Shoulder

Allowing a full 180-degree range of motion on three different planes, the shoulder is a truly extraordinary joint. It is a complex structure made of three separate joints, working together to give you a tremendous range of motion. Yet, it is often true that the more a joint can do, the more can go wrong — and so the more specialized treatment it requires. Florida Orthopaedic Institute physicians have the expertise and experience to provide comprehensive care of the shoulder including nonsurgical treatments, arthroscopic, and open surgeries.

Since your shoulder is such a complicated part of your body, there are many conditions that can affect it. The following helps provide you with an overview of some of the more common shoulder ailments.

Shoulder Arthroscopy

Surgeons at Florida Orthopaedic Institute use shoulder arthroscopy to examine and repair various problems inside and around the shoulder joint, using very small incisions. An arthroscope allows the surgeon to see all the structures inside the shoulder and make repairs using specialized instruments.

Because the arthroscope and surgical instruments are small, the surgeon only needs to make small incisions. Smaller incisions result in less pain and shorter recovery time. Most shoulder arthroscopies are performed an outpatient basis without an overnight stay at a hospital.

Arthroscopic surgery treats a variety of common shoulder problems including rotator cuff tears, labral tears, shoulder instability, impingements bursitis, tendonitis, and arthritis.

Bursitis or Tendinitis

Overuse injuries from continually over-exerting activities are some of the major cause of bursitis or tendinitis. Overuse injuries are commonly found in individuals who play competitive sports, but can also be related to repetitive activities such as painting or stocking shelves. The overuse activities cause friction and scraping of the rotator cuff and its nearby joints. Bursitis or tendinitis is cared for by moderating and reducing the activity, along with a rehabilitation program prescribed by a Florida Orthopaedic Shoulder specialist.

Shoulder Impingement

Shoulder impingement is typically found in athletes that regularly do over-the-head motions. If medical expertise is consulted and treated in the early stages, shoulder impingement can be corrected in a conservative nonsurgical manner. Delaying consultation can result in more damage to the impingement. If you are experiencing pain while performing an overhead activity, consult a Florida Orthopaedic Institute specialist as soon as possible. If this condition is detected early on, adjusting the associated activity including prescribed physical movements/exercises and, possibly, a cortisone injection may return you to your normal activity. If this is not successful, surgery may be required.

Rotator Cuff Tear

A significant injury, such as falling, can cause a rotator cuff tear. Rotator cuff tears can also be caused by a prolonged breakdown or degeneration of the associated tendon. Symptoms may include radiating pain from your shoulder down your arm, pain while sleeping on the affected side, or weakness of your arm while attempting to perform daily activities. The more the pain worsens, the more it probably indicates that the tear is getting larger. If you experience these or similar symptoms, it’s important that you consult with a Florida Orthopaedic Institute surgeon who specializes in this area. Your surgeon will likely recommend an MRI (magnetic resonance imaging) to confirm and identify the extent of the injury.

If identified early on, nonsurgical treatment may care for your rotator cuff tear. Prescribed under the care of your Florida Orthopaedic Institute surgical specialist, nonsurgical care may include anti-inflammatory medicine, cortisone injections and physical therapy. If your tear is significant and has not responded to a nonsurgical care approach, surgery will probably be recommended. The goal of our shoulder specialists is to collaborate and work with you to relieve your pain and restore your strength.

Fractured Collarbone

Fractured collarbones typically occur in children or people who fall on the side of their shoulder. Most these injuries can be cared for nonsurgically with a sling and/or splint. If the injury is found to be a severely displaced fracture or joint separation, you may need require surgery. At Florida Orthopaedic Institute, we have physicians who specialize in providing comprehensive care of the shoulder, including fractured collarbones.

Rotator Cuff Tears

The rotator cuff is a group of muscles and tendons in the shoulder. They hold your upper arm bones in your shoulder sockets. They keep your arm stable while allowing it to lift and rotate. Too much stress on the rotator cuff can cause a tear. This can be a painful injury.

A rotator cuff tear is a tear in the tissues connecting muscle to bone (tendons) around the shoulder joint. People who perform the same shoulder motions repeatedly are very susceptible to the condition. Symptoms include shoulder pain and weakness.

