Conditions

Don’t let chronic pain or an injury keep you from enjoying an active life. The links below provide information on common conditions

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AC Separated Shoulder

The acromioclavicular joint is the region which is typically known as the point of the shoulder. This area is where the collar bone or clavicle meets the shoulder blade. This particular part of the shoulder blade is called the acromion and the acromioclavicular joint. This joint has an important contribution to shoulder stability and the overall mechanics of the arm. The acromioclavicular joint is stabilized by various groups of ligaments that hold the collar bone and shoulder blade together. In addition, there are ligaments that originate on the collar bone and extend on a different part of the scapula called the coracoid, which allow for stability in the up and down plane.

AC Shoulder How did I get this injury?

The acromioclavicular joint typically occurs from a fall onto the tip of the shoulder. Contact sports such as football can cause this injury after certain kinds of hits. In sports, people often refer to these injuries as shoulder separations. In addition, with our health conscious society, falls from bicycles will often cause this injury as well. The injury then is typically a separation of the normal articulation between the clavicle and acromion. There are six described types of acromioclavicular separations and these are based on the extent of ligament tearing.

AC Shoulder Symptoms

When these injuries occur, patients typically report pain localized to the AC joint region, which is again near the point of the shoulder. Lifting the arm initially may be painful, if not impossible. Patients will often note deformity with the clavicle riding high with comparison to the opposite clavicle. Depending on the severity of impact, patients may also note numbness and tingling in the upper extremities. With severe AC joint separation, the diagnosis is often obvious with the deformities present.

AC Shoulder Diagnosis

As with any medical condition, a thorough history and physical examination is important. As mentioned, the use of physical exam often will easily make the diagnosis, given the deformity present. However, there is often other associated shoulder injuries which need to be evaluated for in these falls.

Arthritis

Arthritis Shoulder Conditions

Your shoulder’s sore. You ignore and avoid it, but it progresses to a deep ache, especially at night. Then you can’t move your arm as easily, and moving it in some directions may grind and be quite painful. Next, it may become weak or even lock up when you’re doing something as simple as getting dressed. It’s arthritis, and it’s not going to get better without treatment. There are multiple arthritic conditions, some mild and some severe. Their location dictates the degree of functional impairment. Treatment is a combination of rest, medication, adapting your activities, physical therapy, heat and ice, cortisone injections – and in severe cases, shoulder replacement surgery.

3 Bad New Bearers

There 3 primary types of arthritis are: Osteoarthritis, a degenerative bone disease typically caused by wear and tear that affects those over 50, slowly destroying cartilage (bones’ outer covering). Posttraumatic arthritis resulting from fracture, dislocation, torn rotator cuff or similar significant injury, where symptoms can develop slowly, long after the injury is healed. Rheumatoid arthritis, involving chronic inflammation of the inner lining of the joint.

Bursitis

Bursitis — the itis of overuse

To lessen the friction caused by movement, each of your shoulder joints has a fluid-filled sac called a bursa. Chronic or excessive overuse of your shoulder can inflame the bursa and cause it to swell. That’s shoulder bursitis, and it’s painful. Fortunately, bursitis treatment is simple enough: rest, physical therapy and anti-inflammatory prescription medication. Minimizing or eliminating the activities that lead to the condition is also recommended. When bursitis causes the joint to stiffen, the condition is called frozen shoulder.

Labral Tear Impingement

What is a Labral Tear?

The acromioclavicular joint is the region which is typically known as the point of the shoulder. This area is where the collar bone or clavicle meets the shoulder blade. This particular part of the shoulder blade is called the acromion and the acromioclavicular joint. This joint has an important contribution to shoulder stability and the overall mechanics of the arm. The acromioclavicular joint is stabilized by various groups of ligaments that hold the collar bone and shoulder blade together. In addition, there are ligaments that originate on the collar bone and extend on a different part of the scapula called the coracoid, which allow for stability in the up and down plane.

How did I get a labral tear injury?

The acromioclavicular joint typically occurs from a fall onto the tip of the shoulder. Contact sports such as football can cause this injury after certain kinds of hits. In sports, people often refer to these injuries as shoulder separations. In addition, with our health conscious society, falls from bicycles will often cause this injury as well. The injury then is typically a separation of the normal articulation between the clavicle and acromion. There are six described types of acromioclavicular separations and these are based on the extent of ligament tearing.

