Tag: Shoulder

  • 11
  • Oct
Rotator Cuff Tendinitis
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Brief Outline of Rotator Cuff Tendinitis

Rotator cuff tendinitis results from the irritation and inflammation of the tendons of the shoulder in the area underlying the acromion. The condition is sometimes known as pitcher’s shoulder though it is a common injury in all sports requiring overhead arm movements, including tennis, volleyball, swimming and weight lifting, in addition to baseball.

Anatomy and physiology

The shoulder (or glenohumeral) joint is a ball-and-socket structure formed by the top portion of the arm bone (humerus) associated with the scapula or shoulder-blade. The rotator cuff aligns the head of the humerus into the scapula. Occasionally, following repetitive use of the rotator cuff, the humerus can ride up to pinch the cuff and irritate the fluid-filled subacromial bursa that acts to cushion the rotator cuff and acromion/humerus.

Cause of Rotator Cuff Tendinitis

Inflammation of the tendons of the shoulder from tennis, baseball, swimming, etc. Irritation of the bursa of the rotator cuff from repetitive overhead arm motion. Pre-existing disposition including anatomical irregularity.

Signs and symptoms of Rotator Cuff Tendinitis

Weakness or pain with overhead activities, brushing hair, reaching, etc. Popping or cracking sensation in the shoulder. Pain in the injured shoulder, particularly when lying on it.

Complications if left Rotator Cuff Tendinitis unattended

Rotator cuff tendinitis can worsen without attention as the tendons and bursa become increasingly inflamed. Motion becomes more limited and tendon tears can cause further, in some cases, chronic pain. Further, the acromion may react to prolonged irritation with the production of bone spurs, which contribute to further irritation.

Treatment for Rotator Cuff Tendinitis

Rehabilitation and prevention for Rotator Cuff Tendinitis

Following the rest and healing of the injured shoulder, physical therapy should be undertaken to strengthen the muscles of the rotator cuff. Occasionally, injections are required to reduce pain and inflammation. Moderation of rotator cuff use, adequate recovery time between athletic activities, and strength training can all help avoid the injury.

Long-term prognosis for Rotator Cuff Tendinitis

Given proper rest as well as physical therapy and (where needed) injections, most athletes enjoy a full recovery from this injury. Should a serious tear of the rotator cuff tissue occur, surgery may be required, although a recovery to pre-injury levels of activity is usually expected.

Rotator Cuff Tear
Rotator Cuff Tear

Shoulder Specialist Treating Rotator Cuff Tedinitis

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

  • 11
  • Oct
Shoulder Impingement Syndrome
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Brief Outline of Shoulder Impingement Syndrome

Shoulder impingement syndrome is a chronic condition caused by repetitive overhead activity or throwing events that damage the glenoid labrum, long head of the biceps brachii, and the subacromial bursa. A narrowing of the space between the rotator cuff and the acromion results in shoulder pain and loss of movement, due to deficit in the affected rotator cuff, a group of muscles and tendons necessary to secure the arm to the shoulder joint. The rotator cuff permits free rotation of the arm.

Shoulder Impingement

Anatomy and physiology

The rotator cuff is composed of four muscles: subscapularis, supraspinatus, infraspinatus and teres minor, as well as their musculo-tendinous attachments. The subacromial bursa (a fluid-filled sac), is the largest and most commonly injured bursa in the shoulder region, and provides the rotator cuff with lubrication to assist movement. The rotator cuff acts to stabilise the glenohumeral joint. Damage, including tears to the rotator cuff, can cause the humeral head to migrate during elevation of the arm, leading to impingement.

Cause of Shoulder Impingement Syndrome

Repeated overhead movements as in tennis, swimming, golf, and weight lifting. Irritation of the rotator cuff due to throwing sports including baseball. Underlying predisposition, including rheumatoid arthritis.

Signs and symptoms of Shoulder Impingement Syndrome

Shoulder pain and difficulty raising the arm in the air. Pain during sleep when the injured arm is rolled on. Pain during rotational movements such as reaching into a back pocket.

Complications if left Shoulder Impingement Syndrome unattended

Increasing stiffness of the joint and further loss of motion may result should impingement be ignored. Rotator tendons may be torn, should athletic activity be undertaken prior to full recovery. Tendinitis and bursitis frequent develop with impingement as a pre-condition.