Rotator cuff tears are very common, with more than 3 million cases in the U.S. per year.

A medical diagnosis is needed, and diagnostic imaging is often used for confirmation.

Bioinductive Implant

Surgeons at Florida Orthopaedic are now repairing rotator cuff tendon tears quickly with a new minimally invasive surgical approach using the latest technology: a postage-sized bioinductive implant that induces new tendinous tissue to grow and help tendons heal.

Rotator cuff tears are caused by a variety of factors, including genetics, trauma, age or activity-related injury. Tears that start out small often develop into larger, more painful and debilitating injuries due to continuing degeneration of the torn tendon. This new technology biologically augments the tendon through the induction of new tendinous tissue growth helps patients get back to the activities they love.

Shoulder Arthritis

Shoulder arthritis can affect your range of motion and ability to do everyday things. It can be caused by a number of different factors including osteoarthritis and rheumatoid arthritis. Often hereditary, osteoarthritis most commonly occurs in people over the age of 50. Osteoarthritis in younger people can be a result of an injury or trauma, such as a fractured or dislocated shoulder, known as posttraumatic arthritis. Pain while (and after) moving the shoulder, pain while sleeping and a limited range of motion are common symptoms.

Physicians at Florida Orthopaedic Institute are nationally renowned for treating shoulder arthritis and in shoulder replacement surgery.

Osteoarthritis and Rheumatoid Arthritis of the Shoulder

Osteoarthritis strikes when the shoulder joint wears thin. Rheumatoid arthritis is caused by inflammation of the lining of the joint that that ultimately destroys the lining of the joint due to the chemicals produced. Degeneration and tearing of the tissues can also result.

If you have pain in your shoulder that limits your motion, your Florida Orthopaedic Institute shoulder specialists may recommend replacing the head of the bone or the entire socket. As always, your surgeon will discuss the best treatment options for your situation.

Bankart Repair

A Bankart Repair is a minimally invasive surgical procedure that repairs a tear of the glenoid labrum in the shoulder.

When the shoulder pops out of joint frequently and tears the inferior glenohumeral ligament, it’s called a Bankart lesion, named after English orthopedist Arthur Bankart.

A Bankart Repair re-anchors the torn pieces of cartilage to restore security and stability to the shoulder.

Bicep Tendon Tear

When the biceps muscle is torn from the bone at the point of attachment (tendon) to the shoulder, a biceps tendon rupture occurs. While this can occur at the elbow, the biceps tendon is most commonly torn at the shoulder. Biceps tendon ruptures occur more often in men than women and most injuries happen at 40 to 60 years of age due to chronic wear of the biceps tendon.

In younger individuals, the tear usually comes from trauma such as an auto accident or fall. Biceps tendon ruptures can also occur at any age. People who perform repetitive overhead lifting, work in occupations that require heavy lifting and athletes who lift weights or participate in aggressive contact sports are at risk.

Biceps Tenodesis

Surgery to repair the biceps tendon is called biceps tenodesis. It is typically used when the biceps tendon causes pain in and around the shoulder.

Shoulder pain can be the result of inflammation and wear and tear to the tendon due to injury, overuse, and aging.

Other causes can be torn tissues or problems with the rotator cuff, often occurring in athletes.

CALCIFIC TENDONITIS OF THE SHOULDER

One of the most common causes of shoulder pain, calcific tendonitis (or tendinitis) occurs when calcium deposits build up in your muscles or tendons. It usually occurs in the rotator cuff although it can happen anywhere in the body.

The group of muscles and tendons that connect your upper arm to your shoulder is known as the rotator cuff. Calcium buildup in this area causes pain and discomfort as well as restricting the range of motion in your arm

Calcific tendonitis is more likely if you play sports like basketball or tennis or perform a lot of overhead motions, such as heavy lifting.

Dislocated Shoulders

Dislocated shoulders are an injury in which the upper arm bone comes out of the shoulder blade socket. Despite a relatively high awareness of this injury, dislocated shoulders are relatively rare, with fewer than 200,000 cases in the United States per year.

Most people are able to self-diagnose the injury with symptoms including swelling, pain, and inability to move the joint. Dislocated shoulders need prompt medical care to move the bone in place, plus splinting, medication, and rehabilitation.

