Saanichton, BC

Dr. Miguel A. Lipka

Shoulder

This is categorized under:

Shoulders are the work horses of the body. Some of the shoulder disorders that can occur include:

  • Athletic injuries
  • Overuse syndromes
  • Post-traumatic lesions
  • Degenerative lesions
  • Arthritis

Treatments vary by the type of injury and the condition of the patient.

Glenoid Labrum Tear

The glenoid, or socket joint of the shoulder, is surrounded by a fibrocartilaginous supporting structure called the labrum. Injuries to the tissue surrounding the shoulder socket can be caused by acute trauma or repetitive shoulder motions. Examples include falling on an outstretched arm, a direct blow to the shoulder, sudden pull or a violent overhead reach, such as occurs when trying to stop a fall or slide. Throwing athletes and weight lifters can experience tears due to repetitive shoulder motion.

Tears can be located either above (superior) or below (inferior) the middle of the glenoid socket. A SLAP lesion (superior labrum, anterior [front] to posterior [back]) is a tear of the rim above the middle of the socket that may also involve the biceps tendon.

Signs and symptoms of glenoid labrum tears include:

  • Pain, usually with overhead activities
  • Catching, locking, popping or grinding
  • Occasional night pain or pain with daily activities
  • A sense of instability in the shoulder
  • Decreased range of motion
  • Loss of strength

Treatment includes:

  • Rest
  • Cold therapy to reduce pain and inflammation
  • NSAID's (non steroidal anti inflammatory drugs such as ibuprofen)
  • Rehabilitation program
  • Surgery to re-attach the labrum to the glenoid

Following surgery the shoulder will usually be kept in a sling for 3 or 4 weeks. More sports specific training can be done after 6 weeks, although full fitness may take 3 or 4 months.

Rotator Cuff Tear

Although there are many reasons for shoulder pain, a common problem for people over 40 years of age is a rotator cuff tear.

The rotator cuff is comprised of the muscles and tendons that surround the top of the upper arm bone - the humerus -- and hold it in the shoulder joint. A sudden tear may result from a single traumatic event or develop gradually because of repetitive overhead activities. A partial tear may cause pain when the arm is lifted in a certain arc away from the body (painful arc syndrome) and a complete tear may limit the aility to raise the arm.

Signs and symptoms of rotator cuff tears are:

  • Recurrent, constant pain, particularly with overhead activities.
  • Pain at night that prevents you from sleeping on the affected side.
  • Muscle weakness, especially when attempting to lift the arm.
  • Catching and grating or cracking sounds when the arm is moved.
  • Limited motion.
  • Usually occurs in the dominant arm, which is the right shoulder for right-handed people; left shoulder for left-handed people.
  • May be triggered by a specific incident.

Most rotator cuff tears can be treated without surgery. Non-operative rotator cuff treatments may include:

  • Physical therapy
  • Anti-inflammatory pain medications
  • Cortisone injections

The goal of treatment is to reduce inflammation and strengthen the uninjured muscles around the shoulder to compensate for the torn muscles.

In the minority of patients where non-surgical treaments are not effective, surgery may be recommended. Surgery is performed to repair the torn tendons.

Shoulder Fracture

Shoulder blade fractures represent 1 percent of all broken bones. High energy blunt trauma, such as a motorcycle or car crash or falling from a significant height can fracture the shoulder blade.

Signs and symptoms for shoulder fractures include:

  • Extreme pain when you move the arm
  • Swelling around the back of the shoulder
  • Skin abrasions
  • Redness and bruising around the area
  • Bones may appear out of position

Both diagnosis and severity of a shoulder fracture can be confirmed by X-rays.

Nonsurgical treatment with a simple sling works for most fractures of the scapula or shoulder blade. The immobilization device holds your shoulder in place while the bone heals.

If you have a fracture where the bone has moved out of place significantly, or where a fracture in the neck of the scapula results in severe deformity of the bone, you may need further evaluation. In some cases, you may need surgery in which the doctor uses plates and screws to hold the bone together.