I have heard horror stories regarding failed rotator cuff repairs. I am on the fence about going through with a repair. What kinds of things lead to a successful repair and what can I do to make sure, if I do go through with it, that mine works? The best outcomes of rotator cuff repairs come from a variety of factors. Personal factors, like the location and extent of the repair, as well as the patient’s age and overall health play a big role in success rates. Surgical technique choice ...

I am slated to have a rotator cuff repair in a few weeks and my surgeon says he wants to inject “platelet-rich plasma” at the site to further healing. Does this really work? The latest research suggests that there is no benefit to using platelet-rich plasma during a rotator cuff repair to speed up the tendon repair site and that it can actually increase the risk of infection. However, keep in mind that your surgeon will make his best judgment call on technique depending on numerous...

How does one go about getting the "finesse" of pitching back after shoulder surgery? I had a labral tear repair and can pitch the baseball okay. But I'm noticing some difficulties with pitch control and wondering how I can get the "wobble" out of my pitches. Nothing I've tried so far has helped. Many overhead throwing athletes find that pitch accuracy, speed, and endurance can be compromised by injury and/or recovery after reparative or restorative surgery for that injury. And as you already kno...

I had one steroid injection for my frozen shoulder so far. There's been no change that I can see so far. Are there some exercises I can do to go along with the injection treatment? Before prescribing the best treatment for your shoulder, it's always important to know you have the correct diagnosis. For example, the terms frozen shoulder and adhesive capsulitis are often used interchangeably. The two terms describe the same painful, stiff condition of the shoulder no matter what causes it. A mor...

Everytime I life my arm up overhead, I get a loud snapping sound and instant pain. It feels like it's coming from my shoulder blade. This is becoming a major problem in my life because I am a lacrosse player on a college scholarship. What can I do to stop this from happening? You may have a problem that involves the scapula (shoulder blade). Without a properly functioning scapula, smooth and coordinated motion and function of the arm is compromised. Problems affecting the scapula that can disrup...

Three years ago, I had a very severe rotator cuff tear repaired. When I went in for a check-up the surgeon did a follow-up X-ray and ultrasound of the shoulder. Found out the tendon never really healed but I'm still much better. How do you explain that? According to a recent study from Washington University in St. Louis, adults with very large tears of the rotator cuff (the four tendons/muscles surrounding the shoulder) can get pain relief and improved function after surgical repair -- even if ...

If I have arthroscopic surgery to stabilize my chronically dislocating shoulder, what kind of rehab should I expect? The surgeon will use an all-arthroscopic "bony bank bridge" method of reconstruction. Surgeons from the Steadman Philippon Research Institute in Colorado recently wrote about their experiences using of an all-arthroscopic Bony Bankart Bridge (BBB) surgical technique for chronic shoulder instability. It was a fairly small study with only 15 patients. This is a fairly uncommon injur...

I have multidirectional shoulder instability from playing hockey as a kid. My surgeon has suggested I try some physiotherapy before thinking about surgery. Will this really help? Patients are often sent to physiotherapy for strengthening when the shoulder joint is unstable. But physiotherapists don't prescribe the same exercise program for everyone. The therapist uses clinical skill, expertise, experience, and evidence-based information to decide which mode (type) of exercise to use. The same de...

The nurse practitioner I am seeing for a frozen shoulder told me it is a "self-limiting" problem and I don't need any special treatment. Just wait and the body will self-correct. Is this really true? Many adults (mostly women) between the ages of 40 and 60 years of age develop shoulder pain and stiffness called adhesive capsulitis. Sometimes this condition is referred to as "frozen shoulder." But, in fact, adhesive capsulitis and frozen shoulder are two separate problems.As the name suggests, ad...

I developed an impingement syndrome of my shoulder slowly over time. I've had acupuncture and physiotherapy and also massages and still have pain all the time. Where do I go from here? Pain can be a good thing. For one thing, it is protective. It is a normal response of the body when there is an injury. The body uses pain to protect itself while it is healing. But in time, the healing processes are completed and the pain goes away. That is the normal healing response.But in cases like yours, a p...

I had a steroid injection for a painful rotator cuff shoulder problem. I was expecting relief from the pain fairly quickly but nothing happened. The surgeon wants to inject the shoulder again. If it didn't work the first time why do it again? Injection of a steroid (antiinflammatory) and a numbing agent into the subacromial bursa is a fairly common treatment for rotator cuff problems. An inflamed bursa (a fluid-filled sac between the muscle and bone) can cause pain when the arm is raised (forwa...

I am a semi-professional pianist with a serious problem that could put the kibosh on my career. Anytime I play for more than an hour, my hands start to go numb. I've heard that it's possible to do some technical retraining but I don't know how to go about this. What do you recommend? As you well know, musicians often spend quite a bit of time in awkward positions. The pianist may get in the habit of slouching or hunching over the keyboard. Some piano music requires the pianist to stretche the fi...

