Shoulder

What is the Rotator Cuff?

The rotator cuff is an intricate group of four small tendons that regulate movement of the shoulder. The purpose of these four tendons are to maintain the position of the humeral head (ball) on the glenoid (socket) of the shoulder during movement.  These deep tendons around the shoulder are referred to as postural muscles–a postural muscle is one which is active with many fine and mundane movements in normal life.  In contrast, the deltoid muscle provides power and strength to the shoulder and is primarily active with more strenuous and explosive movements. While the rotator cuff does not directly contribute to power movements of the shoulder, significant damage to the rotator cuff leads to an “uncoupling” of the powerful deltoid from the shoulder joint.

How do Rotator Cuff Tears occur?

There are two types of rotator cuff tears: Degenerative and traumatic.  Since the rotator cuff is involved in so many aspects of shoulder and arm use,it is vulnerable to wear and tear as we get older, even from routine everyday use. Conversely, traumatic tears occur suddenly, with injury.  Violent pulling of the arm, falling onto the shoulder and other types of trauma can cause the rotator cuff to acutely tear.  These result in pain, sudden loss of the ability to raise the arm away from the body.  These typically have a narrow window of several weeks during which these can be repaired for best results.  Beyond this window, the tendon quality and ability of the tendon to heal can become impaired.

I never injured my shoulder–how did I tear my Rotator Cuff?

Traumatic tears occur with injuries, however degenerative tears are actually more common.  Degenerative tears of the rotator cuff occur over one’s lifetime.  Health and genetics certainly can affect development of tears.  Two people over time with similar activities may develop tears in their tendon at vastly different periods in their life.  These differences are largely due to health and genetics.  Certainly, prolonged strenuous use of the shoulder can make these tears more likely.  Additionally, bone spurs in the shoulder can mechanically damage the tendon over time.  However, this phenomenon, known as external impingement, is less common than previously thought.  Degenerative tears occur over time and may not always be initially symptomatic.  

How do I know if I damaged my Rotator Cuff?

Common symptoms of rotator cuff problems include pain with reaching, painful clicking in the shoulder, difficulty performing strenuous or athletic activities, especially throwing.  Loss of strength holding the arm away from the body can occur as can pain radiating down the arm, not necessarily at the shoulder itself.  Arm pain at night is also strongly associated with rotator cuff disease. However, the symptoms of shoulder bursitis, rotator cuff tendonitis and rotator cuff tears overlap significantly, therefore it is recommended that you be evaluated if you have these types of symptoms.

Is surgery the only option for my Rotator Cuff Tear?

This depends heavily on the characteristics of your tear but surgery is never the only option.  There are certain tears for which we recommend against surgery and certain tears for which the outcome may be best with surgery.  Partial tears in particular are very amenable to nonsurgical treatment, including rest, physical therapy and injections or a combination of these measures. 

Physical therapy is highly effective for rotator cuff disease when performed in conjunction with our specific recommendations to target the specific tendons of the shoulder that are affected.  Oral anti-inflammatory medications may be recommended.  Additionally, cortisone injections can be quite helpful as a part of treatment but are used on a repeated basis only in specific settings.  Regenerative medicine, particularly PRP injections can be effective in select types of rotator cuff issues.

What type of surgery is recommended for Rotator Cuff Tears?

If surgery is recommended, this is typically done as an outpatient and done arthroscopically.  This is a brief, routine procedure but the recovery can take some time since the rotator cuff is a slow healing tendon. Recovery from rotator cuff surgery can take several months and involves regular attendance at physical therapy.  Depending on the physical demands of your job, some time off work may be necessary.  However, success rates of arthroscopic rotator cuff repair are very high and the vast majority of people return to previous activities including golf, tennis and other more vigorous activities with appropriate postoperative guidance.  We will continue to follow and guide you until you’ve reached that point.  Often, other minor issues which typically may not otherwise require surgery, such as arthritis, bone spurs and bursitis are addressed at the same time as the rotator cuff.

Drs. Silas, Bak and Frush all perform a high-volume of rotator cuff repair surgery and Dr. Moore performs ultrasound-guided tenotomy on diseased tendons that do not require surgical repair.

