Wednesday, 22 of November of 2017

Tag » Shoulder Pain

Shoulder Replacement

For people with severe shoulder pain, shoulder replacement surgery is usually the right choice once more conversation options such as injections and physical therapy fail to provide relief. Although not as common hip or knee replacement (about 900,000 patients every year versus 53,000 per year according to the Agency for Healthcare Research and Quality), shoulder replacement is a very successful and effective procedure.

Who is  a candidate?

The typical candidate for shoulder replacement is someone whose shoulder joint has been severely damaged with osteoarthritis. Symptoms include shoulder weakness and loss of motion, pain that wakes them up at night and difficulty with even simple daily activities that require you to lift or use your arm.

What exactly is replaced?

The shoulder joint includes two bones: the upper arm bone, called the humerus, and the shoulder bone, or scapula. The tip of the humerus, which is shaped like a ball, fits into the part of the scapula that is shaped like a socket. During surgery, the ball of the humerus is replaced with a metal implant, and a plastic “cup” is inserted into the shoulder socket of the scapula. 

As the American Academy of Orthopedic Surgeons points out, patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for this procedure.

But patients who have osteoarthritis and a large rotator cuff tear that can’t be repaired by other methods, may find that traditional shoulder replacement may not be as effective. They may continue to have pain when they try to use their shoulder because of the poor condition of the rotator cuff muscles. Instead, those patients may benefit from a newer procedure called reverse shoulder replacement.

What is a reverse shoulder replacement?

Granted FDA approval in 2004, reverse shoulder replacement is done by “reversing” the implants.  This means attaching the metal ball implant to the shoulder socket and fixing the plastic socket to the end of the arm bone — the exact opposite of the traditional method.

Reverse shoulder replacement allows the shoulder joint to function using the deltoid muscles instead of relying oh the damaged rotator cuff muscles. The “delts” are the triangular muscles that form the rounded outer area on the upper arm.

Deciding who is a good candidate for shoulder replacement or reverse shoulder replacement requires the skill and knowledge of an experienced orthopedic surgeon, one who remains current with the latest technology. If you are having shoulder pain and would benefit from a consultation, call Dr. John Kagan at 239-936-6778 or go to www.kaganortho.com


Rotator Cuff Injury

It’s not surprising that Baltimore Ravens wide receiver Anquan Boldin and San Francisco 49ers wide receiver Mario Manningham complained of shoulder pain in the weeks prior to Super Bowl XLVII. A reported 11 players from both teams were “nursing” shoulder injuries before the big game this past Sunday.

High-impact sports like football can damage the shoulder joint, causing a number of injuries, including damage to the rotator cuff, a group of muscles and tendons that cover the head of the shoulder bone and hold it in place in the socket. 

But it’s not just football players who feel the pain and stiffness of shoulder problems. Golfers and tennis players often have similar complaints.

Any sport that requires repetitive use of the shoulder joint – think of the overhead serve in tennis and the swing required in golf – can stress the rotator cuff and lead to tendinitis (inflammation of the tendons), bursitis (inflammation of the bursa sack) and tears to the ligaments or muscle.

Because the rotator cuff helps keep the shoulder stable and allows for full range of motion, injury causes pain, stiffness and loss of mobility. Generally the pain will be felt along the outside portion or side of the shoulder, rather than deep inside the joint as is the case with osteoarthritis. The pain may wake you up at night and it may hurt to reach overhead.

The first step in treatment is usually conservative. Rest the shoulder, apply ice and take anti-inflammatory medication.  Your doctor may prescribe physical therapy with gentle stretching and strengthening exercises.  Injections with cortisone or other medications can be helpful, too.

More serious injuries, such as a full rotator cuff tear, will not heal by itself and may require surgery.  For more information about the rotator cuff, along with a diagram of the shoulder anatomy, go to www.kaganortho.com/learn-more.


What Is MIS Joint Replacement?

The trend toward bigger is better may apply in some areas of popular culture, but definitely not in the field of medicine, especially for joint replacement surgery.

MIS joint replacement is a minimally invasive surgical technique in which the surgical incision used to open the body is very tiny, just 2.5- to 3.5 inches. In contrast, traditional joint replacement surgery calls for a much larger incision – typically 12- to 14-inches.