Last fall I suffered a shoulder injury that still plagues me. Now I'm starting to have problems with my shoulder blade. Whenever I raise my arm up overhead, the shoulder blade rubs against my ribs causing a grinding feeling. Is this a new problem or part of the ongoing shoulder problem? The scapula (more often referred to as your "wing bone" or shoulder blade) is a key reason why your shoulder and arm normally move and glide smoothly and easily. Not only does the scapula give the shoulder muscle...

I went to an exercise physiologist for some help with a shoulder/scapula problem. She was adamant that I have to do a core training program as part of the rehab. Is this just a craze or is it really all that important? Core training (strengthening the muscles of the belly and trunk) has become quite popular but for good reason. The more we learn about the influence of the center stabilizing areas of the body, the more we realize how important core strength is to movement of the arms and legs.Th...

I am seeing a physiotherapist for my shoulder problem (adhesive capsulitis) and I'm doing pretty well. I was looking on the Internet and saw you can get the same injections to the shoulder as they say work for the knee. It's not a steroid injection but something else. You might be thinking of hyaluronic acid, a substance that is present in the fluid structure outside, around, and between cells. It is a thick substance that is a normal part of the matrix that makes up cartilage.. It's found in th...

I'm looking for any information I can find for my 16-year-old daughter who has a SLAP injury of the shoulder from playing volleyball. There are many different ways to treat this problem. What do you recommend? SLAP stands for superior labral anterior posterior and refers to a tear of the labrum located around the rim of the acetabulum (shoulder socket). The labrum is a ring of fibrous cartilage around the shoulder socket. It helps support and hold the round head of the humerus (upper arm bone) i...

I've been doing some research on the internet about rotator cuff tears. Both my husband and my sister were diagnosed with this as the cause of their shoulder pain when they didn't do anything to injure themselves. We are all in our 40s and healthy (but not athletic) so I'm just wondering what causes this to happen? Rotator cuff tears are actually very common -- perhaps one of the most common injuries to the shoulder. From what we know about this problem, there can be multiple factors that contri...

Can you walk me through the typical treatment for a problem of shoulder instability? I don't know how it happened, but I ended up with one shoulder that just doesn't work normally. The physician who examined me called it unidirectional instability. I'm set up to start physiotherapy next week but what's the big picture look like for something like this? Shoulder instability can be very complex ranging from painful loss of motion to shoulder dislocation. Surgery to restore a pain free, stable join...

I had surgery for a rotator cuff tear two weeks ago. I'm wearing the abduction sling but I truly hate it. I've been given instructions by the surgeon but told not to do anything more than dangle and do circles with the arm while dangling. Would it really hurt anything to give it a tiny bit of movement? The nonhealing rate after rotator cuff repair is fairly high (20 to 90 per cent). This is the case despite all the improvements in the surgical technique and the less invasive aspect of arthrosco...

I am getting ready to have surgery for a rotator cuff tear. The surgeon said I would be wearing a pillow splint under my arm for "four to six weeks." I'm just wondering how they know which it is: four, five, or six weeks? I'd like to be done with all this as quickly as possible. Here's the drill after arthroscopic rotator cuff repair: you are in an abduction brace for four to six weeks. During that time, you may be given a series of passive exercises to complete. Passive exercise indicates that ...

I am totally for this new approach to medicine demanding evidence that treatments prescribed really work. Right now I'm personally dealing with a shoulder impingement problem. I've been seeing a physiotherapist but wonder if I shouldn't just have the surgery and be done with it. What's the evidence for or against this idea? Many people suffer from subacromial impingement syndrome (SIS). Manual laborers are especially susceptible when they are engaged in repetitive motions overhead, handling heav...

Our granddaughter separated her shoulder playing volleyball. They put her in a sling and said to rest it. That's it. Seems like that's how this problem was treated 40 years ago in my day. Haven't they come up with anything new or better than that in all this time? The acromioclavicular (AC) joint has come back into sharp focus in recent days. Because of changes in surgical technology, new advances have been made in the surgical treatment of this problem. You mentioned this condition by its more ...

I am going to have surgery to stabilize my AC joint. It keeps dislocating and exercising it hasn't helped. What's the latest I should know about surgery for this problem? The acromioclavicular or AC joint is the connection between the scapula (shoulder blade) and the clavicle (collarbone). Another term used to describe AC joint injuries is shoulder separation. A shoulder separation is a fairly common injury, especially in certain sports. Most shoulder separations are actually injuries to the acr...

Well, I'm ready to throw the towel in. I have bad arthritis of my AC joint from an old, old football injury. I've tried everything and the pain is unrelenting. I'm going to have the surgeon lop off the end of the bone. Anything I should know before I head in this direction? The acromioclavicular (AC) joint is located in the front of the shoulder where the acromion meets the clavicle (collar bone). The acromion is a curved piece of bone that comes from the back of the scapula (shoulder blade). It...

