Posts Tagged ‘shoulder injury’

Common Causes of Shoulder Pain

shoulder-painThe shoulder is a region of the body comprised of several bones, muscles and tendons. The shoulder’s main function is to help position the hand in space whether it is scratching your back to throwing a football. But mobility has its price: it can lead to increasing problems with instability or impingement of the soft tissues in your shoulder, resulting in pain that may be temporary or continuous.

Most shoulder problems fall into five major categories:

  • Tendon inflammation and tears
  • Instability
  • Arthritis
  • Fracture (broken bone)

Tendon Inflammation and tears

Overuse activities tend to affect people in the form of bursitis and tendinitis. Tendonitis is an inflammation of the tendon, while bursitis is the inflammation of a bursa. A bursa is a small fluid-filled sac usually found over the joints and between tendons and bones that allows for easy gliding.

The most commonly affected tendons in the shoulder are the four rotator cuff tendons. Rotator cuff tendonitis and bursitis are usually caused by a shoulder injury or overuse of the shoulder, such as a job that involves a lot of overhead lifting. With any kind of should injury, the tendons or bursa may become inflamed, meaning there is less space within the joint for the tendons and muscles to move. If the tendon is repeatedly scraped against the shoulder bones, it can gradually weaken and will sometimes tear. This is often referred to as impingement.

Causes: Rotator cuff tendonitis and bursitis are usually caused by a shoulder injury or overuse of the shoulder, such as a job that involves a lot of overhead lifting.

Treatments: Resting the shoulder and avoiding activity or positions that cause pain is often the first course of treatment. Your doctor might prescribe a cortisone injection to reduce the inflammation and control the pain, followed by physical therapy.

Instability

Shoulder instability occurs when the head of the upper arm bone, known as the humeral head, is forced out of the shoulder socket. This can range from a slipping or “catching” feeling in your shoulder, to a complete dislocation where the ball comes all the way out of the socket. Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly, which can cause pain, unsteadiness and ultimately arthritis.

Causes: It takes significant trauma, such as a fall or being tackled in a football game, to cause a completely dislocated shoulder.

Treatments: Doctors will maneuver the arm bone back into the shoulder socket. Once repaired, you’ll likely wear a sling for a few weeks. For recurring dislocations, shoulder surgery may be required.

Arthritis

Shoulder pain can also result from arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as “wear and tear” arthritis. Often people will avoid shoulder movements in an attempt to lessen arthritis pain. This can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.

Causes: Osteoarthritis may be related to sports or work injuries and chronic wear and tear. Other types of arthritis can be related to rotator cuff tears, infection, or an inflammation of the joint lining (e.g. rheumatoid arthritis).

Treatments: Lifestyle changes, such as range-of-motion exercises, physical therapy, or rest. Medications such as ibuprofen or other anti-inflammatory medications may also be helpful to calm inflammation and reduce pain. In some cases once conservative measures have failed, the joint may need to be replaced with an artificial joint.

Fracture

Fractures are broken bones. Shoulder fractures commonly involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade). Fractures often cause severe pain, swelling, and bruising about the shoulder.

Causes: Shoulder fractures in older patients are often the result of a fall from standing height. In younger patients, shoulder fractures are often caused by a high energy injury, such as a motor vehicle accident or contact sports injury.

Treatments: A simple sling or “figure of 8” strap is worn for three to eight weeks, depending on the patient’s pain. Surgery may also be necessary, which may include placing plates and screws or wires and sutures.

When your shoulder is injured, it can disrupt your normal routine. The orthopedic surgeons at Emory Orthopaedic & Spine Center specialize in treating all types of shoulder conditions and injuries. Our physicians are nationally recognized leaders in their surgical field, helping to initiate and design new shoulder treatment techniques and train future surgeons. They also work along each patient and his/her family to tailor each treatment plan to achieve the best possible outcome. This highly-focused and individualized care has resulted in our patients consistently awarding us with the highest level of patient satisfaction scores.

To make an appointment to see one of our Emory shoulder specialists, please call 404-778-3350 or complete our online appointment request form.

About Dr. Gottschalk

gottschalk-michaelDr. Michael Gottschalk grew up in Dallas, Texas as the youngest of three boys. He went on to graduate from JJ Pierce High School in the top 10% of his class and as an AP Scholar with Distinction. Dr. Gottschalk received an academic scholarship to attend the Business Honors Program at the University of Texas at Austin. After graduating from UT Austin, he then went to complete medical school at the University of Texas Health Science at San Antonio. Upon completion of medical school, Dr. Gottschalk completed his Orthopaedic Surgery Internship and Residency at Emory University. While in his training, Dr. Gottschalk received multiple accolades and awards for his outstanding research and was elected as a resident leader to the esteemed American Orthopaedic Association.

After the completion of his Orthopaedic Surgical Training, Dr. Gottschalk was selected to the prestigious Emanuel Kaplan Hand and Upper Extremity Fellowship at the NYU Hospital For Joint Diseases. He was selected as the Hand and Upper Extremity administrative fellow and served on the resident council for quality and safety. During his training at the Hospital for Joint Diseases, Dr. Gottschalk helped treat work related injuries to the NYPD, NYFD, and hotel trade union.

