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Lospa® IS™ Spinal Fixation System Screw System Cage System Hip Anatomy Disease & Injury Total Hip Replacement
Knee Anatomy Disease & Injury Total Knee Replacement
Spine Anatomy Disease & Injury Surgical Treatment
Shoulder Anatomy Disease & Injury Total Shoulder Replacement
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Anatomy

The hip joint is made up of two bones: the pelvis and the femur (the thighbone). It is the largest ball-and-socket joint in your body. The "ball" is the rounded end of the femur (also called the femoral head). The "socket" is a concave depression in the lower side of the pelvis (also called the acetabulum). The femoral head fits into the acetabulum to form the hip joint. This anatomy allows for a lot of motion within the joint — for instance, walking, running or climbing.


The femoral head attaches by way of the femoral neck to the rest of the femur. Cartilage helps prevent friction between the femoral head and the acetabulum, but hip pain can occur if your cartilage begins to wear down or is damaged.

Disease & Injury

Hip pain results from damage to the hip joint. Damage to the hip joint results from a number of causes, including the diseases and injures below:

OSTEOARTHRITIS (OA)

Osteoarthritis is the most common disease of the hip joint. It is often described as the result of wear and tear of the joint cartilage, which explains why it is also known as degenerative arthritis. The hip joint is surrounded with cartilage. The cartilage protects the joint and allows for smooth movement. It also absorbs the pressure and shock created by activities like running and walking. When this cartilage wears down from increasing age, obesity, joint injury or bone deformities, among other risk factors, the bones rub together, causing pain and stiffness.

Symptoms

Joint pain, a creaking or grating sound in the joint, swelling, stiffness, limited movement and joint deformity.

Treatment

The goal of treatment is to reduce joint pain and inflammation, and to improve joint function. Treatments may include medications, dietary supplements, alternative therapies (e.g., acupunture, relaxation therapy), mechanical aids (e.g., shock-absorbing shoes, splints or braces), losing weight, exercise and physical therapy, heat and ice, and corticosteroid injections. The most radical treatment is joint arthroplasty.

Prevention

To reduce your chances of getting osteoarthritis, maintain a healthy weight, do regular, gentle exercise (e.g., walking, stretching, swimming, yoga), and avoid repetitive motions and risky activities that may contribute to joint injury, especially after age 40.

RHEUMATOID ARTHRITIS (RA)

Rheumatoid arthritis is a chronic, systemic inflammatory disorder. RA occurs when the immune system doesn’t function properly. The immune system normally makes antibodies (small proteins) to attack bacteria, viruses and other germs. In people with RA, antibodies are formed against the synovium (the tissue that surrounds each joint). This causes inflammation in and around the affected joints. The actual causes of this autoimmune disease are not clear.

Symptoms

Joint pain, stiffness, redness, warmth and swelling; joint deformity; and, small lumps or nodules under the skin.

Treatment

The goals of treatment are to relieve pain, reduce inflammation, slow down joint damage and improve functional ability. There are a variety of medications to treat the pain and inflammation of RA. Rest reduces active joint inflammation and pain, and fights fatigue. Exercise is important for maintaining muscle strength and flexibility, and preserving joint mobility. Devices that help with daily activities can also reduce stress on joints. Stress reduction can ease the difficulties of living with a chronic, painful disease (e.g., joining a support group, cognitive behavioral therapy, meditation). Joint replacement and tendon reconstruction help relieve severe joint damage.

Prevention

There are no guidelines to reduce your risk of developing rheumatoid arthritis because the exact cause is not known.

ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY

Avascular Necrosis (AVN) Avascular necrosis is the death of bone tissue due to a lack of blood supply.

Cause

Bones are living tissues, and bones receive nutrients through blood vessels. If a blood vessel is damaged, bone can die and collapse. There are many causes of AVN. Anything that interrupts the blood supply to the hip can cause AVN. The most common causes of AVN include femoral neck fracture, dislocation, smoking and excessive alcohol use. Fracture of the femoral neck and dislocation can damage the blood vessels. Smoking causes blood vessels to constrict or narrow. Excessive alcohol use can damage the blood vessels and lead to AVN.

Symptoms

Groin pain, buttock pain, thigh pain and limping.