What is a SLAP Tear?

The labrum is a cartilage structure that circumferentially attaches to the glenoid (socket) of the shoulder.  It provides a rounding shape to the otherwise flat socket of the shoulder and helps the socket mate with the ball, therefore enhancing stability of the shoulder joint.  SLAP stands for Superior Labrum Anterior to Posterior and therefore this type of tear occurs at the superior (upper) part of the shoulder labrum where the biceps attaches.  

How do these tears occur?

The superior labrum can be damaged by repetitive overuse (overhead athletes, heavy manual labor) or with an acute injury.  Occasionally there is just some mild fraying of this portion of the labrum but more serious tears involve actual detachment of this portion of the labrum from the bony socket.  These tears are common in throwers and can also occur from a fall directly on the shoulder. 

What are the symptoms of a SLAP Tear?

Pain with physical activity (throwing, weight training) and even night pain can occur with superior labral tears. While many labral injuries can be diagnosed based on a careful history and physical exam, typically an MRI is required to confirm the diagnosis or assess the severity of the damage. 

I have a SLAP tear–does this absolutely require surgery?

Depending on the severity of the tear and the physical demands of your lifestyle, labral injuries may or may not require surgery.  To be clear, we will aggressively treat your problem to maximize your function but if your lifestyle does not demand high-stress use of your shoulder, surgical treatment may not be appropriate nor necessary.  This is a decision we will make collaboratively with you.  Frequently, a nuanced approach to therapy can help even a high-level athlete avoid surgical treatment.

When surgery is necessary, what type of surgery is it?

When surgery is required, this is done arthroscopically, typically in an outpatient setting. Surgical repair generally takes 30-40 minutes; in older patients with poor tissue quality or impaired blood supply to the labrum, occasionally a relocation of the biceps may be performed to remove a source of pain from the labrum.  A sling is worn for 3-4 weeks, physical therapy is needed for several months.  Most people can return to normal activities within 6-8 weeks but strenuous and athletic activities may require 4-6 months prior to normal return.

Drs. Silas, Bak and Frush are on the leading edge of anatomic restoration and reconstruction of the labrum. We are involved in education and development of surgical techniques with several national and international groups on advanced shoulder arthroscopy.

What is an Anatomic Shoulder Replacement?

Shoulder replacement comes in two broad forms: Anatomic and Reverse.  Anatomic Total Shoulder Replacement (ATSR) is what is used for conventional arthritis as long as the patient has a healthy rotator cuff.  ATSR is the more traditional procedure and involves replacement of the worn bony ball with a metal ball and replacement of the worn socket with a surgical grade polyethylene socket.  This procedure was pioneered and perfected at Columbia’s New York Orthopedic Hospital by surgeons Dr. Bak trained with during his fellowship.  

I’ve heard of hip and knee replacement.  Is Shoulder Replacement new or experimental?

Shoulder Replacement surgery has been done since the 1950’s and has an extensive track record.  A study at Johns Hopkins University several years ago found the complication rate significantly lower than hip and knee replacement and the satisfaction rate to be higher.  Shoulder Replacement is a highly successful procedure.

It sounds like a painful procedure.

All surgery has some anticipated pain during recovery but compared with many other types of replacement, shoulder replacement involves just a minor and brief period of pain.  In fact, we are now frequently doing shoulder replacement as an outpatient procedure.  On appropriate patients a mini-incision can be used for the procedure. MCO surgeons use a muscle sparing approach for this procedure in which we go between, rather than directly through the muscles and use bone-preserving implants.  This leads to a rapid recovery of function and rapid pain relief.

How do I know I need a Shoulder Replacement?

Shoulder arthritis occurs when the smooth cartilage surface of the ball and socket wears, becomes uneven and results in a generally inflamed state of the shoulder joint.  This is usually a gradual process that occurs as a result of genetics in addition to wear and tear occurring over your lifetime.  While the process is gradual, curiously, it is common for the symptoms to have a relatively rapid onset. This can be managed (though not cured) with nonsurgical methods initially.  Physical therapy can be helpful in selected instances but typically, activity modification (rest) and anti-inflammatory medication (oral or injected) can minimize symptoms for months to years.  In select patients, platelet-rich plasma (PRP) or stem cell therapy can be effective.  When the disease begins to interfere with everyday life and function, shoulder replacement surgery is a highly successful option.  Shoulder replacement is less common than that of the hip and knee since we don’t use our arms for walking; however, replacement of the shoulder is considered to be the most successful joint replacement in orthopedics.  

