Shoulder Injuries

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What is the shoulder joint?
The shoulder joint is made of three bones which come together at one place. The arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle) all meet up at the top of the shoulder. The joint between the humerus and scapula, the glenohumeral joint, is a ball-and-socket joint--the ball is on the top of the humerus, and this fits into a socket of the shoulder blade called the glenoid. This joint allows us to move our shoulder though an amazing arc of motion--no joint in the body allows more motion than the glenohumeral joint. Unfortunately, by allowing this wide range of motion, the shoulder is not as stable as other joints. Because of this, shoulder dislocations are not uncommon injuries.

The rotator cuff muscles control rotation of the shoulder. They consist of the infraspinatus, teres minor and supraspinatus which rotate the shoulder outwards and the subscapularis which is one of the muscles which rotate the shoulder inwards.

These muscles are put under a great deal of strain especially in throwing events and racket sports where your arm is above your head a lot. A sudden sharp pain in the shoulder would indicate a possible rupture of a tendon, while a gradual onset is more likely to be inflammation.

What is a SLAP lesion?
A SLAP Lesion, or Superior Labral tear from Anterior to Posterior is a specific injury / tear to the labrum of the shoulder joint.The shoulder joint is a ball and socket joint with a cuff of cartilage called a labrum that holds the humeral head. The SLAP lesion occurs at the point where the tendon of the biceps muscle inserts on the labrum. The mechanism of this injury is usually a fall onto an outstretched arm.

What are the symptoms of a SLAP lesion?
Typical symptoms of a SLAP lesion include a catching sensation and pain with movement, most typically overhead activities such as throwing.

How is a SLAP lesion diagnosed?
Diagnosis can be quite difficult, as these injuries do not show up well on MRI scans. Usually, the diagnosis is made at the time of surgery. A typical course of action when there is suspicion for a SLAP lesion is to try physical therapy, rest, and anti-inflammatory medication.If these treatments do not help the problem, shoulder arthroscopy can be performed, and the injury can be definitively diagnosed and treated.

Surgery for SLAP lesions:
SLAP lesions are usually repaired by keyhole surgery (arthroscopically) through 2 or 3 small incisions. Some SLAP lesions can be simply debrided and cleaned, while most need repairing depending on the severity of the lesion.

What is a Bankart lesion?
When the labrum of the shoulder joint is torn, the stability of the shoulder joint is compromised.A Bankart lesion is due to dislocation of the shoulder, causing a tear in the labrum.  A procedure called a Bankart repair can be performed to fix this ligament. A Bankart repair can a be done either through an incision or an arthroscopically.

What is a Shoulder Dislocation?
A shoulder dislocation occurs when there is an injury to the joint between the humerus and scapula, generally after an injury such as a fall or a sports-related injury. About 95% of the time, when the shoulder dislocates, the top of the humerus is sitting in front of the shoulder blade--an anterior dislocation. In less than 5% of cases, the top of the humerus is behind the shoulder blade--a posterior dislocation. Posterior dislocations are unusual, and seen after injuries such as electrocution or after a seizure.

What is the treatment of shoulder instability?
Treatment of shoulder instability depends on several factors, and almost always begins with physical therapy and rehab. Physical therapy with specific strengthening exercises will help maintain the shoulder in proper position, and will most likely help athletes with multi-directional shoulder instability.

What is a Rotator Cuff injury?
Signs and symptoms

  • Recurrent, constant pain, particularly with overhead activities.
  • Pain at night that prevents you from sleeping on the affected side.
  • Muscle weakness, especially when attempting to lift the arm.
  • Catching and grating or cracking sounds when the arm is moved.
  • Limited motion.
  • Usually occurs in the dominant arm (right shoulder for right-handed people; left shoulder for
    left-handed people).
  • May be triggered by a specific incident.

Risk factors

  • Repetitive overhead motion, such as pitching or painting a ceiling.
  • Heavy lifting.
  • Excessive force, such as a fall.
  • Degeneration due to aging, including a reduction in the blood supply to the tendon.
  • Narrowing of the space (acromioclavicular arch) between the collarbone (clavicle) and the
    top portion (acromion) of the shoulder bone (scapula).
  • Abrasion (rubbing) of the cuff surface by the top portion of the shoulder bone.

Diagnosing a tear
Rotator cuff tears may be partial- or full-thickness. Partial-thickness tears do not completely sever the tendon and may respond well to nonoperative treatments. Full-thickness tears require surgery to correct. Surgery may also be used to treat partial-thickness tears that do not respond to nonoperative treatment.

Treatment options
In most cases, the initial treatment is nonsurgical and involves several modalities.

  • Rest. If the tear is due in part to overuse, resting the shoulder may help.
  • Nonsteroidal anti-inflammatory medications will help control pain.
  • Strengthening and stretching exercises, as part of a physical therapy program.
  • Corticosteroid injections can help reduce pain but cannot be repeated frequently because
    they can also weaken the tendon.

There are several surgical options to treat rotator cuff tears, depending on the size, depth, and location of the tear. If other problems with the shoulder are discovered during the surgery, they will be corrected as well.

  • Arthroscopy, in which miniature instruments are inserted into small incisions, can be used to
    remove bone spurs or inflammatory portions of muscle and to repair lesser tears.
  • A mini-open repair that combines arthroscopy and a small incision can be used to treat full-
    thickness tears.
  • In more severe cases, open surgery is required to repair the injured tendon. Sometimes a
    tissue transfer or a tendon graft is used. Joint replacement is also an option.

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