heavy lifting and strenuous activities during this phase.
3. Full Recovery (3-6 Months): Gradual return to full activity, including sport-specific exercises if needed. Complete recovery may take several months.
Precautions:
Avoid driving for about 6 weeks if it involves the affected shoulder. Follow all post-operative instructions and attend scheduled follow-up appointments to monitor recovery.

Overview

Key Points

Causes:

Acute trauma, such as a fall or lifting heavy objects.
Chronic overuse, often related to repetitive overhead movements or degeneration due to aging.

Symptoms:

Pain in the front of the shoulder.
Weakness when rotating the arm inward or lifting the arm overhead.

Difficulty with activities like reaching behind the back or tucking in a shirt.

Diagnosis:

Physical examination tests, such as the lift-off test or belly-press test, can help identify subscapularis weakness or pain.
Imaging studies like MRI or ultrasound are used to confirm the extent of the tear.

Treatment:

Non-surgical: Physical therapy, rest, and anti-inflammatory medications may be recommended for partial tears.
Surgical: Complete tears, especially in active individuals, may require surgical repair to restore full function and strength.

Suprascapular Nerve Compression

Causes

Repetitive overhead activities.
Traumatic injuries.
Ganglion cysts or other space-occupying lesions

Symptoms

Treatment

Non-Surgical Management: Physical therapy is the first line of treatment, focusing on strengthening the muscles around the shoulder to improve stability.
Surgery: In cases where conservative treatment fails, surgery may be recommended to tighten the loose ligaments and improve shoulder stability.

Shoulder pain and weakness, particularly during overhead movements.
Atrophy of the supraspinatus and infraspinatus muscles.
Difficulty with shoulder abduction and external rotation.

Fracture

Trauma to the shoulder resulting in a break of the bones in and around your shoulder.

Types of Acromion Fractures:

Acromion Fractures

Acromion fractures are injuries to the acromion, a bony projection on the scapula (shoulder blade) that forms part of the shoulder. These fractures are relatively rare and often occur due to direct trauma, such as a fall onto the shoulder or a direct blow.

Symptoms

Pain at the top of the shoulder.
Swelling and tenderness over the acromion.
Limited range of motion and difficulty raising the arm

Diagnosis

Type I: Non-displaced fractures, which are stable and often treated conservatively.
Type II: Displaced but without impingement of the subacromial space, may require surgical intervention.
Type III: Displaced fractures with involvement of the subacromial space, typically requiring surgery to restore normal function.

Diagnosed through physical examination and confirmed with imaging studies like X-rays or CT scans.

Treatment

Non-Surgical: Non-displaced fractures are typically managed with immobilization in a sling, followed by physical therapy.
Surgical: Surgery is indicated for displaced fractures, especially if there is a risk of impingement or if the fracture fails to heal properly (non-union).

Clavicle: Overview

Clavicle fractures, commonly known as broken collarbones, are prevalent injuries that account for about 10% of all fractures and are particularly common in children and adolescents.

Causes

Clavicle fractures typically occur from:

Direct blows to the shoulder, often from falls, sports injuries, or vehicular accidents.
Falls onto an outstretched hand or the shoulder.

Recovery

Symptoms

Sharp pain at the fracture site.
Swelling, bruising, and tenderness along the collarbone.
A noticeable bump or deformity at the fracture site.
Difficulty moving the shoulder and arm.

Diagnosis

Diagnosis is primarily made through a physical examination and confirmed with imaging studies like X-rays. In some cases, a CT scan might be needed to assess complex fractures.

Recovery time varies depending on the severity of the fracture, the patient’s age, and overall health. Children typically heal faster, within a few weeks, while adults may take several months. Physical therapy is crucial for regaining full shoulder function.

Treatment

Non-Surgical: Most clavicle fractures can be treated conservatively with arm support using a sling, pain management, and physical therapy to restore movement and strength.
Surgical: Indicated for displaced fractures, open fractures, or fractures that do not heal properly. Surgery involves realigning the bone fragments and fixing them with plates and screws.

Glenoid Fractures: Overview

Glenoid fractures involve a break in the glenoid cavity, the shallow socket of the shoulder blade where the head of the humerus fits to form the shoulder joint. These fractures can be caused by direct trauma, such as a fall or a car accident, or by shoulder dislocations.

Symptoms

Severe shoulder pain and swelling.
Deformity around the shoulder area.
Inability to move the arm.
Sometimes associated with shoulder instability or recurrent dislocations.

Causes

Diagnosis

Physical examination and imaging studies such as X-rays or CT scans are used to confirm the presence and extent of the fracture.

Treatment

Non-surgical: Minor or stable fractures can be treated with immobilization using a sling and physical therapy to restore range of motion and strength.
Surgical: More complex or unstable fractures may require surgery to realign and stabilize the bone fragments, often with plates and screws.