Treatment

Taking non-steroidal anti-inflammatories and other pain relievers; and, performing non-weight-bearing exercises Bone grafts, decompression of the inside of the bone, realignment of the bone and hip replacement are all available.

Prevention

Because there are many causes, the key to the prevention of joint destruction from AVN is early diagnosis of the underlying cause.

FRACTURE

A hip fracture is a break in the thigh bone (femur). Older people are more prone to hip fractures because bones tend to weaken with age. This bone weakening is called osteoporosis. It is characterized by a decrease in bone mass and density.

Types of hip fractures


1) Femoral Neck Fracture

A femoral neck fracture occurs in the femur about one or two inches below the femoral head. It may disrupt the blood supply and, thus, require hip replacement.

2) Intertrochanteric Hip Fracture

an intertrochanteric hip fracture occurs between the greater trochanter and lesser trochanter.It doesn’t damage the blood supply.

Symptoms

Joint pain, limited joint function and abnormal appearance of the broken leg (e.g., looks shorter, turns outward).

Medication

Your doctor may prescribe pain medication to reduce your discomfort. You might also be given prescription medications (such as bisphosphonates) to help increase bone density. This may help prevent other fractures.

Physical Therapy

If you have surgery, your doctor may recommend physical therapy to help you recover faster. A therapist will teach you range of motion exercises (used to improve flexibility and movement) to help your body get used to a new or repaired hip.

Surgery

If you are healthy enough to withstand surgery, it is the most common treatment for a broken hip. You may have surgery to repair or replace your hip. Hip replacement surgery involves removing the damaged part of your hip and putting an artificial hip implant in its place.

Prevention

One of the most important ways to prevent hip fractures is to prevent osteoporosis. Get plenty of calcium and vitamin D. Eat foods high in calcium. Do weight-bearing exercise that puts pressure on bones and muscles.

Total Hip Replacement

What is total hip replacement (arthroplasty)?

    Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to replace the parts of the hip joint that have been damaged and to relieve hip pain that cannot be controlled by other treatments.

What are the indications for this surgery?

  • Hip pain that limits everyday activities, such as walking or bending.
  • Hip pain that continues while resting, either day or night.
  • Stiffness in a hip that limits the ability to move or lift the leg.
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy or walking supports.

There are no absolute age or weight restrictions for total hip replacement.

What does total hip replacement surgery involve?

  • The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may either be cemented or "press fit" into the bone.
  • A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
  • The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
  • A polyethylene, ceramic or metal liner is inserted between the new ball and socket to allow for a smooth gliding surface.

*During hemiarthroplasty of the hip, only the damaged femoral head and neck are removed and replaced with a bipolar prosthetic

Anatomy

Knee Bones

Knee Bones There are four bones that make up the knee joint: the tibia (shin bone), femur (thigh bone), patella (kneecap) and fibula (on the outer side of the shin). They support the body and transfer forces between the hip and foot, allowing the leg to move smoothly and efficiently.

Meniscus and Cartilage

A really important part of the knee joint is the cartilage. There are two types of cartilage in the knee: articular cartilage, which lines the joint, and the meniscus, which is a special extra layer of thick cartilage. These act as shock absorbers to reduce the forces going through the bones and reduce friction, allowing the bones to move smoothly.

Ligaments

Ligaments are tough, fibrous connective tissues made of collagen, which link bone to bone. In the knee joint, they are the main stabilizing structures preventing excessive movements and instability.

Disease & Injury

The knee joint is a weight-bearing joint that withstands large forces during activity, such as running and jumping. A damaged knee joint can cause great disability. Some diseases and injuries of the knee follow below and, in severe cases, require knee replacement.

OSTEOARTHRITIS (OA)

Osteoarthritis is commonly known as “wear and tear arthritis” or “degenerative arthritis ". OA is the most common cause of arthritis pain in knees. The knee joint is surrounded with cartilage. The cartilage protects the joint and allows for smooth movement. It also absorbs the pressure and shock created by activities like running and walking. When this cartilage wears down from increasing age, obesity, joint injury or bone deformities, among other risk factors, the bones rub together, causing pain and stiffness.

Symptoms

Joint pain, a creaking or grating sound in the joint, swelling, stiffness, limited movement and joint deformity.