Symptoms of a labral tear

When these injuries occur, patients typically report pain localized to the AC joint region, which is again near the point of the shoulder. Lifting the arm initially may be painful, if not impossible. Patients will often note deformity with the clavicle riding high with comparison to the opposite clavicle. Depending on the severity of impact, patients may also note numbness and tingling in the upper extremities. With severe AC joint separation, the diagnosis is often obvious with the deformities present.

What is the labrum?

The shoulder is a ball in socket joint, comprised of the ball, also known as the humeral head, the socket known as the glenoid, and surrounded by a combination of static and dynamic stabilizing units. Both the humeral head and glenoid are lined with a cartilage which absorbs shock, and this is known as the articular cartilage. Surrounding the glenoid is a second kind of cartilage that is fibrous and acts to give a cushion and/or constraint for the humeral head.

What is the function?

The humeral head is much larger than the glenoid; very similar to a golf ball balancing on a tee. The labrum surrounds the glenoid 360 degrees. Attachments include the biceps tendon superiorly and the ligamentous complex which make up the dynamic component for stability. The labrum deepens the dish, so to speak and gives a static constraint to the humeral head, when the shoulder is put through its extraordinary range of motion.

The anatomy of the labrum varies between individuals, and in some, is a very stout structure that appears to be almost like a meniscus in the knee. In others, the labrum is a very thin tissue and maybe part of a complex of laxity. The second function of the labrum is an attachment point for the ligaments and the biceps tendon. While considered a static stabilizer, the labrum is actually dynamic and does move slightly with certain motions of the shoulder. This then leads it to being prone to injury.

Labral tears

Several distinct injury patterns occur in the shoulder relative to the labrum. The shoulder can sustain significant injuries in many planes and in certain severe trauma, the shoulder may dislocate. In a dislocation, the humeral head becomes completely displaced relative to the glenoid, and in so doing, the traction and compression effects of the dislocation may cause the labrum to tear anteriorly and inferiorly or posteriorly and inferiorly, depending on the type of dislocation pattern. Often in a dislocation, a fragment of the glenoid is dissociated with the labral tear. The second type of labral tears occurs as a result of repetitive motion in the shoulder. Examples may be in throwing or in weight lifting, in which the labrum is literally pulled free of the bone. This is most common in a superior position and leads to what is often called a SLAP tear, in which the labrum is torn superiorly, anteriorly, and posteriorly to the biceps tendon attachment.

Some tears occur as a result of chronic degeneration. These tears may be noted at the time of surgery and may not lead to any specific pain in and of itself.

Some tears are very extensive when they are traumatically induced. A complete tear of the labrum free from the bone in association with a large fragment may cause significant mechanical problems.

SLAP tears have often been divided into four distinct types. A type I tear is simple degenerative changes within the tendon, leading to fragments of the labrum. A type II tear is consistent with a complete separation of the superior labrum, anterior and posterior to the biceps and is very common in the throwing athlete. Labral tears types III and IV are often in association with severe traumatic injuries to the shoulder, such as that occurring with a significant distraction event, such as falling and holding on to a ladder while the body is falling away.

Diagnosis of a labral tear

As with any medical condition, a thorough history and physical examination is important. As mentioned, the use of physical exam often will easily make the diagnosis, given the deformity present. However, there is often other associated shoulder injuries which need to be evaluated for in these falls.

The diagnosis of a labral tear may be difficult, as the signs and symptoms of a labral tear often mimic rotator cuff pathology. Physical examination is in accurate, but may at least lead to the identification of a labral tear, based on the clinical suspicion.

An MRI arthrogram is the most sensitive for diagnosing labral tears. A CT arthrogram may also be utilized, but is slightly less accurate.

The best way to ensure the diagnosis of the labral tear is with a diagnostic arthroscopy. This is the most accurate technique, but is invasive.

SLAP Tear

The SLAP Tear Condition

There’s a shallow socket (glenoid) in the shoulder blade (scapula) in which the head of your upper arm bone (humerus) rests. The humerus is stabilized in the glenoid by a socket rim of soft, fibrous tissue (labrum) that provides the anchor for several ligaments. It’s the nature of the labrum to move a little with the shoulder, and that’s what makes it prone to injury. Labral tears cause pain, grinding, popping and catching in the shoulder joint. There are all kinds of tears, as well as a seriously condition called instability. Dislocations can tear the labrum at the lower front (inferior anterior) or lower back (inferior posterior).

Repetitive overhead motion may cause the labrum to tear free of the bone. SLAP (Superior Labrum, Anterior to Posterior) tears are above the middle of the glenoid socket and may affect the biceps tendon. Weightlifters and athletes who throw are particularly susceptible to SLAP tears. Acute trauma may cause extensive labral tearing and major problems with the shoulder’s mechanics.

