January 2017

Helpful Facts To Know About Shoulder Joint Tear

Advances in medical technology are enabling doctors to identify and treat injuries that went unnoticed 20 years ago. For example, physicians can now use miniaturized television cameras to see inside a joint. With this tool, they have been able to identify and treat a shoulder injury called a glenoid labrum tear.

The shoulder joint has three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid. The head of the upper arm bone is usually much larger than the socket, and a soft fibrous tissue rim called the labrum surrounds the socket to help stabilize the joint. The rim deepens the socket by up to 50% so that the head of the upper arm bone fits better. In addition, it serves as an attachment site for several ligaments.

Injuries to the tissue rim surrounding the shoulder socket can occur from acute trauma or repetitive shoulder motion. Examples of traumatic injury include:

Falling on an outstretched arm
A direct blow to the shoulder
A sudden pull, such as when trying to lift a heavy object
A violent overhead reach, such as when trying to stop a fall or slide
Throwing athletes or weightlifters can experience glenoid labrum tears as a result of repetitive shoulder motion.

The symptoms of a tear in the shoulder socket rim are very similar to those of other shoulder injuries. Symptoms include

Pain, usually with overhead activities
Catching, locking, popping, or grinding
Occasional night pain or pain with daily activities
A sense of instability in the shoulder
Decreased range of motion
Loss of strength

If you are experiencing shoulder pain, your doctor will take a history of your injury. You may be able to remember a specific incident or you may note that the pain gradually increased. The doctor will do several physical tests to check range of motion, stability, and pain. In addition, the doctor will request x-rays to see if there are any other reasons for your problems.

Because the rim of the shoulder socket is soft tissue, x-rays will not show damage to it. The doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. In both instances, a contrast medium may be injected to help detect tears. Ultimately, however, the diagnosis will be made with arthroscopic surgery.

Tears can be located either above (superior) or below (inferior) the middle of the glenoid socket.

A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon.

A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion.

Tears of the glenoid rim often occur with other shoulder injuries, such as a dislocated shoulder (full or partial dislocation).

Until the final diagnosis is made, your physician may prescribe anti-inflammatory medication and rest to relieve symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles may also be recommended. If these conservative measures are insufficient, your physician may recommend arthroscopic surgery.

During arthroscopic surgery, the doctor will examine the rim and the biceps tendon. If the injury is confined to the rim itself, without involving the tendon, the shoulder is still stable. The surgeon will remove the torn flap and correct any other associated problems. If the tear extends into the biceps tendon or if the tendon is detached, the shoulder is unstable. The surgeon will need to repair and reattach the tendon using absorbable tacks, wires, or sutures.

Tears below the middle of the socket are also associated with shoulder instability. The surgeon will reattach the ligament and tighten the shoulder socket by folding over and “pleating” the tissues.

After surgery, you will need to keep your shoulder in a sling for 3 to 4 weeks. Your physician will also prescribe gentle, passive, pain-free range-of-motion exercises. When the sling is removed, you will need to do motion and flexibility exercises and gradually start to strengthen your biceps. Athletes can usually begin doing sport-specific exercises 6 weeks after surgery, although it will be 3 to 4 months before the shoulder is fully healed.

Orthopedic Braces: An Alternative To SURGERY

We created a post which highlights an alternative approach instead of going through surgery.  Please read it here: orthopedic-bracing-alternative/

Good Luck

Roger SafontHelpful Facts To Know About Shoulder Joint Tear
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Easy and Effective Tips For Healthy Joints

Living with osteoarthritis is a long-term proposition. It’s your job to stay active and keep your joints healthy so that you can do the things you want and need to do, as independently as you can, for as long as you can.

There’s nothing that I as a physician can do to slow the progression of osteoarthritis, says Elinor Mody, MD, medical director of the Gretchen S. and Edward A. Fish Center for Women’s Health and co-director of the Center for Skin and Related Musculoskeletal Disease at Brigham and Women’s Hospital.

