Dr. J. Michael Bennett is a Board-Certified orthopedic surgeon and sports medicine physician with many years of experience treating shoulder injuries like shoulder pain, rotator cuff, arthritis in the shoulder. If you’re experiencing shoulder pain or limited motion in your shoulder, call us at 281-633-8600 for an appointment and a medical evaluation. We have offices in Houston, TX and Sugar Land, TX and serve patients from all over the Metro Houston area including Katy, Fort Bend County, Missouri City, and Stafford.
Here’s a transcript of the shoulder injuries video:
Occasionally you can have a bone spur underneath this bone here called the acromion. If you have a bone spur underneath the acromion, that bone spur will dig into this tendon or irritate that bursa when you have certain movements like raising your arm above your head. That is called impingement.
When you raise your arm above your head that brings this rotator cuff tendon underneath this bone which exposes it to the bone spur. Chronically that can cause inflammation and pain in some people. Now some people have these bone spurs that don’t bother them at all; and if that’s the case, we don’t do anything with that. If it does bother the patient, oftentimes an injection and exercise will help.
When the injections and exercise do not help, an MRI may be warranted to look at the tendon itself to make sure that it is healthy because sometimes you can have degeneration or tearing of this tendon structure. If you have a partial tendon tear, less than 50 percent, usually injection, exercise, anti-inflammatories and modification of activities are tried first.
If it is a full tear, meaning one of the tendons is actually detached from the bone and retracted backward, depending on your activity level and your pain and what treatment methods you’ve tried previously, surgery may be an option for that patient, particularly if it is an acute injury. Usually we like to treat these sooner as opposed to later, because when that tendon tears it can retract and this muscle will atrophy and actually scar because it is not being used anymore; the tendon retracts back like a rubber band. Then it becomes very hard to pull that tendon back and fix it at a later date.
Usually we do not like to wait more than six to eight weeks, sometimes longer, but usually for the most part we like to fix these within a couple of months. Fixing these tendons, if they’re torn, just requires us to put a small anchor into the bone here with a stitch. The stitch pulls the tendon back down to the bone and holds it into position. That allows the bone or the tendon to grow back into its insertion site in the bone and heal, scar and mature, allowing you to raise your arm back up, externally rotate, or whatever motion that tendon was responsible for previously. That also decreases the risk of multiple tears; if you have one tear in your tendon, most oftentimes the remaining tendons can tear as well. And a posterior tendon tear like this (manipulates model) can spread anteriorly, and if all of your tendons are torn, then you lose the mechanism to hold this ball into the socket. When that mechanism is gone, this ball migrates up into this bone here and actually moves or slides upward, mal-aligning itself with the socket, and you can develop arthritis, and that becomes a very difficult problem to treat, oftentimes requiring arthroplasty or replacement of the shoulder. So that is one main reason why we recommend addressing these smaller tears early as opposed to waiting until they become massive tears and become harder to fix. The earlier you can fix these tears, the better prognosis and long-term outcome you will have regarding your rotator cuff.
Another problem with the shoulder could be acromioclavicular joint arthritis which is where these two bones meet: the clavicle and the acromion. And there’s a joint right here and sometimes this joint will become arthritic and painful and hurt when you reach across your chest in a motion similar to putting a seatbelt on. If that’s the case what happens is this bone bumps into that bone when you reach across and it irritates it. Sometimes we can put some steroid in here to calm this down, sometimes we can physically remove the bone spurs between these two bones, opening up the space so these bones now don’t bump into each other anymore. Occasionally you will have an athlete that falls on his shoulder and this bone will become dislocated, or rise up, and sometimes depending on how much dislocation you have, this can be treated in a sling though sometimes this can require surgery.
Another shoulder injury is shoulder dislocation. We see this occasionally in patients that do contact sports or a patient that has had a traumatic fall. This is when the ball pops out of the socket and takes a piece of the socket with it. That piece of the socket changes the construct of the shoulder, so if you think of your shoulder as a ball and socket mechanism almost like a golf ball and a golf tee, when there’s a chip on the golf tee, the golf ball will roll off. Same thing with the shoulder. When there’s a chip in the cup, the ball will roll off so you are more likely to have recurring dislocation in the shoulder.
This can be a surgical issue which we can address arthroscopically through some small poke holes in the shoulder. Once again it depends on the patient, depends on the activity level, and what their expectations are. But as I’ve said before, if you’ve had any of these symptoms and they’re not improving over one to two weeks, then I do recommend that you seek out a specialist and have your shoulder evaluated. And always, always, do your due diligence and get a second opinion if needed.