Treatment

Medications, dietary supplements, mechanical aids (e.g., shock-absorbing shoes, splints or braces), losing weight, exercise and physical therapy, heat and ice, and corticosteroid injections. The most radical treatment is joint arthroplasty.

Prevention

Maintaining a healthy weight, doing regular and gentle exercise, avoiding repetitive motions and risky activities.

RHEUMATOID ARTHRITIS (RA)

Rheumatoid arthritis is a chronic, systemic inflammatory disorder. RA occurs when the immune system doesn’t function properly. The immune system normally makes antibodies (small proteins) to attack bacteria, viruses and other germs. In people with RA, antibodies are formed against the synovium (the tissue that surrounds each joint). This causes inflammation in and around the affected joints. The actual causes of this autoimmune disease are not clear.

Symptoms

Joint pain, swelling, redness, deformity and fatigue.

Treatment

Medications, exercise. Joint replacement and tendon reconstruction help relieve severe joint damage.

Prevention

There are no guidelines to reduce your risk of developing rheumatoid arthritis because the exact cause is not known.

ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY

AAnterior cruciate ligament injuries are common in contact sports and activities involving a sudden change of direction. Often an ACL injury will occur in combination with injury to other structures in the knee joint.

Symptoms

- Extreme pain
- A lot of immediate swelling from bleeding within the joint, which will feel warm
- An audible pop or crack at the time of injury, and a feeling of instability
- Restricted range of motion, with particular difficulty in straightening the leg

Treatment

If an ACL injury is suspected, immediately stop play or competition. Apply the PRICE principles of protection, rest, ice, compression and elevation to limit pain, and stop bleeding and swelling. Also, seek medical attention as soon as possible. The decision to forego surgery is based on the stability of the knee, the patient’s age, and the activities or occupations in which they are involved. Many people choose to try to stabilize the knee by building up muscle strength, especially in the quadriceps. Recovering from ACL surgery or reconstruction is extremely variable, but generally it can be expected that within four to five months, the knee will start to function normally, and kicking movements and sudden turns may be possible. One year post surgery, the knee may feel almost normal, but total perfection is rare.

Prevention

Many ACL injuries can be prevented if the muscles that surround the knees are strong and flexible. Prevention focuses on proper nerve and muscle control of the knee. Exercises aim to increase muscle power, balance, and improve core strength and stability.

The following training tips can reduce the risk of an ACL injury:

- Train and condition year round

- Practice proper landing techniques after jumps. This involves bending your knees to absorb the force and keeping them in line with your feet

- When you pivot, crouch and bend at the knees and hips. This reduces stress on the ACL

- Strengthen your hamstrings and quadriceps. The hamstring muscle is at the back of the thigh; the quadriceps muscle is at the front. These muscles work together to bend or straighten the leg. Strengthening both muscles can better protect the leg against knee injuries

POSTERIOR CRUCIATEW LIGAMENT INJURY – PCL INJURY

The posterior cruciate ligament is important for stabilizing the knee and preventing it from bending backwards the wrong way.

Symptoms

Symptoms of a PCL injury typically include pain at the time of injury which, over time, may also be felt in the calf region. There will be swelling, although this may be minimal. Pain is reproduced when the posterior cruciate ligament is stressed by attempting to bend the knee the wrong way.

Prevention

When playing sports, wear shoes designed for the surface you’re playing or running on, such as a track or tennis court.

Treatment

The PCL is torn less frequently than the ACL, although it is much more demanding to repair surgically. Usually, the first step with a PCL rupture is to try conservative treatment, such as physiotherapy and strengthening exercises. If this is unsuccessful, bracing may be attempted before surgery is undertaken. The procedure for a PCL reconstruction is similar to ACL surgery, whereby it is an intra-articular operation using a bone-tendon-bone graft to create a new ligament. Recovery from PCL reconstruction surgery is initially quite quick (i.e., from the surgery itself to getting back on your feet), although it is a longer process to get back to sports. Orthopedic surgeons recommend a minimum of six months to a year.

Total Knee Replacement

A Total Knee Replacement (TKR) is a complex procedure that requires an orthopedic surgeon to make precise measurements and skillfully remove the diseased portions of your bone, in order to shape the remaining bone to accommodate the knee implant. During the procedure, the surgeon builds the artificial knee inside your leg, one component at a time, to create a highly realistic artificial joint.

