Dealing with Shoulder Pain? AC Joint Arthritis May Be the Culprit

As a shoulder specialist, I often see patients with shoulder pain that is caused by AC joint arthritis. The AC joint is where the clavicle (collarbone) meets the acromion, the bony projection on the top of the shoulder blade. Arthritis in this joint can cause pain and limit shoulder movement, making even simple tasks like reaching overhead difficult.

If you are experiencing shoulder pain, it's important to see a specialist like me for a proper diagnosis. In my practice, I use a combination of physical examination, imaging tests, and medical history to determine the source of your pain.

If your diagnosis is AC joint arthritis, don't worry. There are several treatment options available that can help you manage your symptoms and get back to your normal activities.

One treatment option is to modify your activity level and avoid movements that cause pain. I can work with you to develop a personalized exercise plan to help maintain strength and flexibility in your shoulder while minimizing stress on the joint.

In some cases, over-the-counter pain medications or corticosteroid injections can help alleviate pain and inflammation. I will discuss these options with you and determine if they are right for your specific case.

For patients with more advanced AC joint arthritis, surgery may be necessary. I specialize in minimally invasive surgery techniques that can effectively treat AC joint arthritis with smaller incisions and faster recovery times than traditional open surgery.

If you're experiencing shoulder pain, don't ignore it. Seeking proper medical attention can help you get the relief you need to return to the activities you love. Schedule an appointment with me to discuss your options for managing AC joint arthritis and getting back to a pain-free life.

Rotator cuff tendinitis

If you are experiencing shoulder pain, weakness, or limited range of motion, you may have rotator cuff tendinitis. This condition occurs when the tendons in the rotator cuff become inflamed or irritated, usually as a result of overuse or injury.

To diagnose rotator cuff tendinitis, I will perform a physical exam and may also order imaging tests such as an MRI or ultrasound to determine the severity of the inflammation and any associated damage to the shoulder.

Treatment for rotator cuff tendinitis may include a combination of rest, ice, anti-inflammatory medication, and physical therapy. I may also recommend corticosteroid injections to reduce inflammation and pain.

In more severe cases, surgical intervention may be necessary. Arthroscopic surgery can be used to repair any tears or damage to the rotator cuff, and a complete recovery can take several months.

It is important to seek treatment for rotator cuff tendinitis as soon as possible to prevent further damage and promote healing. If you are experiencing symptoms, schedule an appointment with me to discuss your options for treatment and recovery.

Arthroscopic labral repair (Bankart repair) animation

An arthroscopic Bankart repair (labral repair) for shoulder dislocations is a very common surgery in my practice. I recently found a good animation from Arthrex on YouTube that can be helpful for patients considering undergoing the procedure.

As always, feel free to contact my office with any questions.

Andrew

Reverse shoulder arthroplasty for complex shoulder osteoarthritis

Reverse shoulder arthroplasty has been used more frequently in patients with complex shoulder arthritis. This procedure is designed for patients who have severe arthritis and rotator cuff damage that has led to significant pain, weakness, and limited range of motion in the shoulder joint.

In a healthy shoulder joint, the ball-shaped end of the upper arm bone (humerus) fits into a shallow socket in the shoulder blade (scapula). The rotator cuff muscles and tendons hold the joint together and allow for a wide range of motion. In a reverse shoulder arthroplasty, the traditional ball-and-socket joint is replaced with a prosthetic device that reverses the position of the ball and socket components.

This reversed configuration of the joint allows the deltoid muscle to take over the function of the damaged rotator cuff muscles and tendons. This can provide significant pain relief and improve the patient’s ability to perform daily activities.

The procedure is performed under general anesthesia, and the surgeon makes an incision over the shoulder joint. The damaged bone and tissue are removed, and the prosthetic components are placed in the shoulder joint. The procedure typically takes two to three hours, and patients will need to stay in the hospital for a few days to monitor their recovery.

After the procedure, patients will need to undergo physical therapy to regain strength and range of motion in the shoulder joint. The length of time for recovery varies depending on the severity of the condition and the extent of the surgery.

