Posts Tagged ‘shoulder instability’

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.

Do You Have Shoulder Instability?

Shoulder instability is caused when the head of the upper arm bone is forced out of the shoulder socket. Because the shoulder joint is the most mobile joint in our bodies, it is also the joint that is most frequently dislocated. Shoulder instability can develop in a variety of ways:

  • Shoulder InstabilityTrauma or injury, including labral tears and/or dislocations of the shoulder joint.
  • Repetitive motion injury, especially among athletes who would make the same overhead motions again and again, causing excessive wear and tear on the shoulder joint (as in baseball, tennis, swimming or volleyball
  • Genetic factors, which can cause general looseness in the joint and surrounding ligaments, tendons, and muscles, especially when the shoulder is put under strain or stress.

Common Symptoms of Shoulder Instability

  • Pain in shoulder caused by injury
  • Dislocated shoulders due to sports, vehicular, or other types of injury
  • History of shoulder “slipping” in and out of socket
  • Acquired shoulder laxity from repetitive activities such as throwing or swimming.

Diagnosing Shoulder Instability

Shoulder instability can be diagnosed with a careful and thorough physical examination. Imaging tests such as x –rays or a magnetic resonance imaging (MRI) help confirm the diagnosis and locate the exact area of injury. MRIs show the soft tissues a bit better than traditional x-rays.

Treatment of Shoulder Instability

Typically shoulder instability is treated with nonsurgical options. If non-operative treatments don’t relieve the pain and instability, surgery is often necessary. If surgery is required to treat shoulder instability, the goal should be to render the shoulder more stable without sacrificing motion. Whenever possible, minimally invasive surgery is done to repair shoulder instability. Minimally invasive arthroscopic surgery is generally less painful, less likely to cause complications, and enables a rapid early recovery process compared to traditional open surgery. Minimally invasive surgery does not require large dissections and splitting muscle layers; as a result the pain from shoulder stabilization surgery is decreased.

The surgery is carried out under general and regional anesthesia. A small fiber optic scope allows the physician to see inside the joint, and instruments are inserted through two small incisions in the joint to repair the ligaments and the labrum. Depending on the severity of the damage inside the shoulder, surgery may involve labral repair, ligament tightening or both.

Recovery from Shoulder Instability

If surgery is required, the patient may need to wear a sling for a few days or weeks. When the sling is removed, the patient will begin physical therapy. The exercises will improve the range of motion and gradually increase the strength in the shoulder. Physical therapy usually lasts 12-16 weeks.

About Spero Karas, M.D.

Dr. Spero Karas Dr. Karas joined the Emory Orthopaedic & Spine Center physician team in 2005. Dr. Karas is a recognized expert in the field of shoulder surgery, knee surgery, and sports medicine, and has been awarded numerous grants for research and product development. A frequent speaker throughout the United States and internationally, his work has been featured in Ski Magazine, Men’s Health, and on NBC, FOX, and CNN network television. He is also active in quality musculoskeletal research, and has been honored by his peers with nominations for numerous research awards. He actively collaborates with medical corporations by developing cutting-edge technology to improve the instruments and techniques in orthopedic surgery.

Dr. Karas received his undergraduate degree from the University of Notre Dame, and his Doctor of Medicine degree from Indiana University School of Medicine. After medical school, he completed a residency in Orthopedic Surgery at Duke University Medical Center. After residency, Dr. Karas completed a Knee, Shoulder, and Sports Medicine Fellowship at the prestigious Steadman Hawkins Clinic in Vail, Colorado. While in Colorado, he served as an Associate Team physician for the Denver Broncos and Colorado Rockies professional sports teams.

In addition his role as an Emory Sports Medicine Center physician, he currently serves as the head team physician for the Atlanta Falcons, a consulting team physician for Georgia Tech University, Emory University, Oglethorpe University, Georgia Perimeter College, and Lakeside High School. Prior to this, he served as chief of the Shoulder Service, team physician, and director of the Orthopaedic Sports Medicine Fellowship at the University of North Carolina at Chapel Hill Department of Orthopaedics. Dr. Karas was selected as one of America’s “Top Sports Medicine Specialists” in Men’s Health Magazine. He has also been named one of the “Top Sports Medicine Doctors for Women” by Women’s Health magazine, “Best Orthopaedic Surgeons in America” by Castle Connolly, and the most trusted sports specialist in Atlanta, Georgia by Atlanta Magazine.
Dr. Karas was a varsity letterman in wrestling at the University of Notre Dame and continues to participate in sports such as golf, skiing, snowboarding, and fitness training. He also coaches little league sports, and is an active member of his church and community. Dr. Karas and his wife, Johanna, are blessed with three very active and beautiful children – Gus, Elena, and Nicholas.