Patients who need this surgery

    There are no absolute age or weight restrictions for total hip replacements.

  • Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of your knee
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

The procedure of the hip replacement surgery

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone.
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
  • Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Anatomy

Spine Bone

The vertebrae are composed of five different sections and 24 bones in total. When we are born, we have 33 bones in the spine but nine of those eventually fuse together. The spine is composed of five different sections:

The cervical area

The main function is to support the weight of the head, around 10 pounds. It also has the greatest range of motion (C1-C7).

The thoracic area

This area protects the organs in the chest by connection to the rib cage. It has a very limited range of movement (T1-T12).

The lumbar area

The main function is to bear the weight of the body. It is much larger than the other areas on the spine (L1-L5).

The sacrum

The sacrum provides attachment of the iliac bones and protects the pelvic organs. It is five different bones fused together.

The coccyx

The coccyx is made up of four bones that are fused together. It doesn’t have an important function. It is a remnant of a tail from our primate ancestors.



Each vertebra consists of


At the front - vertebral body

At the side - the pedicles

At the back - the lamina



At the back of each vertebra, there is a pair of facet joints which articulate with the facet joints of the adjacent vertebra. The vertebral bodies are separated by cushions called intervertebral discs. A disc is made of special cartilage and acts like a shock absorber between the bodies.


Disease & Injury

There are two types of back pain: acute and chronic.

1) Acute back pain is short-term pain, typically lasting from a few days to a few weeks. Most acute back pain is the result of trauma to the back or from a condition like arthritis. Acute pain symptoms range from shooting or stabbing pain to muscle aches, limited flexibility and range of motion, and inability to stand up straight.


2) Chronic back pain lasts for three or more months. It is often progressive, meaning it gets worse over time. The cause of chronic pain can be hard to determine and usually requires treatment from a medical professional.


The main causes of back pain are:

  • • Stress or injury involving the back muscles, including back sprain or strain; chronic overload of back muscles caused by obesity; and short-term overload of back muscles caused by any unusual stress, such as lifting or pregnancy
  • • Disease or injury involving the back bones (vertebrae), including fracture from an accident or as a result of the bone-thinning disease osteoporosis
  • • Degenerative arthritis, a "wear and tear" process that may be related to age, injury and genetic predisposition
  • • Disease or injury involving the spinal nerves, including nerve injury caused by a protruding disc (a fibrous cushion between vertebrae) or spinal stenosis (a narrowing of the spinal canal)

HERNIATED DISK

When people say they have a “slipped” or “ruptured” disc in their neck or lower back, what they are actually describing is a herniated disc, a common source of pain in the neck, lower back, arms or legs.

Symptoms

- Pain and numbness, most commonly on one side of the body

- Pain that extends to your arms and/or legs

- Pain that worsens at night

- Pain that worsens after standing or sitting

- Pain when walking short distances

- Unexplained muscle weakness

- Tingling, aching or burning sensations in the affected area

Treatment

If your slipped disc pain does not respond to over-the-counter treatments, your physician may prescribe stronger medications.


:These include:

- Muscle relaxers to relieve muscle spasms

- Narcotics to relieve pain

- Nerve pain medications like gabapentin or duloxetine

 

Your physician may recommend surgery if your symptoms do not subside in six weeks or if your slipped disc is affecting your muscle function. Your surgeon may simply remove the damaged or protruding portion of the disc without removing the entire disc. This is called a microdiscectomy.

In more severe cases, your doctor may replace the disc with an artificial one, or remove the disc and fuse your vertebrae together. This procedure, called a laminectomy, adds stability to your spinal column.

Prevention

It may not be possible to prevent a slipped disk, but you can take steps to reduce your risk of developing a slipped disk. Those steps include:

- Use safe lifting techniques, such as bending or lifting from your knees, not your waist

- Maintain a healthy weight

- Do not remain seated for long periods; get up and stretch periodically

- Do exercises to strengthen the muscles in your back, legs and abdomen

SPONDYLOLISTHESIS

If a stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to shift out of place. This condition is called “spondylolisthesis”. If too much slippage occurs, the bones may begin to press on nerves, and surgery may be necessary to correct the condition. It is found most frequently within the lumbar (lower back) region of the spine. This is due to the fact that this area is exposed to a great deal of pressure caused by movement associated with lifting heavy objects and twisting the torso.