Have you ever heard of something called platelet-leukocyte gel? I saw an article in a magazine that said it is used to speed up healing after surgery. I'm having a decompression procedure for shoulder impingement. Is it something I should ask the surgeon about? Platelet-leukocyte gel is a substance containing of a mixture of platelet-rich plasma (PRP), white blood cells (leukocytes), and thrombin (for blood clotting). It is taken from the patient's own blood and applied to the surgical site.It c...

Do you think it's true that volleyball players have more shoulder dislocations than anyone else? What about second or third dislocations? Two girls on our team are out with their first shoulder dislocations and we are all worried. Shoulder dislocation is a fairly common problem among many athletes. Athletes at greatest risk seem to be those involved in collision sports. Anyone of any age whether involved in sports or not who has ligamentous laxity and/or who works with the arms above chest level...

I injured my shoulder playing touch football. It popped out of the socket but went right back in. The orthopedic surgeon I saw thinks it will be okay but there is a risk or it popping out again. If it went back in okay, and I don't stress it, will it stay there? There are many possible reasons why a shoulder dislocation might occur more than once. We call this recurrent shoulder dislocations. One of the main reasons is if there's been damage to the stabilizing features of the shoulder. One of th...

The orthopedic surgeon who is treating me showed me the MRI results and I definitely have a tear in the rotator cuff. But I don't remember ever injuring this arm so how is that possible? The shoulder joint is a very complex anatomic structure. In the absence of injury, chronic overuse can be one potential cause of a rotator cuff tear. Sometimes the natural angle of the shoulder or perhaps a too-shallow shoulder socket predisposes a person to microtears or other nontraumatic damage. There could b...

I'm thinking about having a procedure done for my shoulder arthritis called joint resurfacing. The surgeon tells me this has been around a good 30 years so it's not new. If that's true, what kind of results are people getting who have this operation done? Does it hold up? Would I end up with a shoulder replacement anyway and should just start there in the first place? Joint resurfacing has been around since the early 1980s. That gives us 30-years of data to examine in order to see how well this ...

I was walking out to the car to take my 86-year-old father to a dental appointment when he went down. No warning at all. One minute he was up and going, the next he was down and out. He didn't fall hard, just kinda melted to the ground. Even so, he ended up with a shoulder dislocation and fracture. Doesn't it usually take more than that to dislocate the arm? Now I'm worried it will happen again. The type of injury you just described is called a low-energy trauma and accounts for a large number o...

I'm a little concerned about my 72-year-old mother. She fell at home and dislocated her shoulder. The emergency room doctor was able to pop it back in place but she still can't seem to move it normally and it's been three months. Is that normal for this age? What do you suggest? If your mother did not have a follow-up appointment with anyone to re-evaluate her after the closed reduction of her shoulder dislocation, now would be a good time for that. In fact, given your description of her inabili...

I am an orthopedic surgeon and thought you might be able to help me out. I saw a report on postarthroscopic glenohumeral chondrolysis somewhere recently but can't find it again. I seem to recall there were some specific recommendations for surgeons to help prevent this condition. I'd like to review those again. Can you help me out? You may be referring to a recently published report from surgeons at the well-known Kerlan-Jobe Orthopaedic Clinic in Los Angeles. The topic was postarthroscopic glen...

Everyone I see tells me I have a shoulder impingement problem yet I keep having to go for more tests. First it was X-rays, now it's an MRI. If they know what's wrong with me, why do I need another expensive test? A very good question. Let's start with the type of problem you have. The term impingement tells us something is getting pinched. But with so many different soft tissues around the shoulder, exactly what is getting pinched can vary from one person to another.The most common shoulder imp...

Have you ever heard of something called platelet-leukocyte gel? I saw an article in a magazine that said it is used to speed up healing after surgery. I'm having a decompression procedure for shoulder impingement. Is it something I should ask the surgeon about? Platelet-leukocyte gel is a substance containing of a mixture of platelet-rich plasma (PRP), white blood cells (leukocytes), and thrombin (for blood clotting). It is taken from the patient's own blood and applied to the surgical site.It c...

Our granddaughter separated her shoulder playing volleyball. They put her in a sling and said to rest it. That's it. Seems like that's how this problem was treated 40 years ago in my day. Haven't they come up with anything new or better than that in all this time? The acromioclavicular (AC) joint has come back into sharp focus in recent days. Because of changes in surgical technology, new advances have been made in the surgical treatment of this problem. You mentioned this condition by its more ...

Do you think it makes any difference whether surgery to remove the tip of the collarbone at the AC joint is done with an open incision versus arthroscopically? I can have it done either way if I want to -- or I can leave the decision up to the surgeon. Dr. William J. Robertson of Massachusetts General Hospital in Boston offers the results of his own study of surgery for acromioclavicular (AC) joint pain. Comparisons were made in terms of results (shoulder function, patient satisfaction, pain) be...