Reverse shoulder arthroplasty is a safe and effective option for patients with complex shoulder arthritis who have not responded to non-surgical treatments such as physical therapy, NSAIDs, and corticosteroid injections.

If you are experiencing severe pain, weakness, and limited range of motion in your shoulder joint due to complex shoulder arthritis, I encourage you to reach out to our office or click here to discuss nonsurgical and surgical options.

Andrew

Total shoulder vs reverse shoulder replacement

As reverse shoulder replacements become more and more common, patients routinely come in asking about the difference between it and a standard total shoulder replacement. Here goes my explanation:

Anatomic Total Shoulder Arthroplasty:

An anatomic total shoulder arthroplasty, also known as a traditional shoulder replacement, involves replacing the ball-and-socket joint of the shoulder with a metal ball and a plastic socket. This procedure is typically performed when the patient has arthritis of the shoulder joint and has intact rotator cuff muscles.

During the procedure, the surgeon removes the damaged parts of the shoulder joint and replaces them with the artificial joint. The new joint is designed to replicate the natural movement of the shoulder, allowing the patient to regain a significant amount of mobility and function.

Reverse Total Shoulder Arthroplasty:

A reverse total shoulder arthroplasty, on the other hand, is a more recent innovation that was designed for patients with a rotator cuff tear arthropathy or a massive rotator cuff tear with pseudoparalysis. In these patients, the rotator cuff muscles are not functioning properly and cannot support the joint.

During a reverse shoulder replacement, the surgeon reverses the position of the ball and socket joint. This means that the ball is placed on the socket side of the joint and the socket is placed on the ball side of the joint. This changes the mechanics of the joint and allows the deltoid muscle to take over as the main muscle that powers the shoulder.

The purpose of the reverse shoulder replacement is to restore the patient's ability to lift the arm and perform activities of daily living. However, the range of motion may not be as good as with a traditional shoulder replacement.

In summary, anatomic total shoulder arthroplasty is best for patients who have arthritis of the shoulder joint and have intact rotator cuff muscles. A reverse total shoulder arthroplasty is best for patients who have a rotator cuff tear arthropathy or a massive rotator cuff tear with pseudoparalysis or significant deformity. Both procedures can help improve the patient's quality of life and restore function to the shoulder joint, but it is important to consult with your surgeon to determine which procedure is right for you.

As always, please feel free to contact my office with any questions.

Andrew

Rotator cuff repair animation

Rotator cuff repairs have become more and more frequent over the past several years. I recently found a good animation on YouTube from Dr. Robert Hartzler. This animation can be helpful to patients that are considering undergoing a rotator cuff repair and biceps tenodesis.

as always, feel free to contact my office with any questions.

Andrew

What are the symptoms of shoulder arthritis?

This is part 2 of our discussion on shoulder arthritis. Previous posts include:

What is shoulder arthritis?

Pain is by far the most common symptom of arthritis of the shoulder.  This pain is normally aggravated by activity and worsens over time.  The pain may be felt as a deep ache or may be centered in the back of the shoulder.  This pain also normally intensifies with changes in the weather.  Night pain is also incredibly common with most shoulder problems.

Decreased range-of-motion is also very common with shoulder arthritis.  This may be secondary to pain or may be from a tight shoulder capsule or bone spurs.

Please stay tuned for more posts on the diagnosis and treatment of shoulder arthritis.

How do you surgically repair a rotator cuff tear? Part 1

This is part 1 of our discussion on rotator cuff repairs.

Previous posts on rotator cuff include:

• What is a rotator cuff tear?

• What causes rotator cuff tears?

• How do I know if I have a rotator cuff tear?

• How do I treat my rotator cuff tear?

Rotator cuff surgery is a very generic term that encompasses many different procedures.  They can be as minimal as a debridement of the bursa and the rotator cuff with possible removal of any bone spurs called a “smooth and move” procedure.  This procedure is normally reserved for partial rotator cuff tears or rotator cuff tears that are old or have poor tissue quality.  If you have a complete tear of your rotator cuff with good tissue quality and desire a return to an active lifestyle, you may be candidate for a rotator cuff repair. 