Treatment for Shoulder Impingement Syndrome

Rehabilitation and prevention for Shoulder Impingement Syndrome

Following a period of healing, physical therapy will often be used to restore strength and range of motion in the affected rotator cuff. Avoiding or limiting repetitive motions that cause rotator cuff irritation may help prevent the injury. Strengthening exercises and lightweight training to strengthen the muscles of the rotator cuff are also useful preventive measures.

Long-term prognosis for Shoulder Impingement Syndrome

Typically, the condition shows marked improvement within 6-12 weeks. In cases where recovery has not been achieved in 6-12 months, surgery may be recommended to release the ligaments. Surgery is usually followed by physical therapy, and some modification of athletic activity may be necessary to reduce the chances of relapse.

Shoulder Specialist Treating Shoulder Impingement Syndrome

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore

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  • 10
  • Oct
Acromioclavicular Separation
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Brief Outline of Acromioclavicular Separation

Acromioclavicular separation is a separation of the ligaments that connect the clavicle (collar bone) to the shoulder bones (known as the acromion process). Acromioclavicular (AC) joint injuries generally occur in the course of upper-extremity strength training, various throwing sports, and collision sports (particularly, football and hockey). The injury is common among athletes in their 30’s and 40’s. AC Joint Dislocated

Anatomy and physiology

The arm is linked to the axial skeleton by means of the acromioclavicular joint, which connects the lateral end of the clavicle, and the medial border of the acromion of the scapula. A fibrocartilage articular disc partially divides the articular cavity, and absorbs forces and compression in the acromioclavicular joint is stabilised by anterior deltoid muscle, the trapezius muscle arising from the acromion, and additionally, by stabilising ligaments.

Cause of Acromioclavicular Separation

Fall onto the point of the shoulder. Fall onto an outstretched hand. Direct blow to the shoulder.

Signs and symptoms of Acromioclavicular Separation

Pain, tenderness, and swelling at the AC joint. Deformity of the injured joint. Pain or discomfort during cross-body adduction (turning the injured arm inward toward the opposite shoulder).

Complication if left Acromioclavicular Separation unattended

Degenerative joint abnormalities, chronic pain and stiffness and limitations in mobility requiring surgery are possible, should the condition not be given prompt medical attention and allowed proper healing time.

Treatment for Acromioclavicular Separation

Immobilisation of the injured arm with a sling.

Rehabilitation and prevention for Acromioclavicular Separation

AC separations of a less severe nature are successfully treated without surgery, though a thorough healing period of 6-8 weeks us generally required, following which, range-of-motion exercises should be used to avoid stiffness. Exercises directed at maintaining strength and stability of the shoulder and upper back muscles may help prevent the injury and use of padding around the AC joint, particularly during contact sports, may help avoid re-injury.

Long-term prognosis for Acromioclavicular Separation

Given adequate healing time and rehabilitation, most AC separations are resolved without surgery. Should surgery be required, risks of infection and continued pain exist, and recovery time for the athlete is lengthened.

Acromioclavicular Separation Shoulder Orthoapedic Specialist, Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore
Book Appointment Online for Acromioclavicular Separation Treatment
  • 10
  • Oct
Shoulder Subluxation
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Brief Outline of Shoulder Subluxation

The shoylder complex enables extreme mobility due to its anatomical structure, but provides little stability. Shoulder subluxation is a partial dislocation of the ball-and-socket joint of the shoulder. A group of ligaments securely hold the humerus (upper arm bone) in the socket of the shoulder-blade or scapula. Should these ligaments be torn, subluxation may result, in which the ball of the humerus slips partially out of the shoulder socket.

Dislocated Shoulder

Anatomy and physiology

The shoulder region is actually composed of five joints: the sternoclavicular (SC) joint, the acromioclavicular (AC) joint, the coracoclavicular joint, the glenohumeral joint, and the scapulothoracic joint, where the shoulder-blade glides on the chest wall. The articulation referred to specifically as the shoulder joint is the glenohumeral joint, whereas the other articulations are joints of the shoulder girdle. The structure of the shoulder permits a wide arrange of motion, allowing the positioning of the arm and hand. Instability in the shoulder joint complex, particularly following dislocation, can result in subluxation.

Cause of shoulder subluxation

A direct blow to the shoulder. A fall onto an outstretched arm. Strenuously forcing the arm into an awkward position.