Dr. Gottschalk and his wife Kim are delighted to be back in Atlanta with their new addition to their family, Reese Gottschalk. When not at work he enjoys spending time with his family and dog, Riley the Rhodesian Ridgeback. His other hobbies include working-out, golf, tennis, and fly-fishing.

Rotator Cuff Surgery

rotator cuffThe rotator cuff is a group of four tendons and their attached muscles that stabilize the shoulder and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.

When the tendons and muscles of the rotator cuff are overly stretched or damaged, the shoulder may begin to hurt. Patients with a rotator cuff tear usually have a dull ache in their upper arm in the area of the deltoid muscle. Neck pain on the same side may develop over time, as well as dull headaches. Patients may experience weakness or “popping” in the shoulder. and have difficulty with over-head shoulder activities (tennis, swimming, getting dressed). Night pain is a common finding with rotator cuff injuries, and may result in the inability to sleep.

If you’ve torn your rotator cuff, your doctor may recommend surgery if your pain does not improve with nonsurgical methods. These include exercises using light weights and rubber bands, anti-inflammatory medications and massage to relieve discomfort. Continued pain and inability to perform the activities of daily living are the primary indications for surgery, and if you’re very active and use your arms for overhead work or sports, your doctor may also suggest surgery.

Surgery to repair a torn rotator cuff most typically involves sewing the torn edges of the tendon to their insertion on the top of the humerus, but partial tears may only require a trimming or smoothing procedure (debridement) to remove loose fragments of tendon, thickened bursa, and other debris from around the shoulder joint.

In open shoulder surgery, a surgeon makes an incision in the shoulder to open it and view the shoulder directly while repairing it. However, most tears can be fixed via arthroscopic surgery. Arthroscopic rotator cuff repair is a minimally invasive technique for repairing a damaged rotator cuff. Using a small fiberoptic camera, the surgeon repairs the rotator cuff through 2-3 small incisions (portals) in the shoulder. Arthroscopic techniques result in less pain and stiffness, thus leading to a faster initial recovery time. Because arthroscopic tools are thin, your surgeon can use very small incisions, rather than the larger incision needed for standard, open surgery.

Surgery for rotator cuff repair requires significant recovery time. The patient will most likely wear a sling for four to six weeks. It will take approximately 3 months for initial healing of the tendon, but patients may begin light activities, such as writing and typing, almost immediately after surgery. Light weightlifting and shoulder strengthening begins 10-12 weeks post-operatively. You may not have significant pain relief or an increase in motion for several months following rotator cuff surgery. The healing process, coupled with physical therapy takes an extended period of time, sometimes up to six to nine months for a full recovery.

About Dr. Karas

Spero Karas, MDSpero Karas, MD,  is the Director of the Orthopaedic Sports Medicine Fellowship Program and an Associate Professor of Orthopaedic Surgery at Emory University. Dr. Karas is an internationally recognized expert in his field, which includes sports medicine, surgery of the shoulder and knee, and arthroscopic surgery. He has been recognized as one of America’s “Top Orthopaedic Doctors” in Men’s Health Magazine April 2007 and “Top Sports Medicine Specialists for Women” in Women’s Health Magazine. Atlanta Magazine has named him “Atlanta’s Most Trusted Sports Medicine Specialist” for the past eight years.

Dr. Karas came to Emory in 2005, after serving as Chief of the Shoulder Service and team physician at the University of North Carolina in Chapel Hill. He currently serves as team physician for the Atlanta Falcons, as well as a consulting team physician for Emory University and Georgia Tech athletics. He cares for patients and athletes of all levels: professional, collegiate, scholastic, and recreational.

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Athletic Injuries: Young Athletes Play Through the Pain

Athletic Injury Young AthletesA new study shows that many young athletes keep on playing after they’ve been injured. And all too often, those injuries could have been prevented. Safe Kids Worldwide, a global nonprofit organization with a mission of preventing unintentional childhood injury, found that kids are suffering from overuse injuries, dehydration, and even head injuries.

Kids are under pressure to play at a much higher level and with more intensity than they did decades ago. A pitcher who shows potential may play on two or three different teams during a single season. And Safe Kids found there’s a lot of pressure to stay in the game—even when you’re hurt.

A new Safe Kids study shows a third of young athletes who play team sports suffer injuries severe enough to require medical treatment. But nearly 90% of parents underestimate how much time kids need to recover.

As a result, Emory pediatric orthopedic surgeon Dr. Nicholas Fletcher says, a lot of kids play hurt.

“Kids think if they take a week off, they’ll get kicked off the team, or their parents won’t let them play anymore. It’s very important for the kid to stay on the team, so a lot of times they’ll mask the injury,” says Dr. Fletcher.

Safe Kids found that half of the coaches said they’d felt pressure—either from kids or parents—to put an injured child back in the game. And nearly a third of kids said they would play hurt unless their coach made them stop.

“One of the biggest take-home messages I try to convey to coaches is that this 11-year-old also has a 12-year-old and a 13-year-old and a 14-year-old season,” says Dr. Fletcher, who sees a lot of young players with ACL tears, hip injuries, and throwing injuries. Many of those problems are from overuse. He says if a young athlete is not given time to heal and given proper treatment, he or she can be left with lifelong problems.

Has your son or daughter suffered a sports injury and kept on playing? We welcome your questions and feedback in the comments section below.

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