But here’s the interesting twist. Whether the surgeon uses traditional surgery or a minimally invasive technique, the device used to replace the arthritic hip, knee or shoulder is always a full-size, traditional plastic or metal implant.

How is that possible? Technology.

Standard operating procedure calls for the surgeon to make a large incision and then retract the tissue, giving him a large surgical field in which to operate and insert the new artificial implant.

The new MIS technique uses a completely different approach. First, miniature specialized surgical instruments have been developed that are small enough to inset through a tiny incision.

Then, to overcome the restriction of a dramatically reduced surgical field, the specialized surgical instruments are equipped with a light source and video capability. Video images of the interior structure are sent in real-time to a monitor, giving the surgeon highly magnified 3D images of the operating field.

Performing minimally invasive surgery not only requires the right surgical instruments, it also takes training and certification to learn the surgical skills and manual dexterity required to become proficient in minimally invasive techniques.

In addition, the surgeon has to have a successful practice and track record that allows him to consistently perform the technique to keep his skills up to date and his surgical outcomes good.

Not everyone is a good candidate for MIS joint replacement. But the advantages of this new advance are extensive. The benefits include less blood loss, reduced trauma to the body, fewer days of hospitalization and faster overall recovery. Minimally invasive techniques are definitely a positive trend for the future of orthopedic care.

Want to find out more about minimally invasive techniques to treat joint pain? Go to www.kaganortho.com/learn-more. If you have chronic osteoarthritis that doesn’t respond to nonsurgical treatment, ask your doctor if you a good candidate for MIS joint replacement.

The trend toward bigger is better may apply in some areas of popular culture, but definitely not in the field of medicine, especially for joint replacement surgery.

MIS joint replacement is a minimally invasive surgical technique in which the surgical incision used to open the body is very tiny, just 2.5- to 3.5 inches. In contrast, traditional joint replacement surgery calls for a much larger incision – typically 12- to 14-inches.

But here’s the interesting twist. Whether the surgeon uses traditional surgery or a minimally invasive technique, the device used to replace the arthritic hip, knee or shoulder is always a full-size, traditional plastic or metal implant.

How is that possible? Technology.

Standard operating procedure calls for the surgeon to make a large incision and then retract the tissue, giving him a large surgical field in which to operate and insert the new artificial implant.

The new MIS technique uses a completely different approach. First, miniature specialized surgical instruments have been developed that are small enough to inset through a tiny incision.

Then, to overcome the restriction of a dramatically reduced surgical field, the specialized surgical instruments are equipped with a light source and video capability. Video images of the interior structure are sent in real-time to a monitor, giving the surgeon highly magnified 3D images of the operating field.

Performing minimally invasive surgery not only requires the right surgical instruments, it also takes training and certification to learn the surgical skills and manual dexterity required to become proficient in minimally invasive techniques.

In addition, the surgeon has to have a successful practice and track record that allows him to consistently perform the technique to keep his skills up to date and his surgical outcomes good.

Not everyone is a good candidate for MIS joint replacement. But the advantages of this new advance are extensive. The benefits include less blood loss, reduced trauma to the body, fewer days of hospitalization and faster overall recovery. Minimally invasive techniques are definitely a positive trend for the future of orthopedic care.

Want to find out more about minimally invasive techniques to treat joint pain? Go to www.kaganortho.com/learn-more. If you have chronic osteoarthritis that doesn’t respond to nonsurgical treatment, ask your doctor if you a good candidate for MIS joint replacement.

 


Shoulders Injections to Control Pain

Depending on the diagnosis, often the first step in treating shoulder pain and stiffness may be an injection with a mix of pain-relieving anesthesia and cortisone, a powerful anti-inflammatory medication. Here are some of the ways injections can be helpful:

1) Reducing the pain and swelling from bursitis – an inflammation of the small fluid-filled sacs located in the shoulder joint.

2) Decreasing the discomfort from rotator cuff tendonitis, an inflammation of the tendons and muscles in the shoulder.

3) Treatment for early stage osteoarthritis, a degenerative disease of the cartilage that covers the joint.