What does the surgery and recovery involve?

Total shoulder replacement surgery takes approximately one hour and does require use of a sling for approximately 4 weeks after surgery.  Typically, within the first several days after surgery, pain is quite minimal.  A small window in the rotator cuff is made and use of the sling and rehabilitation focuses on protection of this window as it heals.  We use a lesser tuberosity osteotomy technique for our rotator cuff window which has been shown to provide superior strength and healing in comparison to other techniques used in shoulder replacement. Total shoulder replacement has traditionally been done in a hospital setting, however our MCO team has been pioneering an innovative approach to pain and a minimally invasive technique that has allowed us to transition many of our patients to outpatient shoulder replacement. Return to activities such as golf, tennis and swimming are permitted and encouraged roughly 3 months after surgery.

Drs. Silas and Bak have extensive experience in shoulder replacement as Motor City Orthopedics is one of the highest-volume shoulder replacement centers in Michigan.

What is a Reverse Shoulder Replacement?

Reverse Total Shoulder Replacement (RTSR) is so named since the “ball” of the new shoulder is placed where the socket is typically located in the native shoulder.  Likewise, the “socket” of the new shoulder is precision bored where the ball of the native shoulder was. This allows the joint to function in situations where the rotator cuff is badly damaged.

Why would I get a Reverse Shoulder replacement instead of a standard replacement?

Shoulder replacement comes in two broad forms: Anatomic and Reverse.  Reverse shoulder replacement is used when the arthritis is accompanied by significant damage or disease involving the rotator cuff.  While anatomic shoulder replacement is successful in achieving pain relief in these situations, reverse replacement is a better option to maintain excellent function and provide longevity in situations involving rotator cuff damage. RTSR has proven so successful, it may also be the recommendation for patients who may not have severe arthritis but have a severe rotator cuff tear that has either failed repair or is too badly damaged for repair. 

Prior to 2004 there was not a good surgical solution for patients with arthritic shoulders and rotator cuff damage.  Reverse Total Shoulder Replacement has been one of the major developments in orthopedics so far this century and has revolutionized shoulder surgery.

Is one type of replacement better than the other?

Both Anatomic and Reverse shoulder replacement are highly successful.  Anatomic allows for slightly more internal rotation (movement of the arm behind the back)–but only in patients with a healthy rotator cuff.  RTSR is used for patients with an unhealthy rotator cuff–in these patients anatomic replacement provides pain relief but very little motion above the head or away from the body whereas RTSR provides both pain relief and excellent mobility.  

What are my options for arthritis and rotator cuff problems besides replacement?

Combined shoulder arthritis and rotator cuff disease can be managed (though not cured) with nonsurgical methods initially. Physical therapy can be helpful in selected instances but typically, activity modification (rest) and anti-inflammatory medication (oral or injected) can minimize symptoms for months to years.  In select patients, platelet-rich plasma (PRP) or stem cell therapy can be effective.  When the disease begins to interfere with everyday life and function, shoulder replacement surgery is a highly successful option.  Shoulder replacement is less common than that of the hip and knee since we don’t use our arms for walking; however, replacement of the shoulder is considered to be the most successful joint replacement in orthopedics.  

What does the surgery and recovery involve?

RTSR is performed in less than an hour and MCO is performing a large percentage of these on an outpatient basis due to the minimal pain we have observed using our muscle-sparing technique.  A sling is worn for 2 weeks after RTSR and approximately a month of physical therapy is recommended.  Pain relief and performance are very similar to anatomic shoulder replacement and similar activities, including golf, tennis and swimming, are permissible after reverse shoulder replacement.

Drs. Silas and Bak have extensive experience in shoulder replacement as Motor City Orthopedics is one of the highest-volume shoulder replacement centers in Michigan.

How does a Shoulder Dislocation happen?