A rotator cuff repair is most commonly done by stitching the tendon back to its original site on the humerus.  In active patients who have a old, complete tear with poor tissue quality, the options are more limited, unfortunately.  Luckily, a new procedure called the superior capsular reconstruction may help restore some shoulder function that would otherwise be impossible.

What is shoulder arthritis?

This post is part 1 of my posts on shoulder arthritis.

Arthritis is the abnormal wearing down of cartilage in the joint.  Cartilage is the smooth, protective layer that acts like a cap at the end of bones in joints.  The complete cause of the most common type of arthritis, osteoarthritis, is still unknown.  We believe that it is a combination of genetic and activity related factors.  The other type of arthritis is called inflammatory arthritis and may include rheumatoid arthritis.  

Arthritis in the shoulder is normally between the ball of the humerus and the socket of the shoulder blade.  Patients can also get arthritis between the shoulder blade and the collar bone, called AC joint arthritis.

Stay tuned for my next posts about the diagnosis and treatment of shoulder arthritis.

Shoulder arthritis

How do I treat my rotator cuff tear? #Seattle #AAOS

This post is a continuation of our talk on rotator cuff tears. Today, we will be discussing the symptoms and diagnosis of rotator cuff tears. Previous posts included:

• What is a rotator cuff tear?

• What causes rotator cuff tears?

• How do I know if I have a rotator cuff tear?

Nonsurgical treatment is usually based on avoiding activities that cause shoulder pain, nonsteroidal antiinflammatory medications, and extensive shoulder stretching at home or with physical therapy.  Often times, the pain in your shoulder is secondary to shoulder stiffness.  Once the stiffness has been resolved, the shoulder pain improves significantly.  In the past, many physicians have recommended steroid injections into the shoulder.  Many shoulder specialists, like myself, do not recommend this course of treatment often due to its negative effect on the rotator cuff tendon.  Steroid injections can make the rotator cuff tendon weaker and more prone to more extensive tearing.

If you had a significant injury that resulted in a rotator cuff tear or you have not improved with extensive physical therapy and home exercises, minimally-invasive rotator cuff surgery may be an option for you.  To learn more about rotator cuff surgery, continue reading here.

I am now a member of the American Shoulder and Elbow Surgeons! #ASESMembers

I am very happy to announce that I have been selected as a candidate member of the American Shoulder and Elbow Surgeons. The American Shoulder and Elbow Surgeons is a society made up of the leading national and international shoulder and elbow surgeons. As the premier organization of shoulder an elbow surgeons, it strives to serve patients and further research and education concerning shoulder and elbow issues. I couldn’t be happier and honored. Thank you #ASES.

Guest posts coming soon!

I will be introducing guests posts from upper extremity experts that I know and trust, discussing all things involving upper extremity injuries and treatment. As many of my patients also suffer from issues regarding the hand and wrist, I believe that this will be a great resource for patients going forward. Stay tuned!

How do I know if i have a rotator cuff tear?

This post is a continuation of our talk on rotator cuff tears. Today, we will be discussing the symptoms and diagnosis of rotator cuff tears. Previous posts included:

• What is a rotator cuff tear?

• What causes rotator cuff tears?

The most common symptoms of rotator cuff tears are:

• pain at night, especially if lying on the affected shoulder

• pain when lifting or lowering your arm or with specific movements

• weakness when lifting or rotate your arm

• cracking or popping sensation when moving her shoulder in certain positions, especially overhead

Tears that happen suddenly, such as from a fall or when lifting something heavy usually cause intense pain.  You may also notice that you are unable to lift your arm after this injury.
Tears that develop slowly due to overuse, usually begin by some vague pain in her shoulder that progresses to worsening pain and then significant pain and weakness.

Some rotator cuff tears, especially those that occur slowly over time, are sometimes not painful.  These tears, however, may still result in some weakness and other symptoms.

Rotator cuff tears can be diagnosed with history and physical examination on most occasions.  Sometimes, advanced imaging such as MRI or ultrasound can be used to confirm a diagnosis of a rotator cuff tear.

