Shoulder and Elbow Problems
For those who live an active lifestyle, there is always a risk for an injury to the muscles or bones. Among the most commonly affected joints are the shoulder--thanks to its wide range of motion-- and the elbow. Whether injuries occur from overuse, age or trauma, our physicians are committed to working with you and offering a variety of options that fit your lifestyle and activity level.
Causes and Symptoms
Maladies (painful conditions) of the shoulder and elbow can be mild or severe and triggered by a variety of causes. The most common causes of limited movement and shoulder pain include inflammation, tendonitis, sudden injury, arthritis, calcium buildup and irritation to the tendons or ligaments that support the shoulder. Elbow pain can be caused by arthritis, pinched nerves, overuse and sudden injuries like a fall. Tennis elbow and golfer’s elbow are examples of commonly treated elbow conditions.
Symptoms of pain and soreness can be the same whether the problem is related to an “old” injury or degenerative conditions such as arthritis. Initially, pain at the site may limit your ability to use your arm normally and can progress to pain both at rest and at night.
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Non-Surgical Treatment
For many injuries to the shoulder and elbow, your doctor will be able to treat you with non-surgical interventions. While not everyone will find success without surgery, we strive to give our patients practical options when we can. Rest, ice, physical therapy and anti-inflammatory oral medications can all be considered for treatment of shoulder and elbow conditions prior to surgical interventions.
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Reverse Total Shoulder Replacement
Total shoulder replacement surgery involves removing old or damaged bones of the joint and replacing or resurfacing the remaining bone. The bone at the end of your upper arm is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. In contrast to total shoulder replacement surgery (shoulder arthroplasty), the components of the artificial joint are placed in reversed positions to allow the deltoid muscle at the shoulder to raise the arm. This procedure is used when painful arthritis is present and the rotator cuff is torn and not functioning.
Like traditional total shoulder replacement, physical therapy following the procedure helps to ensure the best outcomes. Each case will depend on your type of injury and need and will be evaluated on a case- by-case basis. The success of shoulder replacement surgery lies significantly in the experience of the physician completing it.
Replacement surgery is usually completed with general anesthesia, but in some cases you can have it done while you are awake. The decision will really be up to you and your doctor, and will depend on the type of procedure you are having.
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Arthroscopic Rotator Cuff Repair
The rotator cuff is a group of tough, flexible tendons and muscles of the shoulder that are responsible for holding the bones of the shoulder together. Susceptible to damage from overuse, injury or other complication, the rotator cuff allows for flexibility, fluid movement and stabilization of the shoulder. To repair the rotator cuff, doctors may need to remove loose fragments of tendon or foreign debris from the joint, make more room for the rotator tendon, sew torn tissues back together or shave sharp spots (also known as spurs) off surrounding bone.
While rotator cuffs can be repaired with an open incision technique, arthroscopic repair requires less recovery time and usually results in less pain. Through the insertion of a long thin tube, doctors can examine a joint and make repairs by inserting special instruments down through the tube and watching the results on a television screen as they work.
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Arthroscopic Shoulder Stabilization Procedures
Also known as a Bankart repair, shoulder stabilization procedures help patients who have injured the bony ball of the shoulder joint after it has been driven or pulled out of the socket. When a dislocation happens, either the ball will pop back into place on its own, or you might have to have a doctor or friend help put it back in place.
Instability is the ongoing sensation of the shoulder continuing to slip out of socket after the initial injury. Each time it slips out of place, it takes less and less force to cause it come out of place and will eventually cause many people to have trouble completing normal daily activities. On the other hand, they may only feel the joint move out in certain positions, like with their arm overhead to throw a ball, and they will avoid that position to prevent the feeling that their shoulder will dislocate.
Injuries to the supporting structures that hold the bones centered and in the joint can heal improperly or in the wrong position after a dislocation. Stabilization surgery helps reposition these tendons and ligaments in the proper position to regain stability of the joint.
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Tendon and Ligament Repairs and Reconstruction
Tendons and ligaments are tough, resilient structures that hold bones and muscles in position. Able to stretch and flex a bit, these connective tissues are essential for proper function and pain-free movement.
To complete a repair, our surgeons will make an incision over the injured area and reattach the tendon or ligament to the surrounding tissue.
If there is significant damage your doctor may need to complete a graft—or take a section of undamaged tissue from another part of your body and use it as a patch in the injured area. Repairs or reconstruction of ligaments and tendons can be done under general, regional or local anesthesia. Your doctor will work with you to find a method that fits your needs.
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Operative Fracture Treatment
In some cases, a fracture (broken bone) may be severe and can’t be set or put back into its original place by hand. For others, the injury to the bone has been so traumatic that surgery is necessary for repair and rebuilding. Bones that have been crushed may require the placement of artificial structures like plates, screws or metal shafts to hold together remaining bones or take their place.
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Impingement Syndrome Surgery
When an injury to the rotator cuff muscles occur, they begin to swell and can become compressed by the surrounding bony structures of the shoulder. As the pressure increases, blood flow to the very small vessels inside the muscle can cause the tissues to fray—much like an old rope does over time—and make simple movements like reaching overhead painful. The most common symptoms include difficulty reaching behind the back or overhead and weakness of the shoulder.
Most cases of impingement syndrome can be treated with oral anti-inflammatory medications like ibuprofen, stretching or avoiding movements that aggravate the injured area, cortisone injections, and physical therapy. If these measures are not successful your doctor may need to evaluate your injury further with an MRI scan to look for tears in the rotator cuff muscles. Resistant impingement and rotator cuff tears could require surgery to repair.
To schedule an appointment or physician referral with our shoulder and elbow specialists, call South Florida Orthopaedics & Sports Medicine in Stuart, Florida at (772) 288-2400 or request an appointment online. We serve patients along Florida’s Treasure Coast, including Fort Pierce, Port St. Lucie, Jensen Beach, Stuart, Palm City, Hobe Sound, and Jupiter, as well as Indiantown and Okeechobee.
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