I injured my shoulder playing touch football. It popped out of the socket but went right back in. The orthopedic surgeon I saw thinks it will be okay but there is a risk or it popping out again. If it went back in okay, and I don't stress it, will it stay there? There are many possible reasons why a shoulder dislocation might occur more than once. We call this recurrent shoulder dislocations. One of the main reasons is if there's been damage to the stabilizing features of the shoulder. One of th...

Do you think it's true that volleyball players have more shoulder dislocations than anyone else? What about second or third dislocations? Two girls on our team are out with their first shoulder dislocations and we are all worried. Shoulder dislocation is a fairly common problem among many athletes. Athletes at greatest risk seem to be those involved in collision sports. Anyone of any age whether involved in sports or not who has ligamentous laxity and/or who works with the arms above chest level...

The orthopedic surgeon who is treating me showed me the MRI results and I definitely have a tear in the rotator cuff. But I don't remember ever injuring this arm so how is that possible? The shoulder joint is a very complex anatomic structure. In the absence of injury, chronic overuse can be one potential cause of a rotator cuff tear. Sometimes the natural angle of the shoulder or perhaps a too-shallow shoulder socket predisposes a person to microtears or other nontraumatic damage. There could b...

I am in a quandry as to what to do. I have always been athletic but have started developing some shoulder problems in my 30s that I can't seem to overcome. My right shoulder seems too loose and even hangs down compared to my left. I have to consciously hold it up and back to make it even with the left side. Years of competitive sports may be catching up with me. What can I do about this? What should I do? You may be describing a situation of shoulder laxity (joint looseness) or possibly even sho...

I just came back from the orthopedic surgeon's office where I got a shot of cortisone in my shoulder for an impingement problem. I forgot to ask what I can and can't do for activity and exercise. Now it's Friday after hours and I have the weekend ahead of me. What advice can you give me? Each physician may offer different counsel to patients depending on the current problem, age, general health, and past medical history. Some surgeons may give you permission to do anything you feel up to. Others...

I'm thinking about having a cortisone injection into my shoulder. Since I'm very sensitive to all medications, can I suggest the physician use a lower dose than usual? Is this out of line?

I have severe shoulder pain and very limited motion. The surgeon says I have a Stage I tear of the rotator cuff and wants me to go to physiotherapy. I think I need surgery. Should I get a second opinion? There's never anything wrong with getting a second (and sometimes even a third) opinion when you are in doubt. It may be helpful for you to know that studies show that people can have severe symptoms with a minor tear of the rotator cuff. And it's possible to have no symptoms despite a massive (...

I'm trying to figure out what to do about my shoulder. The X-ray shows a big bone spur under the part the surgeon called the acromion. The rotator cuff is torn and I have something the physiotherapist calls scapular dyskinesia. Everyone has a different idea about how to treat these three problems. Is there any one-way to go or even an order of steps that should be followed? You are not alone in this dilemma. Many adults experience shoulder pain. One of the most common causes of mechanical should...

I had a rotator cuff repair surgery six months ago that failed. The surgeon wants to redo it. What sorts of things should I consider? Surgeons everywhere are grappling with the fact that rotator cuff repairs aren't always successful. There are many different reasons why this may happen. Let's take a look at causes of failure from both the patient and surgeon side of the equation. That might help you review your own case, ask appropriate questions, and make an informed decision.The two top facto...

Is it possible to tear the rotator cuff and not know it? I don't have any pain but my shoulder just doesn't work the way it should. I seem to recall injuring my arm years ago. Do you think I should see a doctor? Shoulder pain or the lack of shoulder pain is not always a reliable symptom to indicate the status of the rotator cuff. Studies show that a significant number of older adults actually have a torn rotator cuff and don't know it. And shoulder pain can be caused by other problems other than...

I had a full-thickness rotator cuff tear that was repaired using a special blood plasma product. It's supposed to speed up healing and recovery. Right now I'm still in the special pillow sling. I'm not scheduled to start rehab until the end of four (maybe six) full weeks. Is that faster than usual (i.e., without the special treatment)? The retear rate of repaired rotator cuffs is pretty high during the first three months postoperatively. That's why patients are put in an immobilizer and only all...

I am considering having rotator cuff surgery but my surgeon says my osteoporosis may be a problem. I've been told that my brittle bones may make it harder to get a good result. Is there anything I can do about this? Vitamins? Medications? I have seen commercials for medications that are supposed to help. But I've also heard reports on the radio that the drugs aren't all they are cracked up to be? What's the best way to go? You are right that studies have shown there's a fairly high failure rate ...

I had a very large rotator cuff tear repaired but it didn't hold. The surgeon said it was both a mechanical and a biologic failure. Can you explain it? Massive (very large) rotator cuff tears are at great risk of retears. Studies show a retear rate as high as 94 per cent. Not all of those retears are symptomatic but that is still not a very successful outcome.Retears are considered "failures" that fall into one of two categories: mechanical and biologic.Mechanical failure refers more to the tec...