Stay tuned for the next post on rotator cuff treatment.

What causes rotator cuff problems?

This is a continuation of my blog series on rotator cuff issues. Today, we will discuss what causes rotator cuff problems.

Rotator cuff problems can fall along a wide spectrum of issues.  The most common is inflammation of the rotator cuff called rotator cuff tendinitis.  Along with this issue is inflammation of the bursa sac called bursitis.  Sometimes, the rotator cuff tears off of the humerus bone.  This can range from a small, partial tear of the rotator cuff tendon to a complete tear of the rotator cuff tendon.  Many times, complete rotator cuff tears begin with minor tendinitis that progress to partial tearing and then complete tear.

There are two main causes of rotator cuff tears: acute injury and degeneration.

Injury to your rotator cuff is usually caused by lifting something very heavy with a jerking motion.  This can tear the rotator cuff tendon off of the humerus bone.

Location of rotator cuff pain

Degenerative tears are by far the most common type of rotator cuff tears.  These tears are often caused by wearing down of the tendon slowly over time.  This type of tear usually starts with tendinitis and progress to partial thickness tears and complete tears.  These can be due to repetitive stress or just wear over time.

Stay tuned for more information about rotator cuff tears. More information can be found here.

Bicep Tendon issues and repairs

Many people hit the gym to get their beach body where they’d like it to be before the summer, but there are sometimes issues with pain or inflammation that can get in their way.

Biceps tendonitis is the technical term for irritation or inflammation in your upper biceps tendon, which attaches your biceps (the muscle located at the front of your upper arm) to your shoulder bones.  Tendons are tough strips of connective tissue which connect muscles to bones and let you move your arms, legs, and other body parts, and your biceps muscle has three of them: two that attach it to your shoulder bones and one that attaches it to your radius, one of your two forearm bone, at your elbow.

What are some of the causes for a bicep tendon injury?

Biceps tendon damage is most often simply the result of wear and tear due to normal daily use. Tendons age just like everything else in our bodies, and as we age they tend to weaken and degenerate just from being used every day over a lifetime. This slow degeneration can be accelerated by overuse or repeating the same motions over and over.

What are the symptoms of a bicep tendon injury?

If you tear your biceps tendon, the most obvious symptom will be pain—sudden and severe pain. Depending on where the tendon is injured, you may feel this in your upper arm or at the elbow. You may feel or even hear a popping sound when the tendon tears.

Other signs that you might have torn your biceps tend are:

• A sudden, sharp pain at your shoulder or in your elbow as the tendon tears

• Bruising of your upper arm in the injured area

• Weakness in your shoulder or your elbow as the muscle becomes detached

• Difficulty turning your arm and hand between palm-up and -down positions, as the detached muscle is unable to do its work

• The front of your upper arm may appear misshapen if the tendon is torn completely. Muscles, when properly attached, are stretched like rubber bands. When the tendon tears, it no longer holds one end in place and the muscle recoils, forming a bulge in your arm.

What are the treatment options for a bicep tendon injury?

While surgery may be necessary to repair a torn biceps tendon, many people are able to function normally without a surgical repair. The appropriate treatment depends on the type of injury and its severity, and in many cases symptoms can be relieved by the same treatments used for tendonitis. Tears that occur at the elbow require surgical repair more often than those at the shoulder.

Some surgical procedures can be done arthroscopically, using small incisions rather than a single large one, although open surgery has very good results and is the one that I prefer.

Surgical repairs for a biceps tendon injury may include:

Reattaching the remaining tendon to the bone.  This procedure is called a biceps tenodesis.

What is the rotator cuff?

The rotator cuff

A common condition that I see and am asked about in clinic is rotator cuff tears.

Rotator cuff problems are some of the more common and frustrating issues that patients can deal with throughout their lives.  Rotator cuff issues can weaken your shoulder and make activities of daily living, like combing your hair or getting dressed painful and difficult to do.

What is the rotator cuff?

Your shoulder is made up of three bones:

• your upper arm bone, called the humerus,

• your shoulder blade, called the scapula, and

• your collar bone, called the clavicle.  