Shoulder Dislocations occur typically as a traumatic event, frequently as the result of an injury during sports or an awkward fall.  The most common mechanism is a stretching of the arm behind the shoulder with the palm facing forward–such as a linebacker’s arm when the running back runs through his arm tackle.  The ball typically moves forward on the socket and gets caught in the front of the socket. In a small percentage of patients, the ball actually moves behind the socket and this type of injury is best recognized by an experienced shoulder physician. Note a dislocation is different from a separation which involves a different area of the shoulder.

In patients with more chronic instability, the shoulder can start to slip out with low-energy activities such as reaching up or even during sleep.  Proper treatment of this degree of instability is imperative to allow normal, everyday function.

What are the symptoms?

Shoulder Dislocations are immensely painful and any movement of the arm hurts.  The arm may feel “dead” and any attempt to bring the arm across the body makes the pain worse.  There may also be a deformity or fullness in the front of the shoulder. Suspected shoulder dislocations require emergent “reduction” or a setting of the ball back onto the socket, usually with sedating medication in the Emergency Room. There are injuries that are slightly lesser (subluxation) in which the ball is partially out of the socket and these sometimes “pop” back in place prior to receiving medical attention.

What type of damage occurs in my shoulder?

Shoulder Dislocations result in significant damage to the labrum and ligaments that maintain stability of the shoulder joint. Occasionally minor fractures involving either the ball or socket can occur, rarely a major fracture can occur–xrays are necessary to assess for this type of damage.

What is the treatment for a Shoulder Dislocation?

While this can be treated with a period of rest and physical therapy, recent studies have shown earlier surgical restoration of the labrum can lead to better long-term results in higher level athletes.  The decision between surgical repair and rest/therapy is a shared process and based largely on your desired level of activity going forward—our goal is always to restore you to the highest level of activity you desire. In some patients with lower overall demands on their shoulders, nonsurgical management can provide a successful return to all desired activities. For higher level athletes, particularly collision athletes, surgical repair may provide a more predictable path back to high level participation.

While we know that ligaments and labrum are always going to sustain some degree of damage in a dislocation, the degree of collateral damage plays a significant role in determining proper treatment.  X-rays and MRI are frequently necessary to determine the extent of the structural injury. With certain types of ligament tears, surgery may be more likely to help and rehabilitation more appropriate for other types of tears. Likewise, the socket or the ball can also be damaged by a dislocation and depending on the severity of such damage, surgery may be more or less likely to be recommended.

What type of surgery is done for this problem?

Arthroscopic repair will be recommended for typical patients with dislocations requiring surgery.  This is an outpatient procedure to repair of the damaged labrum and the ligaments which typically are stretched from the shoulder dislocating.  This is a relatively minor and outpatient surgery but return to sport may take 4-6 months depending on the demands your particular activities place on your shoulder.  Several months of therapy are also necessary for a full recovery. However, some patients have more complex patterns of instability that may require more than a routine arthroscopic repair.

Several variants of shoulder damage can occur and these subtleties are of paramount importance to recognize as the recovery and treatment can vary significantly.  Bony damage to the humeral head is called a Hill-Sachs lesion and can require a specialized arthroscopic repair or bone graft to treat successfully.  If there is bony damage to the glenoid, a Latarjet procedure can become necessary. We are one of the few centers in the country performing arthroscopic Latarjet repairs.  This involves the transplant of bone from one part of the shoulder to the damaged area. This is an uncommon procedure but highly successful for athletes with more severe collateral damage to their shoulders.  

Even more uncommon is a HAGL lesion in which the labrum does not tear, rather the ligaments tear from the ball instead; with more advanced types of tearing of the shoulder ligaments, a standard shoulder stabilization operation will likely fail. Indeed, the most common cause of failed instability surgery is using a one-size-fits-all basic repair technique in someone who has a complex injury pattern that was unrecognized either preoperatively or intraoperatively.  A HAGL injury should be recognized on the MRI and is certainly evident during arthroscopy for those experienced in its diagnosis and surgical repair.

While many surgeons are trained in basic instability repair, Drs. Bak, Frush and Silas are trained and experienced in all techniques of shoulder stabilization and will perform the operation best suited to your specific pattern of instability. We frequently get these types of patients referred to us due to our ability to transition to different repair techniques, even intraoperatively.