I had X-rays and a bunch of tests done to figure out what's wrong with my shoulder. I was told I have a shoulder impingement and need an MRI. The MRI wasn't "conclusive" so now I need "diagnostic arthroscopy." All this is adding up to a big medical bill. Am I just being led down the path of no return? Shoulder impingement syndrome can be difficult to diagnose. Sure the physician can tell the symptoms that characterize this problem: you have trouble lifting your arm up overhead easily. The same t...

Do you think there's any risk in delaying rotator cuff surgery indefinitely? I'd like to take a wait-and-see approach but I'm afraid that could jeopardize surgery if it turns out that's what I'll need. The four tendons of the rotator cuff attach to the deep rotator cuff muscles. This group of muscles lies just outside the shoulder joint. These muscles help raise the arm from the side and rotate the shoulder in the many directions. They are involved in many day-to-day activities. The rotator cuff...

I saw a picture in a biking magazine of a guy who could lift his mountain bike up over his head after having a shoulder replacement. I have a shoulder replacement and there's no way I can do that. Why not? Joint replacements are usually done for one of three major reasons: 1) there's been a traumatic injury that cannot be repaired, 2) there's significant joint erosion from degenerative joint disease, and 3) the patient has rheumatoid arthritis.The type of joint replacement (design) and surgery t...

How in the world did I end up with a frozen shoulder? I'm 36-years-old, very healthy, and athletic. But one day I woke up with a stiff shoulder and the rest is history. Three years later and I am still struggling to get back to 'normal.' Adhesive capsulitis, sometimes called a "frozen shoulder" still baffles physicians and scientists alike. No one knows what really causes it -- or how to treat it. Women, age over 40, and shoulder injuries (trauma) head the list of possible risk factors.But adult...

I'm finding quite a bit on the Internet about anterior shoulder dislocations but not much about posterior dislocations. What are the guidelines for rehab and recovery for this kind of injury? Shoulder dislocations are not uncommon. Most dislocate forward (called an anterior dislocation). Less often are the posterior shoulder dislocations. As the name suggests, a posterior shoulder dislocation occurs when the head of the humerus (upper arm bone) pops backwards out of the shoulder socket.As you ha...

What's the difference between a frozen shoulder and adhesive capsulitis? The term frozen shoulder has been around since the early 1930s. But recent research has been able to show that every stiff, painful shoulder isn't necessarily a true "frozen shoulder."You've heard the alternate term for this problem: adhesive capsulitis. According to the authors of a recent review, frozen shoulder and adhesive capsulitis are not the same things. What's the difference?Frozen shoulder is a vague term similar...

I was trying on clothes at the mall the other day in front of those three-way mirrors. I noticed that one of my shoulder blades is sticking out. What could be causing this? Should I do anything about it? What you may be seeing is something we call scapular winging. Scapula is another word for shoulder blade. Scapular winging, of course, describes the position of the scapula as it "sticks out."Sometimes you see scapular winging in young children. They haven't developed the full strength of the ar...

I am having a weird shoulder problem. I don't have any pain but every time I reach back to put my seatbelt on, my left shoulder clunks. What could be causing this? You may have some shoulder instability meaning the head of the humerus (upper arm bone) isn't being held exactly in the middle of the shoulder socket where it belongs. If the humeral head is just slightly forward of the center of the socket, when you reach back, the head shifts back into place.The clunk you feel may be the round head ...

I have a chronic shoulder "instability." It's not bad enough to justify the expense of surgery yet but it is affecting my daily activities. I've heard that there's a new platelet injection therapy for tendon problems. Would this help me? You may be referring to platelet-rich plasma (PRP) (also known as blood injection therapy). PRP is a medical treatment being used for a wide range of musculoskeletal problems.Platelet-rich plasma (PRP) refers to a sample of serum (blood) plasma that has as much ...

The MRI I had taken of my right shoulder showed that my rotator cuff tear (repaired 10 years ago) was no longer whole. Somewhere along the line, it tore again. I never felt a thing and the arm works just fine. Is it possible they misread the MRI? A tendon rerupture usually shows up on an MRI as an empty space where there is a gap between the bone where the tendon should be attached and the tendon itself. The end of the torn tendon is called the tendon stump. Usually this empty space is filled wi...

I knew I tore my rotator cuff a couple of years ago but it didn't bother me so I didn't have surgery. When I started developing some shoulder pain, the orthopedic surgeon did an MRI on me and found that the muscle has atrophied and the tear has filled in with fat. Is that normal? The natural history (what happens) to an unrepaired rotator cuff tear depends on several factors. The size of the original tear, the cause (trauma versus degenerative soft tissue changes), and your activity level since ...

My sister has a chronically dislocating shoulder. She tried rehab but got kicked out because she either didn't go to her appointments or if she did, she didn't do her exercises. Should she have surgery for something like this and be done with it? Should I go with her and make this suggestion to the doctor? Someone with a chronically dislocating shoulder that doesn't respond to conservative (nonoperative) care is usually a good candidate for surgery. But (and that's a big "but"), a history of non...