Symptoms

People with severe cases may be unable to perform daily activities. Some of the most common symptoms are:

- Persistent lower back pain

- Stiffness in the back and legs

- Lower back tenderness

- Thigh pain

- Tight hamstring and buttocks muscles

Treatment

Nonsurgical treatment methods include:

- Wearing a back brace

- Physical therapy

- Taking over-the-counter or prescription anti-inflammatory drugs (such as ibuprofen) to reduce pain

- Epidural steroid injections


Surgical treatment

Surgery may be needed if slippage progressively worsens, or if back pain does not respond to nonsurgical treatment and begins to interfere with activities of daily living. A spinal fusion is performed between the lumbar vertebra and the sacrum. Sometimes an internal brace of screws and rods is used to hold together the vertebrae as the fusion heals.

Prevention

Since there is no stopping the aging process, spondylolisthesis prevention can be difficult, if not impossible. However, maintaining good physical and cardiovascular fitness is one way to prepare the body to cope with symptoms that sometimes can accompany spondylolisthesis, including pain, tingling, numbness or muscle weakness.

LUMBAR SPINAL STENOSIS

Lumbar spinal stenosis is a condition caused by narrowing of the spinal canal. In medical terms, stenosis refers to a narrowing or stricture of a duct or passageway.

Symptom

Lumbar spinal stenosis may or may not produce symptoms, depending on the severity of your case. The narrowing of the spinal canal itself does not produce these symptoms. It is the inflammation of the nerves due to increased pressure that may cause noticeable symptoms to occur. When present, symptoms may include:

- Pain, weakness or numbness in the legs, calves or buttocks

- Pain radiating into one or both thighs and legs, similar to sciatica

- In rare cases, loss of motor functioning of the legs

- In rare cases, loss of normal bowel or bladder function


Pain may decrease when you bend forward, sit or lie down. Pain may get worse when you walk short distances.

Treatment

Nonsurgical treatments:


- Activity modification

- Exercise

- Non-steroidal anti-inflammatory drugs (NSAIDs)

- Epidural injections


Surgical treatments:

Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery. Surgery is done to relieve pressure on the nerves or spinal cord. You and your doctor can decide when you need to have surgery for these symptoms. Surgery may include removing a bulging disc, removing part of a vertebra or widening the opening where your spinal nerves are. After some spinal surgery, the surgeon may fuse some of the spine bones to make your spine more stable.

Prevention

Because almost everyone has some osteoarthritis of the spine by age 50, you can’t really prevent lumbar spinal stenosis. However, you may be able to lower your risk. Following are some ways to keep your spine healthy:


- Get regular exercise. Exercise strengthens the muscles that support your lower back and helps keep your spine flexible. Aerobic exercises like walking, swimming, cycling, and weight training are all good for your back

- Maintain good posture. Learn how to safely lift heavy objects. Also, sleep on a firm mattress and sit in a chair that supports the natural curves of your back

- Maintain a healthy weight. Excess weight puts more stress on your back and can contribute to developing symptoms of lumbar spinal stenosis

SURGICAL TREATMENTS FOR BACK PAIN

1. Discectomy

A discectomy is a procedure to remove a portion of the spinal disc that rests between each vertebra-.A herniated disc is the most common reason for spine surgery. When a discectomy is performed, the fragment of herniated disc is removed to relieve the pressure on the spinal nerves.

2. Foramenotomy

A foramenotomy is also a procedure used to relieve pressure on a nerve, but in this case, the nerve is being pinched by more than just a herniated disc. A foramenotomy removes a portion of bone and other tissue that may be compressing the nerve as it exits the spinal column. Often a foramenotomy is performed along with a discectomy to ensure that there will be sufficient room for the compressed nerve.

3. Laminectomy

A laminectomy is done to relieve pressure on the spinal cord itself. A laminectomy is most commonly used to treat spinal stenosis, a condition where pressure builds up around the spinal cord and spinal nerves. Depending on the amount of bone removed, a laminectomy may also require a spinal fusion to be performed. When enough bone and ligaments are removed, the fusion becomes necessary to stabilize the spinal column.