I have never had a dislocation but my shoulder pops and feels unstable.  What could be going on?

Some athletes have a condition in which the ball repeatedly comes close to dislocating but does not quite come completely out and lock in front of the socket.  This is known as a subluxation. While less dramatic than a dislocation, these can negatively affect confidence and ultimately, performance in an athlete.  Additionally, the cumulative damage of this lesser injury can, over time, approach the amount of anatomic damage that can be done with a single dislocation event.  When shoulder subluxations are treated early and appropriately, frequently a full recovery can be made without surgery. If this becomes a more chronic condition, surgical repair via outpatient arthroscopy could become necessary.

When can I go back to sports or work?

This depends highly on the physical demands of your job or sport.  For general, everyday activity, most people feel relatively normal within 6 weeks.  For overhead athletes/throwers, it takes generally 6-9 months until a return to full, high-level throwing.  Our collision athletes are able to return to sports approximately 4-5 months after surgery.  For athletes in predominantly lower-extremity sports (soccer, skiing, snowboarding, etc), 3-4 months is a safe timeframe for return.  Depending on your unique circumstances, we will get you back to your activities at the soonest but safest time.

What is a Latarjet Procedure?

The Latarjet procedure is a technique pioneered in France which is used in complex shoulder instability.  It is typically reserved for patients who have experienced recurrent instability after surgical correction or for patients who have suffered serious bony damage to their shoulder joint as a result of multiple injuries. 

How do you pronounce Latarjet?

Lat-ar-jay–it is named for the French surgeon, Dr. Michel Latarjet.

What happens during the Latarjet Procedure?

This is usually an open procedure which takes just over an hour and is done on an outpatient basis. A prominent bone on the front of the scapula known as the coracoid process is transplanted to the front of the shoulder socket using several screws.  This supplements the missing bone that is often present off the front of the socket in individuals with severe instability and therefore reconstitutes the bony socket.  Additionally, several tendons remain attached to this transplanted bone which provide an internal restraint that further bolsters the stability of the shoulder.  

Why would I need a Latarjet Procedure instead of a standard repair?

This is an excellent option for shoulder instability but is reserved for the more complex cases since it is a more involved procedure than the arthroscopic procedure used in routine cases. Additionally, this procedure requires the bone transplant to heal for the procedure to be successful. It is used for patients who have more extensive bone damage than a typical unstable shoulder. 

Dr. Bak is extensively trained and experienced in this technique and employs it on a routine basis in patients with more advanced forms of shoulder instability.  He is one of only several Midwest surgeons who performs this procedure arthroscopically as well as open.  He has also personally modified this technique to use stronger steel screws to eliminate one of the more common complications of screw breakage.

What is a Separated Shoulder (AC joint injury)?

A shoulder separation is an injury to the acromioclavicular (AC) joint–this is the junction between the acromion (part of the scapula) and the outer end of the collarbone. Note that a shoulder separation differs from a shoulder dislocation which refers to the ball and socket joint. The AC joint can often be felt as a slight prominence on the top of your shoulder.  

How does an AC joint injury occur?

The AC joint can be injured by impact to the shoulder, such as falling onto the shoulder or a hockey player going into the boards.  These injuries have several degrees of severity which correspond to how elevated the collarbone is in relation to the rest of the shoulder. Lower severity injuries respond well to nonsurgical treatment and therapy, typically with full return of function.  

What are the symptoms of an AC joint injury?

Pain directly on top of the shoulder after a trauma is universally present.  For at least the first several days, it is difficult and painful to try to raise the arm up or out away from the body.  In higher grade injuries, a deformity or prominence of the outer end of the collarbone is noted on top of the shoulder.  In rare cases, numbness or weakness of the hand can be present. In more chronic situations, clicking or grinding can be present at the AC joint.

How is an AC joint injury treated?

Most AC joint injuries can be treated with a 3-6 week period of rest and gentle rehab.  Lower grade injuries generally don’t require surgery but there may always be a mild prominence of the injured joint, however, no long term functional limitations are expected after lower grade injuries.