My 18-year-old son had a seizure severe enough that his shoulder dislocated posteriorly. The shoulder has popped back in but there is a concern that it will pop out again. The surgeon doesn't want to do surgery until a) our son has finished at least six months of physiotherapy and b) his meds are regulated enough to prevent another such episode. This sounds like a reasonable plan but I'm checking around to see if other surgeons would handle it differently. According to a recent review on posteri...

I just found out that I have a rotator cuff tear and damage to the biceps pulley. I'm having surgery next week for both. Are these two problems part of the same thing, separate issues, related to each other, or what? Let's start with describing the biceps pulley. The full name of the pulley mechanism is biceps reflection pulley. It is a sling of soft tissue fibers made from surrounding shoulder ligaments and tendons of the shoulder rotator cuff. The sling helps keep the biceps tendon inside a gr...

Is everything that goes wrong with muscles, tendons, and joints related to age? I've had two shoulder injuries that the surgeon says are both caused by "degeneration". One was a rotator cuff tear. The other was a tear in the biceps pulley I'm 72-years-old, so what's going to go next? It's true there are certain changes that occur in the musculoskeletal system as we get older. For example, age-related loss in muscle mass, strength, and endurance of skeletal muscle is termed sarcopenia.Sarcopenia ...

What are the chances I can heal from a full-thickness tear of my rotator cuff? Only the supraspinatus tendon was damaged. Right now they are recommending physiotherapy with surgery as a back-up plan. Many adults who have a rotator cuff tear consider waiting to see if the shoulder will heal on its own without surgery. There has always been a question whether rotator cuff tears can heal without surgery.It is clear that painful symptoms can be treated effectively without surgery. But does the torn...

I am a cabinet maker with an unfortunate problem: shoulder pain. The surgeon wants to release part of my biceps tendon away from the shoulder. She says this won't affect my work and will probably reduce my shoulder pain. Would you recommend this type of surgery? There are many different causes of shoulder pain. Any problem inside or around the joint can create pain. One of the more common sources of shoulder pain occurs when there is some type of pathology of the long head of the biceps tendon (...

I'm on my third shoulder surgery now. Now I have what they call a "Popeye deformity." Will I need surgery for this? A Popeye deformity is defined as any abnormal shortening or defect of the biceps muscle. The biceps tendon attaches between the elbow and the shoulder. It helps you lift your arm straight up and bend the elbow. There are two parts: the short- and long-heads of the biceps. Each one attaches in a slightly different place on the arm.A Popeye deformity is usually pretty obvious. There'...

I had a rotator cuff repair but I still have shoulder pain. It's right in the front of my arm and mostly hurts when I raise my arm up. Should I go back to the surgeon? See my physiotherapist? Give it some more time? I can't quite figure out what to do. Pain that lingers after a shoulder surgical procedure is not all that uncommon. But you are right to wonder what's causing it and what can be done about it. A follow-up visit to both your surgeon and your physiotherapist would be a good idea. The...

My orthopedic surgeon thinks I have something called coracoid impingement. She wants me to see a physical therapist before considering surgery. What can a therapist do for this problem? The coracoid process is a small hook-like structure at the top front part of the scapula (shoulder blade). The coracoid process works together with the acromion to stabilize the shoulder jointThe acromion is a curved piece of bone that comes from the back of the shoulder blade around and over the top of the sho...

What is chondrolysis? My sister says she got this after having arthroscopic shoulder. Can anything be done about this? Chondrolysis is defined as a generalized (all over) loss of the articular (surface) cartilage of the glenohumeral joint. The glenohumeral joint refers to both sides of the shoulder joint: the round head at the top of the humerus (upper arm bone) and the glenoid (shallow groove that functions as the shoulder socket).The fact that the condition is generalized (rather than a local ...

Is it possible to have a rotator cuff strain that is not a rotator cuff tear? When it comes to injuries of the rotator cuff, there are actually three possibilities. There can be a strain, muscle tear (partial or full-thickness), and degenerative defects.A rotator cuff strain has been defined as an intact rotator cuff (no tear) but with edema (swelling) and bone bruises where the rotator cuff attaches to the bone. These are tissue changes that have been observed with MRIs.Traumatic injury resulti...

Despite my daily workout routine I tore my rotator cuff. The surgeon says I probably had a worn out tendon to begin with and the exercises helped but couldn't prevent the injury. Is this true? Maybe I'm just not doing the right kind of exercises (or maybe not enough exercises). The rotator cuff is a group of four muscles and their tendons that surrounds the shoulder. They function in two ways. First, they help hold the head of the humerus (upper arm bone) in the acetabulum (shoulder socket). Sec...

I'm 66-years-old and participating in the Senior Olympics for the first time. Right out of the shoot, I tore my rotator cuff (the subscapularis muscle). What would you predict for recovery time? The largest muscle in the rotator cuff is the subscapularis. This muscle helps rotate the shoulder and arm inward (internal rotation). The subscapularis helps stabilize the shoulder in the socket and prevent forceful anterior (forward) dislocations.The subscapularis also helps balance the force applied o...