Rotator Cuff Injury

How did I get this tear?

While rotator cuff tears can occur from a single traumatic injury like falling, most tears occur through overuse. People who are most at risk are those who engage in repetitive overhead activities like baseball, weight lifting and tennis. Recent studies also indicate there may be a genetic component to rotator cuff tears. Family members of those with rotator cuff tears are more likely to have it and those with a rotator cuff tear in one shoulder are more likely to have the other side affected as well.

Symptoms

People with rotator cuff tears commonly complain of pain and weakness when lifting the arm. The pain often radiates to the side of the arm. Many also report difficulty sleeping and waking up from the shoulder pain. Despite rest and use of antiinflammatories, the symptoms continue for months without resolution.

Diagnosis

A rotator cuff tear is diagnosed with a combination of the physical exam and diagnostic imaging (MRI). On the physical exam, weakness is usually evident with rotator cuff testing. The MRI is an excellent test to visualize the size and location of the tear. It can also identify the quality of the remaining tissue which can have an impact on the treatment options available to you. Useful Rotator Cuff info

  1. Rotator Cuff tears do not heal by themselves. The reason is mainly mechanical. The rotator cuff is like a stretched out rubber band. Once the rotator cuff tendon tears from it’s bone bed, it retracts and the two ends are no longer in proximity to each other. As a result, they cannot heal.
  2. Rotator cuff tears typically get bigger over time. Recent studies indicate 40% of tears increase in size over the course of 3 years.
  3. Larger tears have higher retear rates and poorer functional outcomes when compared to smaller tears.
  4. Rotator cuff tears undergo fatty infiltration and muscle atrophy over time. Fatty infiltration is irreversible and permanently weakens the tendon.

Tendonitis

Tendonitis Treatment

Shoulder tendonitis means the tendons that connect muscles to bones are wearing down. It may be the result of a degenerative disease, repetitive wear and tear, or overuse due to sports- or work-related activities.

A shoulder specialist will usually recommend shoulder tendonitis treatment that includes medication, ice and rest. Strength and flexibility can often be restored with a combination of tendonitis shoulder exercises. Surgery is an option in extreme cases.

Biceps Tendon Tear

Less lifting, rotation and flexibility. More pain.

The biceps muscle runs from elbow to shoulder and helps your arm rotate, your elbow bend and your shoulder remain stable. At the upper end, the 2 biceps tendons attach to the top of the shoulder socket (glenoid) and your shoulder blade (at the coracoid process). The long head of the biceps tendon travels all the way through the shoulder joint to its attachment point atop the socket and is more vulnerable to injury than the short head of the tendon. Aging and repetitive lifting can cause the long head of the tendon to fray and tear. Overloading while lifting overhead or falling on an outstretched arm can result in an outright biceps tendon tear. When the biceps tendon tears, it can’t hold the biceps muscle taut, sometimes causing an unnatural bulge between shoulder and elbow: “Popeye Muscle.”

We’ll get to the bottom of what’s causing your pain with state-of-the-art imaging:

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CT-Scan

How a CT-Scan Works

A CT-Scan, short for computed tomography scan, works much like an X-ray machine to provide doctors and surgeons with an internal view of the human body. A standard X-ray works by directing electromagnetic waves through a part of the body towards a metal target on an opposing side. As the electromagnetic waves pass through the body, the soft skin tissue does not absorb the wave but the harder, denser materials such as bone and ligaments do absorb the wave making them visible to the camera. Standard X-ray cameras work much like a regular camera but are capable of processing x-ray light as opposed to visible light. A CT-Scan works in much the same way but it uses a camera that is capable of capturing soft tissue as well. CT Scans also use a rotational camera to generate image “slices” of the organ or body part under investigation. In this way, the doctors are able to generate a 3D image out of these image slices of the patient and are able to pinpoint exactly where the problem is located.

How a CT-Scan Helps

A CT-Scan is typically employed to supplement standard X-ray or ultrasonographic images. For example, CT-Scans are routinely used to detect colon cancer or other abdominal diseases such as diverticulitis, renal stones, appendicitis, pancreatitis, or bowel obstructions. It is also used to detect heart disease for patients with a high risk of developing this disease. CT Scans can also be used to detect head trauma such as a hemorrhage, tumor, aneurysms, or infarction. This type of technology is the preferred method to detect pulmonary embolisms or lung cancers since it is much less invasive than other methods. For a patient with a complex bone fracture, a CT Scan will prove to be an invaluable tool since the doctors will be able to generate a full picture of the break where this would otherwise not be available in a standard X-ray. For the same reason, a CT Scan can also be helpful with sprains or ligamentous injuries with astounding detail. Clearly, CT Scans offer doctors many advantages since they are able to generate a clearer image of the problem.