In higher grade injuries or those that do not respond to observation and natural healing, a reconstruction of the joint may be necessary to restore the anatomy and ligamentous restraint between the collarbone and the scapula.  A ligament graft is used to reconstruct the coracoclavicular ligaments which allows for full return of function and strength in the vast majority of patients. This is an outpatient procedure but does require a 4-6 week period of immobilization to allow full healing of the reconstructed ligaments.  Strenuous and athletic activities may require up to 3 months of healing prior to return to those activities.  Drs. Silas, Bak and Frush treat these injuries commonly, especially in our football, hockey and mountain biking patients.

I have pain in the front of my shoulder, how can this be my biceps?

The biceps muscle originates from the front of the shoulder blade and attaches just below the elbow.  While most associate the biceps with movement and strength of the elbow, the long head of the biceps can become inflamed and/or damaged at the shoulder.  In the case of inflammation or tendonitis, frontal pain of the shoulder particularly with combined elbow and shoulder movements is common.  This can typically be managed with rest, therapy and anti-inflammatory medication.  

What happens if the long head of my biceps ruptures?

Occasionally, ruptures of this tendon can occur.  While not as functionally disruptive as a biceps tendon injury at the elbow, patients can develop some spasm and soreness in the biceps.  Further, it may result in what’s commonly referred to as a “Popeye” deformity since the biceps muscle belly slides down toward the elbow.  The short head of the biceps typically remains attached at the shoulder and therefore long head ruptures do not always require surgery.  However, if biceps spasm is persistent or the cosmesis is unacceptable, this can be repaired via an outpatient surgery.  Rotator cuff issues are commonly seen in conjunction with a long head biceps injury so evaluation and, occasionally, repair of the rotator cuff may be considered along with a long head biceps repair (referred to as a biceps tenodesis).  

Drs. Moore, Silas, Bak and Frush are all adept at diagnosing and treating these problems. 

What is Batter’s Shoulder?

This is a condition typically involving the lead shoulder in a baseball hitter during which the shoulder briefly comes out of joint during a swing (and usually a miss), resulting in a tear of the posterior (backside) of the labrum and a deep bruise to the front part of the ball.  

What are the symptoms?

Sudden onset of shoulder pain in the front shoulder of a hitter and difficulty swinging the bat with power following the incident.  Pain with strenuous activities (strength training) after the incident, though not necessarily with catching/fielding, assuming it occurs in the non-throwing arm.

How does this happen?

Patients typically experience this as a sudden onset of pain in the shoulder, most commonly when deciding late to swing the bat. This usually happens during live pitching on a breaking ball that begins to break unexpectedly into the strike zone after the batter was beginning to relax and “take” the pitch or on a pitch that is breaking low and away from the hitter.  It is uncommon to see this in practice situations when the batter swings at each pitch with a predictable rhythm.  In rare cases, this can occur in the trailing shoulder during an uncontrolled swing and miss.

How is this treated?

Based on the description of the injury and the physical exam, an MRI is generally helpful in confirming the diagnosis. As most hitters’ lead shoulder is their non-throwing shoulder, this can often be treated nonsurgically, at least initially.  This is much more likely to require repair in the small percentage of hitters who throw with their trailing shoulder (bats left, throws right or vice versa).  In these patients and those who fail nonsurgical management, arthroscopic repair of the posterior labrum and ligaments is performed as a minor outpatient procedure.  Return to hitting typically requires 3-4 months and if this involves the throwing shoulder, up to 6 months for a full return to baseball.

This is an underdiagnosed condition, often being written off as a strain and only becomes evident after several months of lack of treatment.  Drs. Bak, Frush, Silas and Moore have seen this condition frequently and are accustomed to its identification and successful treatment whether surgical or not.

What is Impingement Syndrome of the shoulder?

Impingement syndrome is a widely recognized cause of shoulder pain involving a growth of a bone spur on the underside of one of the primary shoulder bones (acromion) which may cause mechanical irritation and/or damage to the underlying rotator cuff tendons.  

I’ve been told I have Bursitis and also Impingement Syndrome.  Which is it?