Can anyone get one of those new reversed shoulder replacements? I had a regular shoulder implant that didn't work so I need to replace the replacement. The reverse shoulder arthroplasty is a new enough procedure that surgeons are still studying who would benefit from this implant. The procedure is called a reverse shoulder arthroplasty.The round ball-shaped bone that normally fits into the shoulder socket is removed and replaced with an artificial cup. The anatomic socket is replaced with a tita...

Can you please give me some basic info on reverse shoulder replacements? Along with hip and knee joint replacements, shoulder replacement has become increasingly popular for people with pain and loss of motion from arthritis. But the shoulder is a bit different from the hip and knee. A tear in the muscles around the shoulder (called the rotator cuff) can complicate things.Replacing the joint without an intact, functioning rotator cuff may not improve the situation. Without the muscles to hold th...

If I have a rotator cuff tear but it doesn't bother me, what are the chances it will just go away? The rotator cuff is a group of four muscles and their tendinous attachments that surround the shoulder in the socket. They provide both stability (to hold the head of the humerus in the socket) and strength for smooth and controlled movement.Unfortunately, tears of tendons and especially of the rotator cuff don't "go away". The body does initiate a healing response. Although the tendon can't repair...

I have a frozen shoulder that just isn't getting better. I've heard they can put you to sleep and manipulate the joint. Is there some other easier way to get the motion back without that kind of trauma? Manipulation under anesthesia has the advantage of restoring shoulder motion without using an open incision. But it does have the disadvantage that it is tearing or rupturing the tight, scarred down joint capsule.If you haven't tried the conservative route of physiotherapy, you might want to cons...

What's the difference between adhesive capsulitis and a frozen shoulder? I thought they were the same thing but my sister who is a physician's assistant says they are not. Your sister is correct: frozen shoulder and adhesive capsulitis are actually two separate conditions.What separates these two diagnoses? Both show up looking like a painful, stiff shoulder. But adhesive capsulitis (as its name implies) affects the fibrous ligaments that surround the shoulder and form what's called the capsule....

What's the best way to recover from a frozen shoulder? Many adults (mostly women) between the ages of 40 and 60 years of age develop a strange case of shoulder pain and stiffness called adhesive capsulitis. You may be more familiar with the term frozen shoulder to describe this condition.There isn't a one-best-treatment known for adhesive capsulitis. A review study was published on the topic. The authors are two orthopedic surgeons from the Hospital for Special Surgery in New York City. They re...

Am I too old to have shoulder surgery? I've had a bum shoulder for 20 years. I'm getting too old to put up with this problem. Is it too late to have the surgery now? In theory, yes, you could have surgery to repair (probably reconstruct) that bum shoulder. But in reality, you'll need to have an orthopedic surgeon evaluate your arm in order to answer that question for you. The standard treatment for recurrent shoulder dislocation is to reattach torn muscles and smooth or repair the labrum if it h...

I'm playing the odds here. With a Bankart lesion in both shoulders, I'm trying to rehab with physiotherapy and skip the surgery. What's the likelihood that I can recover on my own? A Bankart lesion occurs when a shoulder dislocation has caused a tear in the labrum. The labrum is a tough rim of fibrous cartilage around the shoulder acetabulum (socket). It is designed to help hold the shoulder in the otherwise shallow socket. Loss of the integrity of the labrum increases the risk of shoulder insta...

If my shoulder popped out of the socket but went back in the socket by itself, do I have a subluxation or a dislocation? Subluxation is usually defined as an incomplete instability event that did not require manual assistance to reduce it. Manual assistance refers to a doctor or emergency medical technician using a hands-on technique (or surgery) to put the joint back in place. A shoulder that pops out of the joint but goes back in on its own is technically still a subluxation.Dislocation is a c...

Loss of circulation to the hands can occur with arms raised overhead from one of several different problems.

I have a chronic shoulder problem from a degenerating rotator cuff and now bursitis on top of it. The surgeon has given me two treatment choices to consider: physiotherapy and rehab or surgery. I really don't know which way to go. What do you suggest? Your decision may depend on a number of factors. First, what type of surgery is recommended? This question actually has two parts. Will the surgeon be doing the procedure using an open incision or using an arthroscope (requires only tiny holes to i...

Mother is 72-years old but fairly frail and immobile. She tore a muscle in her chest when the nurses aide was helping transfer her from the bed to the chair. The doctor says not to do surgery (and we agree), but I'm just checking to see if you think this is the right decision. The pectoralis muscle is the large muscle across the chest that is most active when doing push-ups or lifting weights. It is a two-part muscle that attaches above to the clavicle (collar bone) and down the length of the s...