4) Eliminating the pain from trigger points, small, hypersensitive knots in the muscles or connective tissue that form when the muscles do not relax.

Injections are a non-surgical intervention that can be very effective with relatively little downtime required. The physician may use a numbing medication that is applied to the skin to reduce any discomfort associated with the injection. The inject site may be tender for a few days but icing the area will help. Injections can be repeated over time as needed to control pain and inflammation. Unlike taking oral steroid medication, there are no long-term side effects from a cortisone injection.

For more information on common treatment options for shoulder pain, go to www.kaganortho.com/learn-more/.com


What is Shoulder Arthroscopy?

If you’ve been having pain or stiffness in your shoulder and your physician recommends arthroscopy, what can you expect? First introduced in the 1970s, arthroscopy is a way of looking inside the shoulder joint without the surgeon making a large incision. It is considered a minimally invasive procedure, which means that there is less trauma to the body, less blood loss and quicker recovery with patients going home the same day as the procedure.

According to the American Academy of Orthopedic Surgeons, the word arthroscopy comes from two Greek words – “arthro or joint and skopein or to look.” A small scope is inserted through a tiny incision in the shoulder into the joint. A mini-camera on the end of the scope transmits images back to a large video monitor in the operating room. The surgeon can look at the monitor and see inside the joint to determine the source of pain and decide how to treat it. Arthroscopy is used for both diagnosis and repair.

To repair damage in the cartilage, bones, tendons or ligaments, the surgeon will make several additional small incisions. Tiny, specially designed surgical instruments are inserted through the incisions and into the joint. Using the instruments, the surgeon can suture torn tissue, remove or shave cartilage and bone spurs, and implant metal or plastic parts joint to aid in stabilizing the joint.

For more information about arthroscopy, go to www.kaganortho.com/learn-more/animations/educational-animations-orthopedics-pain-management


Frozen Shoulder

Frozen shoulder or adhesive capsulitis, is a painful condition where the shoulder literally feels stiff and “frozen” in place with limited or no range of motion. While an injury to the shoulder, or inflammatory conditions such as bursitis and tendinitis can increase the risk for frozen shoulder, many times there is no direct cause. People with diabetes, cervical disc disease of the neck and thyroid disease seem to be at higher risk. The risk also increases with age.

Doctors do know that with frozen shoulder, there is inflammation, scarring, thickening or shrinkage of the joint capsule in the shoulder joint, preventing the shoulder bones from moving freely in the joint.

The first line of treatment for frozen shoulder is usually anti-inflammatory medication, cortisone injections, stretching exercises and physical therapy. Sometimes, it may take anywhere from six months to a year for full return of motion. The early treatment begins, the better.

Your physician may recommend more aggressive treatment to reverse the condition and allow you to use your shoulder and arm again. Shoulder arthroscopy may be scheduled. During this minimally invasive outpatient procedure, the surgeon will remove the build-up of scar tissue and cut tight ligaments in the shoulder that restrict motion. Physical therapy will be prescribed after surgery to maintain range of motion and prevent a recurrence of the frozen shoulder syndrome.

For more information about frozen shoulder or other shoulder-related conditions, go to www.kaganortho.com/learn-more


Shoulder Rotator Cuff Repair

A rotator cuff tear is a challenging shoulder injury that can cause a throbbing ache when you try to raise or lower your arm or lift an object. You might wake up at night in pain if you happen to roll over onto the affected shoulder while you’re sleeping.

What exactly is the rotator cuff?

According to the American Academy of Orthopedic Surgeons, the rotator cuff is a group of tendons that form a covering around the top of the humerus or upper arm bone. These tendons keep the arm in the shoulder socket by attaching the humerus to the shoulder blade. They allow you move your arm and shoulder in various directions.

What causes the rotator cuff to tear?

An activity that repeatedly overstresses the shoulder joint to the point of fatigue can tear one or more of the tendons, causing them to pull away from the shoulder bone. Avid tennis players, baseball pitchers and bodybuilders, as well as painters, carpenters and workers who lift heavy objects are particularly at risk. Falling onto a outstretched arm can also tear the rotator cuff.

But the normal wear and tear that affects the joints with age, such as bone spurs and poor blood circulation, can also weaken the tendons and make them more susceptible to tearing.