Likely both, there is quite a bit of overlap with Shoulder Bursitis and Impingement Syndrome.  Impingement syndrome can cause inflammation and damage to the rotator cuff or the bursa associated with the rotator cuff. The purpose of the bursa is to cushion, lubricate and provide nutrition to the rotator cuff tendon.  The bursa is very rich in nerve endings so inflammation of the bursa can be quite painful.  The same activities that can irritate the rotator cuff can irritate the bursa which tends to be a little more prone to irritation than the rotator cuff tendon itself.  Often, however, shoulder bursitis can be a precursor to development of rotator cuff tendonitis or even degenerative tearing if not appropriately addressed.  Fortunately, bursitis can be treated with nonsurgical means.

Rotator cuff tendonitis is similar to bursitis, just directly involving inflammation of the rotator cuff tendon itself, often following a prolonged course of bursitis.  This can be a more tenacious problem than bursitis but still typically does not require surgery for successful treatment.  Rest, physical therapy and anti-inflammatory medications (either oral or injected) are typically successfully employed to treat these issues.  While surgery is occasionally necessary, this is not the norm in our office as our nonsurgical options have a high rate of long-term success.

What are the symptoms of Impingement Syndrome?

Gradual onset of pain in the shoulder which can extend even down past the elbow.  There is often pain with activity and at night.  Occasionally some clicking and general weakness of the shoulder are present. 

How is Impingement Syndrome treated?

Usually nonsurgically.  When true subacromial impingement is present, it can usually be treated with therapy, oral anti-inflammatory medication and steroid injections.  In rare cases in which these measures fail, surgical removal of the spur typically results in relatively rapid resolution of the problem but does require a period of recovery and rehab.  This is a straightforward and minimally invasive outpatient corrective surgery performed arthroscopically in approximately 30 minutes.

Rotator cuff tendonitis and bursitis often are present with Impingement Syndrome and are also typically most successfully treated with a nonsurgical approach.  

If I have a spur on my acromion, can I get better without having it removed?

Absolutely–Impingement Syndrome is a widely recognized cause of shoulder pain but potentially can be overdiagnosed and overtreated. Often, what is called impingement, is an inherent inflammatory or degenerative condition of the rotator cuff tendon itself.  This is an important distinction to make as spur removal in this setting will not solve the problem, leading to an unsuccessful surgery and recovery.  Furthermore, most of these patients actually see full resolution of their rotator cuff inflammation without any invasive measures.  

Drs. Bak, Frush and Silas treat this condition routinely and have a high rate of successful treatment with nonsurgical methods as well as surgical correction when required.

What is Weightlifter’s Shoulder?

A form of Acromioclavicular (AC) Arthritis, it involves the joint between the outer end of the clavicle and the scapula and is relatively common.  For patients with this condition, pain at the top of the shoulder is common with strenuous activity and at night.  Arthritis of this joint occurs more frequently in men and is often related to heavy physical activity and weightlifting.  It can occur in all ages but is most common in younger men involved in weight training.

How is AC joint arthritis treated?

Unlike most joints that develop arthritis, however, inflammation of the AC joint can spontaneously resolve without surgery.  This requires time and rest, occasionally a cortisone injection may be necessary.  Nonsurgical treatment is the recommended initial treatment.

When is surgery considered for AC joint arthritis?

If the pain does not improve or allow resumption of normal physical activity after nonoperative treatment, surgical treatment may be considered.  Unlike most arthritic joints, this joint does not require a replacement.  Rather, surgical removal of a narrow portion of the collarbone is performed.  This is an outpatient procedure and can be done either arthroscopically or through a small incision just above the shoulder.  The extent of inflammation of the clavicle is the most important factor in deciding to perform this arthroscopically vs. open.  The most common cause of failed arthroscopic treatment of this problem is failure to recognize and remove the entire area of the collarbone involved.  Drs. Bak, Frush and Silas carefully evaluate this issue and your entire shoulder to determine which surgical approach will be most successful for you–all 3 of them are experienced in both approaches.

What is the recovery like and when can I return to physical activity?

After surgery, a sling is worn for several days and then active motion and gentle use of the arm begins.  Generally, your return to vigorous physician activities takes approximately 3 months after surgery.

What is the Clavicle?