Our son is in the military and just ruptured his major chest muscle bench pressing. They made this diagnosis without even an X-ray. Should we accept the physician's assistant's opinion or insist on him seeing a real doctor and having some X-rays taken? Physicians in the military are often spread thin so they do rely on an assistant to carry out the triage, a method of screening and preliminary examination. Those recruits or soldiers who have an obvious problem that doesn't require the expertise ...

My doctor thinks I have shoulder bursitis but wants me to have some ultrasound studies done to confirm it. Aren't there some simpler tests that can answer this? There are some clinical tests examiners can use to help identify which structures in the shoulder might be causing painful symptoms. For example, there are several different tests that require putting the arm in a particular position and/or giving some slight resistance to movement in that position. These are called provocation tests. By...

My sister-in-law and I had the same surgery for a rotator cuff tear two days apart. She's already out of her abduction brace and I'm still lugging mine around. Is it safe for me to stop wearing mine now, too? Don't stop wearing your brace without first discussing the decision with your surgeon. Each patient has his or her own unique injury and repair procedure that dictates post-operative protocol.For example, patients with small tears are often able to take the arm out of the abduction brace af...

My mother fell out of bed and broke her upper arm. She will need a shoulder replacement. She has a choice of the traditional ball in socket joint or the new reverse arthroplasty. Can you give us some idea why one might be better than the other? Shoulder fractures in older adults are definitely on the rise. The upper arm bone your mother broke is called the humerus. A sudden fall from bed or even from a standing position can generate enough force to break the humeral shaft away from the humeral ...

I had shoulder surgery about six months ago. They repaired a torn rotator cuff and a torn labrum. The joint just seems so stiff some days. Is this normal? According to surgeon observation and reported studies, stiffness after shoulder surgery is more common in older adults (40 years old or older). This is especially true when concomitant (combined) procedures such as a rotator cuff repair and a SLAP repair are done at the same time.SLAP refers to the labral tear you have. It stands for superior ...

How is it possible for a relatively healthy 53-year-old to end up with a rotator cuff and labral tear of the shoulder at the same time without an injury? Most rotator cuff tears are the result of sports-related injuries. But there are other mechanisms of injury such as a fall (from a height or from a standing position), lifting heavy items, car accidents, or other accidents.Is it possible that you have experienced one of these injuries in the past but just didn't link it with the damage to your ...

I am 33-years-old and retiring from a professional ball throwing career. My pitching arm has become unstable from overuse. The team doc has suggested I have surgery to tighten up the joint so it will stop dislocating. What kind of surgery can they do for something like this? Joint laxity (even hyperlaxity) is a common shoulder problem among overhead pitchers. Hyperlaxity means the soft tissues around the joint that usually hold it in place are extra long and very elastic. Some people are born wi...

Two weeks ago, I had rotator cuff surgery. I'm doing the pendulum exercises the physiotherapist showed me but I think these are stupid. I'm really ready to start using the arm more. Is there any reason why I can't move on now? It's understandable that you want to progress your exercise program and resume more activity and motion. But we must caution you to follow your surgeon's and your physiotherapist's counsel.And here's why. There's evidence to show that with large tears (complete rupture), t...

My sister had a rotator cuff repair 10 years ago and had a rough time of it. The tear reopened after surgery and she ended up having two more operations. Now I find myself in the same position of needing rotator cuff surgery. Is there any chance things are better now that another decade has passed -- maybe safer, better ways of doing the operation? I definitely don't want to go through what she has.Surgery for the shoulder has changed over the years. A wide incision and open surgery has given wa...

I just had rotator cuff surgery and start rehab in about a month to six weeks. I don't have a job that involves manual labor but I do enjoy a high level of sports activities on the weekends. How soon will I be able to get back into action with those activities? Your level of sports activity and how much demand you place on the shoulder will definitely be a guide to your rehab program. The first variable is how badly was the tendon injured -- full-tears take longer to rehab compared with partial ...

I had an ultrasound picture of my rotator cuff that showed something weird. The muscle that was starting to show signs of wear and tear wasn't torn. It was the other (healthier looking) muscle next to it that went. Is there any explanation for this?

I saw a physical therapist after dislocating my left shoulder. She put me through a complete program until I was ready to get back to work. From start to finish, I was back on the job in eight weeks. How does that compare to other people?

I confess I'm not much for exercise, so when I was diagnosed with snapping scapula syndrome, I skipped the surgeon's recommendation for physiotherapy and just took the antiinflammatory pills. But six weeks later and I'm still not any better really. Maybe if I knew what was involved with therapy, I might be more motivated to go. What can you tell me?

I just found out my shoulder pain is caused by something getting pinched in there. We're not sure just what's getting pinched but the MRIs should help clear up the anatomy of the problem. What's the cause of this condition? You know -- what brings it on?

Have you ever heard of using laser to treat a shoulder impingement problem? How does it work?

I was very active in sports during my high school and college years. I never hurt myself and always felt proud of that fact. But now it turns out I have a rotator cuff tear in both shoulders and didn't even know it. Could these have been there all this time or is this a new development?