4. Spinal Fusion

Spinal fusion is essentially a "welding" process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
Spinal fusion eliminates motion between vertebral segments. It is an option when motion is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a curvature (scoliosis) or severe degeneration of one or more of your disks. The theory is that if the painful spine segments do not move, they should not hurt.
Fusion of the vertebrae in the lower back has been performed for decades. A variety of surgical techniques have evolved. In most cases, a bone graft is used to fuse the vertebrae. Screws, rods or a "cage" are used to keep your spine stable while the bone graft heals.
The surgery can be done through your abdomen, your side, your back or a combination of these. There is even a procedure that is done through a small opening next to your tailbone. No one procedure has been proven better than another.
The results of spinal fusion for lower back pain vary. It can be very effective at eliminating pain, not work at all or anything in between. Full recovery can take more than a year.

5. Spinal Disc Replacement

This procedure involves removing the disc and replacing it with artificial parts, similar to replacements of the hip or knee.
The goal of disc replacement is to allow the spinal segment to keep some flexibility and maintain more normal motion.
The surgery is done through your abdomen, usually on the lower two discs of the spine.
Although no longer considered a new technology, the results of artificial disc replacement compared to fusion are controversial.

6. Dynamic Stabilization

Dynamic stabilization is another option for those trying to avoid spinal fusion, but in need of some stability of the spine. Dynamic stabilization uses screws and rods, similar to a fusion, but these rods allow for limited mobility between each segment. Therefore, dynamic stabilization is intended to allow some limited motion between adjacent spinal segments.

Anatomy

The shoulders are made up of bones, cartilage, muscles, tendons and ligaments. The upper arm bone (humerus), collar bone (clavicle) and shoulder blade (scapula), which are held together by bands of connective tissue called ligaments, make up the shoulder joints. The bones in the shoulders do not provide much stability to the joint and are held in place by muscles, tendons and ligaments. There are two joints in the shoulder. The glenohumeral joint is a flexible ball-and-socket joint formed by the scapula and the head of the humerus bone.

Articular cartilage cushions the shoulder joint and fibrous cartilage (called the labrum) helps to stabilize it. Sac-like structures called bursae (singular is bursa) are located within the shoulder joints. Bursae contain synovial fluid, which lubricates the joints and reduces friction between the bones and muscles, tendons and ligaments.

Bones in the shoulder are attached to surrounding muscles by tendons (fibrous cords of tissue). The rotator cuff is a group of four tendons that connects muscles from the scapula and allows the shoulder to rotate and elevate.


Disease & Injury

Most shoulder problems fall into four major categories:

  • • Tendon inflammation (bursitis or tendonitis) or tendon tear
  • • Instability
  • • Shoulder arthritis
  • • Fracture

TENDONITIS OR BURSITIS

Shoulder bursitis and rotator cuff tendonitis are different ways of saying there is inflammation of a particular area within the shoulder joint that is causing a common set of symptoms. The proper terminology for these symptoms is “impingement syndrome”. Impingement syndrome is a descriptive term for pinching of the tendons and bursa of the rotator cuff between bones. In many individuals with this problem, the shape of their bones is such that they have less space than others. Therefore, small thickenings of the tendons or bursa can cause symptoms.

Symptoms

Common symptoms include:

- Pain with overhead activities (arm above head height)

- Pain while sleeping at night

- Pain over the outside of the shoulder/upper arm

ㆍNonsurgical treatments

- Rest

The first step of shoulder bursitis treatment is to decrease the inflammation. This is best done by avoiding the problems that cause inflammation. The best rule of thumb to follow: 'If it causes pain, don't do it!' This includes simple activities, such as reaching high objects or reaching behind yourself


- Anti-Inflammatory Medications

Inflammation can be treated with anti-inflammatory medications such as Motrin, Advil, Aleve, Celebrex or one of many others. These all fall within the category of 'non-steroidal anti-inflammatory medications.' Taken by mouth, these medications help with the inflammation of the tendons and bursa, and also help reduce the discomfort


- Ice Application

Ice application is a helpful treatment of inflammation for several reasons. Ice can help relieve pain, reduce inflammation and stimulate blood flow to the injured shoulder


- Shoulder Exercises

Some simple exercises or physical therapy may help you return to normal activities without pain. These exercises help to strengthen the rotator cuff and help the shoulder move more efficiently. In addition, it is important to avoid activities that irritate the rotator cuff tendons. These include:


: Overhead weight lifting (such as military presses, etc.)