And in the vast majority of cases, there’s nothing the patient can do that would make the disease get worse faster.

So much of the time, you can manage your osteoarthritis on your own. But sometimes, you’ll need the guidance of a doctor or physical therapist to cope with pain, handle obstacles, and make sure you’re steering in the right direction. When should you seek help?

When you’re beginning an exercise program.

The worst thing someone with osteoarthritis can do is nothing, says Mody. Exercise is particularly important for people with osteoarthritis. Muscle strengthening takes strain off the joints, and core strengthening has been shown to be very important in taking strain off the knee, preventing injury.

You know how to walk, of course, and the trainer at the gym can show you how to use weight machines. But exercising when you have arthritis is a bit more complicated than it is for a healthy 25-year-old. To avoid injury and make the most of your exercise program, consult a doctor or physical therapist when you begin, to get a customized regimen that’s designed for your own individual needs and limitations.

When pain gets in the way.

Are you avoiding your weekly golf game or working in your beloved garden because it hurts too much to walk or bend? Then it’s time to see your doctor.

When you’re having enough pain that it’s preventing you from doing what you need or want to do, it’s time to intervene, says Mody. Sometimes we can relieve the pain with cortisone or other medications, such as drugs that mimic the effect of chondroitin on cartilage.”

Other ways to alleviate pain include:

Using orthotics, custom-made shoe inserts that help protect knees and hips by acting as shock absorbers when walking
Knee bracing to help to stabilize the knee joint
Applying ice to the affected joint may help improve swelling, pain, and range of motion
Topical analgesics to relieve painful joints
Over-the-counter or prescription medications
In other cases, explains Mody, it may be time to talk about joint replacement surgery. It’s important not to wait too long when that becomes necessary, because that can lead to muscle atrophy and joint contracture, and you may never really get back what you lost.

When you need tools.

Much of the time, you can make your own changes to your home environment to stay as independent as possible and minimize your risk of injury. Get rid of throw rugs, put handles in the bathroom and a shower chair if necessary, and go minimalist in your decor, eliminating things like small occasional chairs and tables that block your path and giving yourself plenty of space to walk around.

But there’s a lot more that can be helpful to you. If you’re encountering a lot of difficulty managing independently at home, ask your physician for a physical/occupational therapy referral, or a home safety evaluation.

They’re like MacGyver, says Mody of occupational therapists. If you have bad osteoarthritis of the hands, for example, they have assistive devices for things like doorknobs, jar lids, and writing with pens.

When you’re de-feeted.

One of the biggest risks with osteoarthritis is a fall, and one of the biggest culprits in falling is bad footwear. Especially if arthritis has had an effect on the shape of your feet, you need customized shoes that will keep you comfortable and well balanced.

It used to be that arthritis patients had to wear these ugly orthopedic shoes, says Mody. Today, there’s no reason to be wearing uncomfortable, ugly or ill-fitting shoes. Talk to your doctor about meeting with a podiatrist. Life is too short to be wearing uncomfortable shoes!

One of the biggest problems Mody sees is patients who wait too long to see their doctor for pain. If you wait until you’ve lost a lot of muscle mass, or no longer have the range of motion you used to have, chances are you won’t get it back.

So, if you’re not sure whether you need to see your doctor, ask yourself these questions:

Can I get into and out of the car with minimal difficulty?
Can I put my shoes on independently?
Can I tie my shoes?

These are all motions that require good rotation of the hip, says Mody. If you’re having trouble with them, you need to see your doctor. With the knee, people usually notice when they’ve lost range of motion there, so fortunately I haven’t seen a significant contracture of the knee in a long time.

Then ask yourself one final question: Are you doing all the things you want to be doing? If not, is it because your arthritis is getting in the way? Then it’s time to see the doctor. Our job as physicians is to have people live the longest, most fulfilled, happiest lives they can.

Roger SafontEasy and Effective Tips For Healthy Joints
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