The first line of treatment may be ice, rest, anti-inflammatory medication and steroid injections. More severe injuries will need surgery to reattach the tendon to the humerus. Call the doctor if you’ve sustained an acute, traumatic injury or you have significant weakness, loss of function and pain.

To learn more about treating rotator cuff injuries, go to www.kaganortho.com/learn-more


Shoulder Injections for Pain

When it comes to acute or chronic shoulder pain, many patients want to know about nonsurgical treatment options before they consider surgery. Injections with an anesthetic and steroid solution are one of the most common nonsurgical treatments for shoulder pain. It can be a very effective solution for reducing inflammation, improving range of motion and relieving pain.

Injections are done on an outpatient basis with only local anesthesia so you will go home the same day. Depending on the procedure, X-ray and a contrast dye may be used to help guide the physician in correct placement of the needle into the shoulder joint.

 A variety of shoulder conditions respond well to treatment with injection. For example, it is useful for bursitis, which is an inflammation of the bursa, a small fluid-filled sac that serves as a cushion and reduces friction between the bones and muscles in the shoulder joint. When the bursa becomes inflamed, moving the shoulder can be very painful, even to comb your hair. A corticosteroid medication injected into the bursa will reduce inflammation and discomfort.

Injections can also be effective for nonsurgical treatment of rotator cuff injury, frozen shoulder, early-stage arthritis and for trigger points, the small knots that can form in the muscles and connective tissue around the shoulder and upper back.

In addition, a nerve block is often used to treat pain and inflammation from impingement of the nerves in the shoulder joint. A corticosteroid solution is injected into the nerve to soothe the tissues and reduce inflammation.

For more information about treating shoulder pain with nonsurgical options, go to

www.kaganortho.com/learn-more/animations/educational-animations-orthopedics-pain-management.


Painful Shoulder After Tennis, Weight Lifting or Swimming?

The shoulder joint is one of the most flexible joints in the body, giving you the range of motion needed to swing your arm in nearly every direction.  But the ligaments, tendons and muscles holding the joint together can easily become strained through continuous, repetitive motion. 

 Who’s at Risk for Shoulder Injuries?

 If you’re an avid athlete and enjoy a competitive game of tennis where you’re constantly reaching overhead to serve or hit the ball, you can easily overdo it, leading to discomfort and perhaps chronic pain.  The same situation can happen with people who enjoy swimming laps, gardening or pitching on a baseball team.

Certain jobs can place you at higher risk for shoulder injuries, too, including painting, carpentry, construction and movers. Arthritis can also affect the shoulder joint.  And so can trauma, such as a car accident.

Typical shoulder injuries include shoulder impingement, which is the inflammation of the tendons in the shoulder, often called swimmer’s shoulder, tennis shoulder or rotator cuff tendonitis.  Frozen shoulder is a condition where the shoulder is very painful and stiff, which limits movement.  In addition, the rotator cuff muscles and tendons in the shoulder can be torn. 

Warning Signs To Look For

According to the American Association of Orthopedic Surgeons, the warning signs to look out for with a shoulder injury include: stiffness in your shoulder; pain when you try to rotate your arm in all directions; an unstable feeling like the shoulder is popping or sliding out of the socket; pain when sleeping on the affected shoulder; and general weakness that makes it difficult to lift a grocery bag or open a heavy door.

Treatment with Arthroscopy

 When icing the shoulder, taking ant-inflammatory medications and rest fail to provide relief, shoulder arthroscopy might be the answer.  This minimally invasive procedure can be done to evaluate and diagnose the extent of your injury, as well as treat it.

Arthroscopy is done on an outpatient basis so you’ll go home the same day.   The surgeon will make a tiny incision around the shoulder joint large enough to insert a small instrument called an athroscope.  The arthroscope allows the surgeon to look inside the joint to see the damage, repair torn tissue and remove loose fragments of cartilage.

 After arthroscopic surgery, icing the shoulder will help reduce comfort and swelling.  Most people can return to normal activity within a week to ten days of their procedure.  Physical therapy is usually recommended to help patients regain full function of the shoulder.

For more information on shoulder conditions and other orthopedic-related problems, go to http://www.kaganortho.com/



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