Fractures Of The Shoulder Socket

Fractures of the shoulder socket are a relatively uncommon. They most often occur when there is significant trauma to the shoulder, or as a result of high-energy sports injuries.

The two most common fractures are glenoid lip fractures and glenoid fossa fractures.

Glenoid lip fractures occur during a shoulder dislocation or shoulder subluxation, and the ball comes out of the socket. As the ball dislocates, it can cause a fragment of the bone to fracture as it pushes against the rim of the glenoid socket

Glenoid fossa fractures are less common, often associated with severe trauma.

FRACTURES OF THE SHOULDER BLADE (SCAPULA)

The shoulder blade (scapula) is rarely fractured or broken. Shoulder blade fractures occur in less than 1% of all bone breaks. Shoulder blade fractures occur more often in young men ages 25 to 45 because of their activities and trauma encountered, such as athletics, motor vehicle accidents, and other forms of blunt trauma.

Fractured shoulder blades can also include severe injuries to the chest, lungs, and internal organs, with associated injuries in up to 80% of people.

Symptoms can include pain, swelling, and bruising over the shoulder blade in the upper back or on the top of the shoulder. Other signs of a fractured shoulder blade may include pain when moving the arm, inability to move the arm, and pain with deep breaths.

Reverse Total Shoulder Replacement

During this procedure, the surgeon replaces a damaged shoulder joint with artificial components that reverse the structure of the shoulder. Reverse total shoulder replacement is used to treat conditions that cannot be treated with conventional total shoulder replacement or other procedures.

This procedure is most often used for patients who have had a complete tear of the rotator cuff, especially when those whose injuries have led to an arthritic condition called cuff tear arthropathy. It is also helpful for patients who have had a failed total shoulder replacement.

In 1998, Dr. Frankle of Florida Orthopaedic Institute performed the first reverse shoulder replacement in the United States, here in Tampa.

Glenoid Labrum Tears

The socket joint of the shoulder (the glenoid) is surrounded by the labrum, a fibrocartilaginous supporting structure. Injuries to this area can be caused by repetitive shoulder motions or acute trauma (falling on an outstretched arm, a direct blow to the shoulder, sudden pull or a violent overhead reach when trying to stop a fall or slide).

Glenoid labrum tears are more common in athletes who throw overhead and collision sports, including football, basketball, lacrosse, rugby, wrestling and volleyball. Labrum tears can also result from an acute or traumatic event, like a fall, and with age due to wear and tear.

Rheumatoid Arthritis (RA) of the Shoulder

An autoimmune condition called rheumatoid arthritis (RA) is a common form of shoulder arthritis. If you have RA, it’s common to have pain in both shoulders at one time.

People with RA also experience a tenderness or warmth in their joints or a stiff feeling in their shoulders, especially in the morning.

In Rheumatoid Arthritis, your body attacks your own healthy cells, which include the lining of the shoulder joints. For this reason, Rheumatoid Arthritis is known as an autoimmune disorder.

SLAP TEARS & REPAIRS

A SLAP tear is an injury to the ring of cartilage surrounding the socket of the shoulder joint (the labrum). The labrum helps hold the head of the humerus in place.

A SLAP injury happens where the biceps tendon meets the labrum. This injury is called a “SLAP” tear – SLAP standing for Superior Labrum Anterior and Posterior.

A SLAP repair fixes the tear of the labrum by reattaching the torn labrum to the shoulder socket’s bone, restoring normal anatomy and function of your shoulder.

Nonsurgical treatments are used if the injury is mild to moderate and can include non-steroidal anti-inflammatory drugs and physical therapy.

AC (ACROMIOCLAVICULAR) JOINT INJURIES

The acromioclavicular (AC) joint connects your collarbone (clavicle) and the shoulder blade (acromion). The AC joint is part of the shoulder girdle that supports the shoulder joint.

An injury to the top of the shoulder is an AC joint injury. Injuries to the AC joint are also called shoulder separations.

Trauma, such as a fall directly on the outside of the shoulder, is the typical cause of an AC joint injury. Repeated lifting of heavy weights or objects overhead poorly (overuse) also can result in an AC joint injury.

