What does a rotator cuff tear feel like?

Rotator cuff tears are painful and usually cause a dull ache in the shoulder which worsens with activity and use. The symptoms will vary, depending on how much damage has occurred and if one or several of the tendons have been injured. Patients should seek a second opinion if they experience pain when sleeping on the affected side; weakness in the arm; and difficulty with daily activities such as dressing or reaching behind your back. Our orthopedic shoulder experts are the “Best in Class” and have years of experience when diagnosing rotator cuff injuries. It is important to obtain a second opinion before undergoing any kind of shoulder repair surgery so you can plan for the best possible outcome.

What is a rotator cuff tear?

The rotator cuff is a group of muscles and tendons that work together in the shoulder to keep the head of the humerus (upper arm bone) within the glenoid (shoulder socket). The rotator cuff allows a large range of motion for the shoulder, giving it strength while rotating, turning, and lifting. If one or more of these muscle-tendons becomes damaged, or if the tendon tears off of the bone, it is called a rotator cuff tear.

Does my injured rotator cuff need surgery?

Not all rotator cuff injuries require surgery. In fact, many incomplete tears can heal on their own with ice, rest, activity modification, NSAIDS (non-steroidal anti-inflammatory drugs), and physical therapy.

Different shoulder injuries can have similar symptoms. Rotator cuff tears have similar symptoms with another shoulder injury called a SLAP tear. SLAP tears occur when the cartilage surrounding the shoulder socket tears or becomes damaged. Shoulder bursitis, also called subacromial bursitis can also cause similar symptoms as a rotator cuff injury. The shoulder is a complicated joint and it is important to receive the proper diagnosis and treatment plan. Seeking a second opinion from our experts can save time, energy and money. At BICMD we have the country’s best orthopedic experts who were at the top of their class and can give patients an expert opinion on a number of shoulder conditions.

How is a Rotator Cuff Repair done?

Patients who have failed to experience relief from conservative measures, or for those who have received our expert evaluation and require a rotator cuff repair, typically have this surgery performed arthroscopically. Arthroscopic rotator cuff repair uses a specialized camera, called an arthroscope, and small, specialized instruments, inserted into the shoulder through small incisions. The repair is done within the shoulder joint and is also called minimally invasive rotator cuff repair. The procedure involves reattaching the tendon to the head of the humerus. Different types of tears are handled differently and can include:

• Debridement – Done with a partial tear, where the tissue is trimmed and smoothed.
• Biceps Tenodesis – Can be done in conjunction with a rotator cuff repair. The goal is to find the torn biceps tendon and reattach it to the humerus, allowing it to regain its strength and function.
• Rotator Cuff Repair – The goal is to sew the torn tendon back to the bone where it was originally detached. Strong sutures are sewn through the tendon and surgical anchors, attached to the bone, secure the tendon. It is important for the damaged tendon to be sewn back in its original anatomic position.
  • Double Row Rotator Cuff Repair – The term “double row” refers to the method the surgeon uses to secure the rotator cuff to the bone. Double row fixation is done with a double row of sutures. Double row rotator cuff repair takes more time, but studies have shown the technique results in significantly less re-tear rates. The repaired tendon also has increased load ability, avoiding repair failure.

What are the risks or complications of a rotator cuff repair?

A torn rotator cuff that goes unrepaired can have long-range problems leading to permanent loss of motion, shoulder weakness and progressive degeneration of the shoulder joint. A mis-diagnosis can also cause complications if other shoulder structures are involved. It is important to receive the best-possible diagnosis for your specific shoulder condition. Our experts at BICMD have years of experience in diagnosing and treating shoulder injuries, including rotator cuff tears. They can offer the best treatment plan for your shoulder injury.

How long is the recovery after a rotator cuff repair?

The recovery time following arthroscopic rotator cuff repair can vary depending on the patient’s health, age and type of rotator cuff tear. Active, healthy individuals can expect a full recovery in about 6 months which includes:

• Shoulder immobilization immediately following surgery.
• Passive range of motion (PROM) exercises for 3 to 6 weeks.
• Active range of motion exercises from week 6 to about week 8.
• Physical therapy from week 8 to 12 weeks, depending on the patient’s progress and size of repair.
• Patients experience increased strength and range of motion, with full recovery in about 6 months.

Osteoarthritis of the shoulder is a gradual wearing of the articular cartilage that leads to pain and stiffness. As the joint surface degenerates, the subchondral bone remodels, losing its sphericity and congruity. The joint capsule also becomes thickened, leading to further loss of shoulder rotation.

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Shoulder instability usually occurs when the lining of the shoulder joint (the capsule), ligaments or labrum become stretched, torn or detached, allowing the ball of the shoulder joint (humeral head) to move either completely or partially out of the socket.

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What is a frozen shoulder?

Frozen shoulder is a condition in which the tissues in the shoulder joint become thicker and tighter over time. This leads to limited range of motion, as the shoulder joint no longer has space to rotate properly. Also known as adhesive capsulitis, frozen shoulder is most common in patients between the ages of 40 and 60.

In a healthy shoulder, the upper arm, shoulder blade and collarbone are joined by muscles and tendons in the shoulder capsule. Synovial fluid lubricates the joint for smooth, pain-free movement.

In a frozen shoulder, the tissues in the shoulder capsule thicken and tighten. Stiff scar tissue called adhesions develop and synovial fluid decreases, leading to pain and lack of range of motion in the shoulder. Oftentimes frozen shoulder occurs as a result of unregulated inflammatory tissue in the shoulder leading to excess inflammation of the shoulder capsule – hence the name adhesive capsulitis.