Signs and symptoms of Shoulder Subluxation

Sensation of the shoulder going in and out of joint. Looseness of the shoulder joint. Pain, weakness, or numbness in the shoulder or arm.

Complications if left Shoulder Subluxation unattended

Untreated subluxation can cause wear, and ultimately damage the internal structures of the shoulder, sometimes requiring surgery. Loss of mobility, ongoing pain, and osteoarthritic complications may result from untreated subluxation.

Treatment for Shoulder Subluxation

  • Physiotherapy
  • Surgery to repair the labrum

Rehabilitation and prevention for Shoulder Subluxation

Following immobilisation and healing, strengthening exercises should be undertaken. Recovery depends on factors including the athlete’s age, health, history of previous injury, and severity of subluxation. If the shoulder subluxes frequently during activity, significant physical rehabilitation will be needed and possibly invasive surgery.

Long-term prognosis for Shoulder Subluxation

Normal sports activity may be resumed once a full range of motion without subluxation has been achieved. Prognosis is dependent on the severity of the subluxation and the athlete’s particular history. Subluxation is often due to previous shoulder injury and returning to athletics before full recovery can lead to further and worsening subluxation.

Shoulder Separation Shoulder Orthoapedic Specialist, Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore
Book Appointment Online for Shoulder Subluxation Treatment
  • 09
  • Oct
Dislocation of the Shoulder
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Brief Outline of Dislocation of the Shoulder

Dislocation of the shoulder may occur when a person falls  on an outstretched hand or during abduction and external rotation of the shoulder. Significant force is required to dislocate a shoulder, unless the athlete is experiencing re-injury. A shoulder dislocation occurs when the upper portion of the arm bone (humerus) pulls free of the socket of the shoulder-blade or scapula.

Anatomy and physiology

While several types of shoulder dislocation exist, the most common is anterior dislocatio, which represents ninety-five percent of all cases. In this dislocation injury, the structures responsible for stabilising the anterior shoulder, including the anterior capsule and the inferior glenohumarl ligament, are torn free from the bone. A compression fracture of the posteromedial humeral head is known as Hill-Sachs lesion. More commonly, avulsion of the anterior glenoid labrum can occur, which is known as Bankart lesion. Most commonly, avulsion of the anterior glenoid labrum can occur, which is known as a Bankart lesion. Both often occur as a result of anterior dislocation of the shoulder.

Cause of Shoulder Dislocation

Violent contact with another athlete or solid object. A fall on an outstretched hand. Sudden, violent torsion of the shoulder.

Signs and symptoms of Dislocation of the Shoulder

Severe pain in the shoulder. Arm held away from the body at the side, with the forearm turned outward. Irregular contour of the deltoid muscles.

Dislocated Shoulder

Complications if left Shoulder Dislocation unattended

Dislocation of the shoulder causes tearing of the shoulder ligaments, resulting in the shoulder joint becoming less stable. This results in the shoulder capsule being considerably more prone to successive dislocations during athletics. Immobilisation of the shoulder during the healing phase does not fully prevent such re-injury, which may require surgical intervention, since the immobilised ligament often fails to heal in the proper position.

Treatment for Shoulder Dislocation

  • Realignment or reduction of the dislocated joint.
  • Immobilisation and oral anti-inflammatories

Rehabilitation and prevention for Shoulder Dislocation

Most initial shoulder dislocations are treated without resort to surgery, although subsequent dislocations may require surgical care, and many athletes suffer a range of disabilities following dislocation. An alternative to surgical treatment – prolotherapy – involves injections directed at the anterior shoulder capsule and the insertions of the middle and inferior glenohumeral ligaments. This may offer better relief from pain, restoration of mobility, and a speedier return to athletic activity. Further, the technique avoids the formation of scar tissue common after surgery.

Long-term prognosis for Shoulder Dislocation

A large percentage of athletes may be unable to continue sports following a shoulder dislocation without subsequent injuries or the need for surgical treatment. Furthermore, athletes who undergo surgery following shoulder dislocation are often unable to perform at their former level. The alternative method of prolotherapy may offer relief and more effective healing.

Shoulder Dislocation Orthoapedic Specialist, Dr Kevin Yip

Dr Kevin Yip Orthopaedic Surgeon Gleneagles Singapore
Book Appointment Online for Shoulder Subluxation Treatment
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