SHOULDER INJURIES

     Shoulder injuries are common following a wide variety of activities, and the way an athlete experience these injuries are also varied.  This large variety can make it difficult to for patients to pinpoint the problem.  Some basic knowledge can be a helpful tool, allowing you to gain an understanding of the pain you are experiencing and discuss the problem with your doctor.  Unfortunately, it can be hard to find reliable information.  The button below links to a general overview of the shoulder, its function, common complaints, and general treatment options compiled by the American Academy of Orthopedic Surgeons. 

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ROTATOR CUFF TEARS, BURSITIS, AND IMPINGEMENT

     Rotator cuff tears and impingement syndrome can cause pain on the outside of the shoulder and may manifest as weakness or fatigue when lifting or performing activities above shoulder level.  They are frequently accompanied by stiffness and/or difficulty sleeping.  In most patients , these problems are the result of cumulative "wear and tear" and appear slowly over a period of weeks or months, although symptoms may worsen abruptly after a single event.  In younger patients, a specific injury may cause a traumatic tear.
     In addition to an history and physical exam by an experienced provider, the use of xrays, ultrasound, and MRI can help evaluate these conditions and guide treatment.  When there is inflammation but no clear tearing (e.g. burisits/impingement), or in the case of small or partial tears, a period of activity limitation, therapy, anti-inflammatories,  and occasionally injections can be useful.  In complete tears or partial tears that don't respond to these methods, a rotator cuff repair surgery to reattach the torn tendon to the shoulder bone (humerus) may be recommended.  Dr. Zacchilli performs this surgery arthroscopically, using a fiberoptic camera and specialized instruments and anchors to fix the tear through 2-5 small incisions about half an inch long.

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SHOULDER DISLOCATIONS, INSTABILITY, AND LABRUM TEARS

    

     Shoulder dislocations are one of the most common injuries treated by orthopedic sports medicine surgeons.   While the "ball-in-socket" design of the shoulder joint allows more motion than any other joint in the surgery, it also allows for the shoulder to be placed into risky positions.  Normally, ligaments (strong bands of tissue) connect the ball (humeral head) and the socket (glenoid) to protect them in these positions.  These ligaments attach to the edge of the socket through a structure called the labrum, which works like an O-ring to deepen the glenoid and create a suction seal. 
     When a dislocation occurs, the humeral head slips violently out of the socket, stretching and tearing the ligaments and labrum.  In many patients >30 years old, 6 weeks of rest followed by physical therapy are sufficient to prevent further instability, although there are exceptions.  However, continued instability and repetitive dislocations are relatively common in younger patients and high demand athletes.  In fact, the risk of suffering another dislocation may be as high as 70-90% in some athletes <20 years old.  Additionally, with each dislocation there is a risk that bone will be broken off the ball or socket, making the shoulder even more likely to dislocate.

    Dr. Zacchilli can usually perform surgery (arthroscopic labrum / Bankart repair) to correct this problem with a fiberoptic camera and special instruments through 3 small incisions about half an inch long.  In cases where significant portions of the bone are missing, an open surgery with bone grafting (e.g. Latarjet procedure) may be required.

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