: Throwing activities

: Sleeping with the arm over or behind your head


- Cortisone Injections

If the symptoms are not adequately treated, the next step is usually a cortisone injection, or steroid shot, into the area of inflammation. If the symptoms are significant, your doctor may opt to perform this cortisone injection on an initial visit. The cortisone injection places medication to treat the inflammation directly into the problem area

Surgical treatment

In some individuals who don't respond to simple treatments, surgery may end up being a necessary step.
Patients who are considering surgery should have attempted nonsurgical treatments for at least three to six months without improvement in symptoms. The symptoms should be causing difficulty with the patient's activities, and/or interfering with sleep at night.


The procedure used in the treatment of shoulder bursitis is called a subacromial decompression. This is an arthroscopic procedure performed using instruments inserted through small incisions. One of the instruments inserted is a video camera about the size of a pencil. Another instrument called a shaver is inserted through another incision. The shaver is used to remove the inflamed bursa. Once the bursa is removed, the rotator cuff is inspected to look for any signs of a tear.


Depending on the bone above the rotator cuff, a burr may be used to remove some bone to create more space for the rotator cuff tendons. Often there is a bone spur in this region that can pinch against the rotator cuff--thus the name impingement syndrome.

Prevention

You need to be alert while doing physical exercise. Overusing the muscles of your shoulder may weaken them considerably, especially when you push them to the limit. Proper conditioning of your muscles is a must, as is the need for gradual warming up just before exercising.

SHOULDER ARTHRITIS

Osteoarthritis is the most common type of shoulder arthritis. Also called “wear and tear” arthritis or degenerative joint disease, osteoarthritis is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage surface of the joint is worn away by shoulder arthritis, bare bone is exposed within the shoulder.
The other common type of shoulder arthritis is rheumatoid arthritis. Rheumatoid arthritis is a systemic condition that causes inflammation of the lining of the joints. This inflammation can, over time, invade and destroy the cartilage and bone.

Symptoms

Shoulder arthritis symptoms tend to progress as the condition worsens. They do not always progress steadily with time. The most common symptoms of shoulder arthritis are:

- Pain with activities

- Limited range of motion

- Stiffness of the shoulder

- Swelling of the joint

- Tenderness around the joint

- A feeling of grinding or catching within the joint

Treatment

Nonsurgical treatments:

- Physical Therapy

Stretching and strengthening of the muscles around the shoulder joint may help decrease the burden on the shoulder. Preventing atrophy of the muscles is an important part of maintaining functional use of the shoulder.


- Anti-Inflammatory Medications

Anti-inflammatory pain medications (NSAIDs) are prescription and nonprescription drugs that help treat pain and inflammation. Talk to your doctor before taking anti-inflammatory medication for shoulder arthritis.


- Cortisone Injections

Cortisone injections may help decrease inflammation and reduce pain within a joint. While this will not cure shoulder arthritis, it may diminish the symptoms and help control pain.


Surgical treatments:

- Shoulder Arthroscopy

Exactly how effective shoulder arthroscopy is for treatment of arthritis is debatable. For some specific symptoms of shoulder arthritis, it may be helpful.


- Shoulder Replacement Surgery

In this procedure, the arthritic cartilage is removed and a metal and plastic ball-and-socket implant is placed in the shoulder. This is an excellent option to relieve pain associated with severe shoulder arthritis.


- Reverse Shoulder Replacement

This procedure is called a reverse shoulder replacement because the ball and socket are reversed; the ball is placed on the shoulder blade and the socket is placed on the top of the arm bone. This reverse technique allows better function when there is a non-functioning rotator cuff.


- Prevention

Maintaining a healthy weight, doing regular and gentle exercise, and avoiding repetitive motions and risky activities.

CHRONIC SHOULDER INSTABILITY

Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.