The clavicle, or collarbone, is responsible for connecting your shoulder to your central skeleton and sternum.  Structurally, it can be thought of as a horizontal strut that contributes to the “broadness” of your shoulders along with the shoulder blades on the backside of your body.  It is also a bone that lies close beneath the skin and is an important landmark for several medical procedures as well as forming the “ceiling” of your thorax, the armored chamber that houses your heart and lungs.

What do I do if I think I broke my collarbone?

These are diagnosed with an xray–if you notice a severe deformity, break in the skin, or have numbness or paralysis of your arm, you should seek urgent treatment. Fractures of the clavicle can occur due to a direct frontal blow to the bone but are more common from indirect trauma.  Falling on your shoulder or going hard into a wall or other stationary object, leading with your shoulder, can cause “failure of the strut” or–a clavicle fracture.  These are quite painful initially and it is difficult to use your arm/shoulder immediately after a fracture.  Even moving and breathing are painful during the first several days.

What is the treatment for a Clavicle Fracture?

Fortunately, many clavicle fractures are successfully treated without surgery.  If fractures meet nonsurgical criteria, a sling is worn for several weeks followed by gradual progression of normal function over 4-6 weeks.  Athletics and highly vigorous activities may be restricted for 2-3 months to allow the injury to heal enough for resumption.  Expectations with nonsurgical management are that patients may have a mild deformity, typically only noticed with close scrutiny.  If we are recommending nonsurgical treatment for your clavicle fracture and you are a healthy, active person, it is because, assuming you heal as anticipated, we anticipate that you will have zero limitations once healed.

What type of surgery is done for a Clavicle Fracture?

There is a subset of clavicle fractures for which surgical repair is recommended.  This is based on specific xray criteria in which nonsurgical treatment could result in less than full function or failure of the clavicle to heal without repair.  If this is the type of fracture you have, surgical repair will likely be recommended.  This is done either with a plate and screws or with a pin placed in the center of the collarbone.  When the pin is used, it is necessary to remove it surgically after full healing.  This is not necessary with the plate, however, many patients request plate removal after the collarbone heals.

Surgery is done on an outpatient basis and requires several weeks of sling wear after surgery.  Time of recovery is similar to nonsurgical treatment, generally requiring 4-6 weeks for return to normal everyday function and 2-3 months for return to athletics.  Results are excellent for surgical repair of clavicle fractures with the expectation being complete restoration of all function.

All your physicians at Motor City Orthopedics have extensive training and experience in surgical and nonsurgical treatment of clavicle fractures and will get you back to being yourself quickly and safely.

What is a Frozen Shoulder?

Otherwise known as Adhesive Capsulitis, this is a real and painful condition in which the lining of the shoulder (capsule) becomes inflamed and thickens which produces a painful arm with diminished mobility.

How does a Frozen Shoulder happen?

Typically no direct cause is identified but it can be the result (many weeks after) of minor trauma or even due to an unrelated viral illness such as a cold.  It is also more commonly seen weeks or months after surgery of the neck, breast or chest.  It is most common in middle-aged women and in diabetics.  Once the capsule becomes inflamed, it rapidly thickens and causes difficulty moving the shoulder and nighttime pain.

Is it permanent?

No.  A Frozen Shoulder will typically resolve with time; however the exact amount of time varies widely from person to person and can take weeks in some, years in others.  Physical therapy is helpful and steroid injections into the capsule can be curative.  Fortunately, once a frozen shoulder resolves, recurrence in the same shoulder is extremely rare.

Will I need surgery?

While there is a surgical option for Adhesive Capsulitis, less than 10% of people end up needing this.  Manipulation under anesthesia (forcing the arm to break through adhesions while the patient is asleep) is one option but carries a risk of fracture of the shoulder as well as a lower success rate.  

The preferred technique is arthroscopy of the shoulder with precise surgical thinning of the capsule.  A sling is worn for less than a day and therapy and movement of the arm begins the following day.  The expectation for a Frozen Shoulder treated both surgically or nonsurgically is that the motion will ultimately return to normal.

Drs. Bak and Silas see hundreds of patients annually with Frozen Shoulder and enjoy seeing their patients resume normal life after treatment.