High-energy trauma (e.g., car accidents, sports injuries).
Shoulder dislocations can also lead to glenoid fractures, especially in young, active individuals.

Diagnosis

Diagnosis is typically made through imaging studies like X-rays, CT scans, or MRIs, which reveal the unfused bone fragment.

Os Acromiale: An Overview

Os acromiale is an anatomical variant where the acromion, a bony projection on the scapula (shoulder blade), fails to fully fuse during development. This condition occurs due to an unfused accessory center of ossification, resulting in a small bone segment at the acromion that remains separate.

Anatomy and Development:

The acromion develops from several ossification centers during childhood. When one of these centers fails to fuse with the rest, it results in os acromiale.

Symptoms

Many people with os acromiale are asymptomatic and may only discover it incidentally through imaging.
In symptomatic cases, it can cause shoulder pain, particularly during overhead activities, and may be associated with rotator cuff impingement or tears.

Treatment

Asymptomatic cases often require no treatment.
Symptomatic cases may be managed with conservative treatments like physical therapy or corticosteroid injections.
Surgical intervention may be considered in persistent cases to stabilize or remove the fragment.

Proximal Humerus Fracture

Proximal humerus fractures occur near the shoulder and are common, particularly among older adults. The management of these fractures depends on the type and severity of the fracture.

Types of Fractures

Proximal humerus fractures can be classified into:

Non-displaced: The bone pieces remain in proper alignment.
Displaced: The bone pieces are out of alignment.
Comminuted: The bone is broken into multiple pieces.

Rehabilitation

Nonoperative Treatment

Indications: Generally recommended for stable, minimally displaced fractures, or for patients not deemed surgical candidates.
Initial Care: Immobilization using a sling for a short duration (typically less than two weeks) followed by early motion exercises.
Rehabilitation: Early physical therapy to restore range of motion and prevent stiffness.

Early Physical Therapy: Essential for both nonoperative and postoperative management to regain function and strength.
Gradual Increase in Activity: Tailored to patient recovery progress and fracture healing status.

Prognosis

Most patients with proximal humerus fractures respond well to appropriate management, whether surgical or non-surgical, with a significant emphasis on rehabilitation and physical therapy to ensure optimal recovery.

Operative Treatment

Indications: Severe displaced fractures, fractures with multiple fragments (comminuted), or those not responding to nonoperative treatment.
Procedures:
- Open Reduction and Internal Fixation (ORIF): Surgical realignment of bone fragments and stabilization with hardware (plates and screws).
- Hemiarthroplasty or Reverse Shoulder Arthroplasty: Replacement of the shoulder joint, indicated in cases of severe comminuted fractures or poor bone quality.

Symptoms

Severe pain at the site of the fracture.
Swelling and bruising around the shoulder.
Limited range of motion in the shoulder.
Possible deformity if the fracture is displaced.

Diagnosis

Physical examination to assess pain, deformity, and range of motion.
Imaging studies like X-rays or CT scans to confirm the fracture and determine its severity.

Scapular Fractures: Overview

Scapular fractures, or fractures of the shoulder blade, are relatively uncommon, accounting for less than 1% of all fractures. They typically occur due to high-energy trauma, such as from a car accident or a fall from a significant height.

Types of Scapular Fractures:

Body Fractures: Involve the main part of the scapula; these are the most common type.
Acromion Fractures: Involve the acromion, the bony projection on the scapula.
Coracoid Fractures: Involve the coracoid process, another projection from the scapula.
Glenoid Fractures: Involve the glenoid cavity, where the humerus (upper arm bone) articulates with the scapula.

Treatment

Non-Surgical: Most scapular fractures (over 90%) can be treated with rest, immobilization using a sling, and physical therapy to regain strength and mobility.
Surgical: Surgery is required for displaced fractures, fractures involving the glenoid cavity, or when there is significant injury to surrounding structures.

Scapular fractures generally have a good prognosis with appropriate treatment, though recovery may take several months.

Shoulder

Fellowship at Sydney Shoulder Research Institute in Shoulder surgery.

Pain

Causes

Symptoms

Diagnosis

Treatment

SLAP Tears: Understanding your Shoulder Injury

Prevention

Instability

Overview

Causes

Types of Injuries

Symptoms

Diagnosis

Treatment

Weakness

Symptoms

Diagnosis

Overview

Treatment

Rehabilitation

Stiffness

Glenohumeral Internal Rotation Deficit (GIRD)

Key Points

Fracture

Types of Acromion Fractures:

Acromion Fractures

Symptoms

Diagnosis

Treatment

SLAP Tears: Understanding
your Shoulder Injury

Glenohumeral Internal
Rotation Deficit (GIRD)