Symptoms

- Pain caused by shoulder injury

- Repeated shoulder dislocations

- Repeated instances of the shoulder giving out

- A persistent sensation of the shoulder feeling loose, slipping in and out of the joint or just "hanging there"

Treatment

Nonsurgical treatments:

Your doctor will develop a treatment plan to relieve your symptoms. It often takes several months of nonsurgical treatment before you can tell how well it is working. Nonsurgical treatment typically includes:


- Activity Modification

You must make some changes in your lifestyle and avoid activities that aggravate your symptoms.

- Non-Steroidal Anti-Inflammatory Medications

Drugs like aspirin and ibuprofen reduce pain and swelling.


- Physical Therapy

Strengthening shoulder muscles and working on shoulder control can increase stability. Your therapist will design a home exercise program for your shoulder.


Surgical treatments:

Surgery is often necessary to repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place.


- Arthroscopy

Soft tissues in the shoulder can be repaired using tiny instruments and small incisions. This is a same-day or outpatient procedure. Arthroscopy is a minimally-invasive surgery. Your surgeon will look inside the shoulder with a tiny camera and perform the surgery with special pencil-thin instruments.


- Open Surgery

Some patients may need an open surgical procedure. This involves making a larger incision over the shoulder and performing the repair under direct visualization.


- Rehabilitation

After surgery, your shoulder may be immobilized temporarily with a sling. When the sling is removed, exercises to rehabilitate the ligaments will be started.

These will improve the range of motion in your shoulder and prevent scarring as the ligaments heal. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan. Be sure to follow your doctor's treatment plan. Although it is a slow process, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.

Prevention

- Do regular exercise to strengthen the supporting muscles.

- Use proper athletic training methods.

- Do not increase exercise duration or intensity more than 10 percent per week.

- Modify activities to prevent excessive external rotation and overhead motions of the shoulder.

FRACTURE

Fractures are broken bones. Fractures commonly involve the clavicle (collar bone), proximal humerus (top of the upper arm bone) and scapula (shoulder blade). Fractures of the clavicle or the proximal humerus can be caused by a direct blow to the area from a fall, collision or motor vehicle accident.

Because the scapula is protected by the chest and surrounding muscles, it is not easily fractured. Therefore, fractures of the scapula are usually caused by high-energy trauma, such as a high-speed motor vehicle accident. Scapula fractures are often associated with injuries to the chest.

Sympoms

Common symptoms of shoulder fractures include:

- Pain

- Swelling and bruising

- Inability to move the shoulder

- A grinding sensation when the shoulder is moved

- Deformity – “It does not look right”

Specific Findings

1) Clavicle Fracture

- Swelling about the middle of the collarbone area

- An area that may have a "bump," which is actually the prominent ends of the fracture under the skin

- Shoulder range of motion is limited, although not as much as with fractures of the proximal humerus


2) Proximal Humerus Fracture

- A severely swollen shoulder

- Very limited movement of the shoulder

- Severe pain


3) Scapular Fracutre

- Pain

- Swelling

- Severe bruising about the shoulder blade

Treatment

1) Clavicle Fracture

Most clavicle fractures can be treated without surgery. Surgery is necessary when there is a compound fracture that has broken through the skin or the bone is severely out of place. Surgery typically involves fixing of the fracture with plates, and screws or rods inside the bone.


2) Proximal Humerus Fracture

Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is usually required. Surgery usually involves fixation of the fracture fragments with plates, screws or pins, or it involves shoulder replacement.


3) Scapular Fracutre

Most fractures of the scapula can be treated without surgery. Treatment involves immobilization with a sling or shoulder immobilizer, icing and pain medications. The patient will be examined for additional injuries.
About 10 to 20 percent of scapula fractures need surgery.
Fractures that need surgery usually have fracture fragments involving the shoulder joint or there is an additional fracture of the clavicle. Surgery involves fixation of the fracture fragments with plates and screws.

Prevention

Keep in mind that strengthening your upper body and improving your flexibility can reduce the risk of shoulder injuries. The stronger and more flexible your joints, the more easily they are able to withstand impact or hold up under repetitive motions.
Do not push yourself beyond safe limits. If an activity causes discomfort in your shoulder, don’t do it.

Total Shoulder Replacement

Coming Soon