People younger than 35 are the most common to get AC joint injuries, with males five times more likely than females. Activities like football, biking, skiing, and hockey have the highest risk for this injury, especially for younger athletes.

ATRAUMATIC SHOULDER INSTABILITY

Atraumatic shoulder instability is a condition when the shoulder starts to slip part way out of the shoulder joint without having a significant injury. Specifically, the head of the humerus slowly, over time, slips out of its socket, without having experienced an injury or a traumatic incident.

Atraumatic shoulder instability can come from a variety of causes. A small or flat shoulder socket, weak muscles, disuse, stretchy ligaments, and loss of normal coordination may contribute to atraumatic shoulder instability.

CLAVICLE FRACTURES

A common shoulder injury, a clavicle fracture is a break of the bone that rests between the shoulder blade and the sternum, usually called the collarbone. The collarbone helps connect your arms to your body.

Clavicle fractures account for 5% of all adult fractures and 13% of children’s fractures. The clavicle is the most commonly broken bone in the human body.

They are the most common pediatric fracture and about half of the clavicle fractures occur in children under the age of seven. Clavicle fractures occur more often in males and are roughly 5% of all fractures seen in hospital emergency rooms.

Clavicle fractures are often treated without surgery, but in severe cases, surgery may be needed.

IMPINGEMENT SYNDROME OF THE SHOULDER

Impingement syndrome of the shoulder happens when soft tissues in your shoulder rub and press against a part of your shoulder blade called the acromion. This can irritate a soft sac called the subacromial bursa and your rotator cuff tendons.

Also called rotator cuff tendinitis, it is a common condition with over 200,000 cases in the U.S. every year. Injury and overuse and are the most common causes. Symptoms include stiffness around the shoulder joint and pain that is often described as a dull ache.

TRAUMATIC SHOULDER INSTABILITY

When any part of the shoulder sustains some type of repetitive, chronic, forceful contact leading to gradual weakening, it is called traumatic shoulder instability. The injury affects the shoulder’s ability to move freely and function properly. These injuries usually result from severe and unexpected events that cause immediate and significant damage.

Some of the more common specific traumatic instabilities are ligament tears near the glenoid bone, SLAP (Superior Labrum, Anterior and Posterior) tears or lesions, and TUBS syndrome (Traumatic Anterior Shoulder Instability) – also called a Bankart lesion.

SHOULDER INJURIES IN THE THROWING ATHLETE

Overhead throwing places very high stress on the shoulder and the parts that keep the shoulder stable. When these high stresses are repeated many times, they can lead to a wide range of overuse injuries in throwing athletes.

Most commonly seen in baseball pitchers, throwing injuries in the shoulder can occur in athletes who participate in sports such as tennis, volleyball, swimming, and track and field events that require repetitive overhead motions.

Shoulder pain or instability can also result from conditions including tendinitis, rotator cuff tears, labrum tears/SLAP injuries, bicep muscle tears and impingement (when an injured shoulder presses against a neighboring part).

SHOULDER SEPARATIONS

A shoulder separation can occur when trauma damages the ligaments around the acromioclavicular (AC) joint. The AC joint is where the collarbone (clavicle) meets the shoulder blade (scapula).

A mild shoulder separation sprains the AC ligament but does not move the collarbone and looks normal on X-rays. A more serious injury tears the AC ligament and sprains or slightly tears the coracoclavicular (CC) ligament, putting the collarbone out of alignment. A severe shoulder separation completely tears both the AC and CC ligaments and puts the AC joint noticeably out of position, with a more significant bump.

SUBACROMIAL DECOMPRESSION

Subacromial impingement is a pain you feel when you raise your arm. It happens when tendons in your shoulder press and rub against a part of your shoulder blade called the acromion. Subacromial decompression is the surgery to repair a subacromial impingement and is commonly done with the help of a special camera called an arthroscope.

Trapezius Strain (Muscle Strain of The Upper Back)

When you stretch or tear the trapezius, one of the major muscles of the back, you can get a trapezius strain. Your trapezius is responsible for moving, rotating, and stabilizing the shoulder blade. It also helps extend the head at the neck. Symptoms depend on which part of the muscle is injured and can include stiffness, soreness, and aching and burning sensations.