Your arm is partially kept in your shoulder socket by the rotator cuff.  The rotator cuff is a group of four muscles that come together to form tendons that cover the head of your humerus.  The rotator cuff attaches to the humerus and allows you to lift and rotate your arm.  

On top of your rotator cuff, you have a lubricating sac called the bursa.  The bursa allows your rotator cuff to freely glide when you move your arm.  Sometimes, the rotator cuff or the bursa become inflamed and painful.

shoulder bursa

Stay tuned for more information about rotator cuff tears. More information can be found here.

Use of Platelet-Rich Plasma for the Improvement of Pain and Function in Rotator Cuff Tears: A Systematic Review and Meta-analysis With Bias Assessment. #ASES #AAOS #Health

https://www.ncbi.nlm.nih.gov/pubmed/31743037?dopt=Abstract

I am routinely asked about platelet rich plasma (PRP) treatment for rotator cuff tears. PRP is obtained from a patient’s blood and is then injected into injured tissue like rotator cuffs. Many physicians perform this procedure (I do not), but the effectiveness has not been well established at the time of this blog. The above article looked into the effectiveness for rotator cuff tears. Their conclusion that “significant improvements in PRP-treated patients were noted for multiple functional outcomes, but none reached their respective minimal clinically important differences” shows that the PRP has yet to show any functional improvements for rotator cuff tears. I encourage patients to have frank discussions with their physicians about the potential risks and benefits of this procedure before proceeding.

Shoulder Replacements detailed and their benefits #Health

When people typically think of a joint replacement they will think of a knee or hip.  However, shoulder replacements, though less common, can have a resounding effect on the quality of life of the individual.

Shoulder joint replacement is a safe, effective procedure to help with painful conditions of the shoulder that cannot be adequately managed with medications or therapy.

Why are shoulder replacement procedures performed?

Your shoulder is a ball-and-socket joint that’s comprised of three bones: the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The ball, or head, of your upper arm fits into a shallow socket in your shoulder blade.  When your shoulder is functioning properly, a thin, smooth tissue called synovial membrane makes fluid that lubricates the cartilage, allowing your shoulder to move smoothly and easily without much friction. The muscles and tendons that surround the shoulder provide support, and all these structures working together allow the shoulder to rotate through a greater range of motion than any other joint in the body.

Conditions such as arthritis can cause joints to lose their cartilage covering, and when you move, bone will move on bone without adequate protection. The result can be very painful, and you may experience a limited range of motion that hampers your ability to accomplish your daily activities.

What are the different types of shoulder replacement procedures?

Shoulder replacement surgery replaces the ball and sometimes the socket with man-made parts. Often the ball is replaced with metal and the socket is replaced with plastic. The components can be held in place with cement, or they can be made of material that lets new bone grow into the joint component over time, holding it in place.

There are several types of shoulder replacement surgery:

Hemiarthroplasty – the ball part of the head is replaced with an artificial joint that has a stem to extend into the shaft part of the bone. It’s usually used for fractures but is also often used for shoulders affected by arthritis.

Shoulder resurfacing – a different type of hemiarthroplasty that requires the removal of less bone. Instead of removing the ball part of the joint, a metal cap is simply placed over it.

Total arthroplasty – this replaces both the ball and socket and is usually used for specific types of arthritis. Your doctor will take into consideration your age, how badly worn the natural joint is, and the condition of the tendons around the joint. A total arthroplasty will sometimes be performed using a resurfacing component.

Reverse shoulder arthroplasty – artificial components are fitted in reverse, with the socket to the upper arm bone and the ball to the shoulder blade. It’s usually only performed on patients with severe arthritis and extremely poor rotator cuff tendons around the joint. It’s sometimes be used if a patient has both a severe joint fracture and poor tendon function.

I, as your surgeon, will determine the location, type, and extent of your shoulder problem before recommending the type of joint replacement that would be most suitable in your particular case.

Are you a candidate for shoulder replacement surgery?

The decision to have shoulder replacement surgery should be made in cooperation with you, your family, your family doctor, and your orthopedic surgeon