MRI

How Magnetic Resonance Imaging (MRI) Works

Magnetic Resonance Imaging, or MRI, gives radiologists a detailed picture of internal body structures without necessitating invasive techniques. When a person enters the strong magnetic field in an MRI scanner, the nuclear magnetic resonance of the water molecules in the body shifts, and radio waves at a resonant frequency to the water molecules cause them to ‘flip’ orientation in the magnetic field. When the radio waves cease, the molecules revert back to their original, lower-energy state, and the excess energy is released in the form of a photon. Depending on the tissue, the nuclei will return to their equilibrium state at a specific rate. The photons and their relative rate of return to normal is detected and precisely mapped by the on-board scanner and uploaded to a computer for viewing by the physician, who sees not a collection of photons, but a highly detailed image of the tissues from whence they emanated. 3-D imaging is also possible if the magnetic fields are rotated by small distances and imaged at each interval. Contrast agents (usually given intravenously about 20 minutes before scanning) can be helpful for imaging tissues with a similar ‘rate of return, ‘ giving tumors, blood vessels, or other similar structures a ‘rate of return’ which will provide a greater contrast with the tissues around them. Some types of MRI can even give live-feed visuals of movement within the body, such as the pumping action of the heart.

How Magnetic Resonance Imaging (MRI) Helps

One of the major benefits of the MRI is its level of detail-because the particles responsible for the imaging are so small (nuclei of atoms), the specificity and contrast of the image are very clean-cut and easy to use for diagnosis. Additionally, the MRI has significant advantage over X-rays and CT scans because it does not use ionizing radiation, and is therefore less harmful to the body’s tissues than the rays used for X-ray and CT imaging. Not only is the MRI safer, but it also has the unique capability of imaging both hard and soft tissues concurrently, allowing a more informed look at a body system, such as a joint. As an example, the ability to look at both the cartilage and the bone can lead to a faster, more accurate diagnosis of a knee problem. In clinical use, the MRI is utilized primarily for the location or diagnosis of cancerous growths. This is especially helpful in the brain, where surgery is much more delicate. An MRI can give the exact size and location of a tumor, allowing cleaner and safer removal by operation. Furthermore, magnetic resonance imaging is a good option for determining the site and extent of an inflammation or injury in a single test, rather than necessitating an X-ray plus another scan for soft tissue damage. Overall, the MRI provides a clear, in-depth look at any part of the body with minimal risk to the patient, and its variations and multiple functions provide a versatile tool for diagnosis.

X-Ray

How Digital X-Ray Machines Work

X-Ray machines use X-Rays, a type of electromagnetic radiation, to create images of a patient’s body in order to help a doctor diagnose a problem. A vacuum tube, known as an X-Ray tube, creates the X-Rays by using a high voltage to excite electrons to a high speed as they pass from a hot cathode to metal anode. This process creates a wide spectrum of X-Ray waves, and an aluminum filter is usually in front of the X-Ray tube to catch the unnecessary and harmful lower-energy X-Rays before they reach the patient. The high-energy X-Rays then pass through the patient’s body, and a digital sensor captures the image on the other side. This sensor essentially acts as a digital camera. The X-Rays create the image based on density and composition. Areas of high density, like bones, show up lighter; areas of low density, like air, show up darker.

How Digital X-Ray Machines Help

If a surgeon suspects a problem that could show up on an X-Ray, he or she will usually order an X-Ray first before resorting to more comprehensive, yet more expensive, tests. X-Ray imaging is most helpful in detecting problems in the skeletal system such as fractures, bone spurs, or arthritic changes. X-Rays can also be helpful for diagnosing certain problems in the body’s soft tissues. For example, chest X-Rays can help diagnose pneumonia, tuberculosis, or lung cancer. Abdominal X-Rays can help determine if there are pockets of air or fluid where there should not be or if there are blockages in the digestive system. Gall stones and kidney stones also usually show up well on X-Rays. X-Rays are not useful for diagnosing problems with the brain or muscles. With the newer digital X-Ray machines, results are available immediately and it is easy for doctors to share the files with each other if necessary. Digital X-Rays also have an advantage over old-fashioned film X-Rays in that if the image doesn’t come out well, the technician can tell right away and take another one, rather than having to wait for the film to develop.

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