Frozen shoulder causes

The causes of frozen shoulder are multifactorial. The condition is seen commonly in people with endocrine abnormalities such as Diabetes and Thyroid disorders. In addition – perimenopausal women are oftentimes afflicted with adhesive capsulitis. Other causes of frozen shoulder can include extended periods of shoulder immobilization. Some cases of frozen shoulder are caused by long periods of shoulder immobilization. Patients who have undergone a mastectomy, arm or shoulder surgery, or who have had their arm immobilized while a fracture is healing, are more likely to experience a frozen shoulder.
Risk factors for frozen shoulder

Certain people are more likely to experience a frozen shoulder than others. Some medical conditions increase the likelihood of suffering from a frozen shoulder, as does age and gender. Populations that are more likely to suffer from a frozen shoulder include:

• Women
• People between the ages of 40 and 60
• Diabetics
• People with over- or under-active thyroid
• Cardiovascular disease patients
• Tuberculosis patients
• People with Parkinson’s disease
• Stroke patients who have trouble moving their arm

How does frozen shoulder develop?

Frozen shoulder tends to develop slowly, over a period of weeks or months. The first sign of frozen shoulder is shoulder pain, which develops into more and more difficulty moving the shoulder. There are three phases of frozen shoulder development:

Phase 1 – The Freezing Stage – In this stage, the shoulder becomes painful and range of motion slowly decreases. The freezing stage generally occurs over six to nine weeks.

Phase 2 – The Frozen Stage – The frozen stage is when the shoulder is stiff and immobile, though usually the shoulder is less painful in the frozen stage than the freezing stage. This stage generally lasts for many months.

Phase 3 – The Thawing Stage – Frozen shoulders generally improve on their own over the course of a couple years. Most frozen shoulders are able to return to their prior level of function, strength and range of motion without treatment.

How a frozen shoulder is diagnosed

To diagnose a frozen shoulder, a physician generally starts by asking the patient to move the affected arm into different positions to assess the patient’s level of pain and range of motion. Frozen shoulder affects both passive and active range of motion. By asking the patient to move the affected arm, the physician is able to determine active range of motion. The physician will also ask the patient to relax while he or she moves the arm for the patient, which will determine passive range of motion.

Many cases of frozen shoulder can be diagnosed with only a physical examination and medical history. On some occasions, however, addition testing may be required, including X-rays, ultrasounds or an MRI. These additional tests can be helpful for ruling out other health conditions with similar symptoms to frozen shoulder.

Treatments for Frozen Shoulder

Treatment for frozen shoulder focuses on reducing pain and restoring range of motion in the affected shoulder. Depending on the severity of the frozen shoulder, many different treatments are available.

Medication – Over-the-counter pain relievers such as ibuprofen are commonly prescribed to reduce pain and inflammation of a frozen shoulder. Sometimes, prescription pain relievers are prescribed if over-the-counter medications do not provide the right level of relief.

Physical Therapy – Physical therapy can be particularly helpful for frozen shoulder patients. A physical therapist can teach patients range-of-motion exercises that will help loosen the tightened tissues in the shoulder joint and restore healthy movement.

Shoulder manipulation – Under general anesthesia, a physician will move the patient’s shoulder into different positions to help loosen the tightened tissues. General anesthesia is used to prevent the patient from feeling pain during the procedure. This is a non-invasive method of frozen shoulder treatment.

Steroid injections – Corticosteroid injections placed in the shoulder joint can help to reduce pain and improve range of motion in the shoulder. Steroid injections are a common treatment in the beginning stages of frozen shoulder.

Joint distention – In joint distention, sterile water is injected into the shoulder joint to stretch the capsule and provide more room for the shoulder joint to move properly.

When to have frozen shoulder surgery

Most cases of frozen shoulder recover on their own one to two years after the onset of symptoms. But in some cases, such as those with persistent symptoms that do not clear after non-surgical treatments, frozen shoulder surgery may be necessary. Surgery is generally a last resort treatment for frozen shoulder, as non-surgical methods are usually sufficient to treat the patient’s symptoms.

The purpose of frozen shoulder surgery is to release scar tissue, adhesions, and other anatomical abnormalities that are preventing the shoulder from moving normally. Frozen shoulder surgery is generally done with arthroscopy, using a tiny camera to help the surgeon visualize the structures inside the shoulder. Small incisions are made, and the arthroscope is inserted along with other miniature surgical tools.

Recovery time for frozen shoulder surgery is approximately three to six months. During that time, the patient will undergo physical therapy and participate in at-home exercises to keep the shoulder mobile while it is healing. This prevents a recurrence of frozen shoulder.

What is a clavicle fracture or a broken collarbone?

The clavicle, also called the collarbone, is part of the shoulder and connects the upper part of the breastbone to the shoulder blade. You can find your clavicle easily, at the base of your neck and extending to the shoulder on each side. A clavicle fracture or broken collarbone occurs when this thin, long bone breaks. A clavicle fracture is a common injury and most often occurs in children and young adults. A broken collarbone is most often caused by sports trauma, but can also occur from a fall, traffic accident, and in infants, from the birth process. Clavicle fractures can be common, but it is often good to get a second opinion regarding the treatment from an expert at BICMD. Our “best in class” orthopedic surgeons have extensive training and expertise on the best treatment methods for clavicle fractures. They can advise you on who to see and what the best treatment should be for your specific injury.

What are the types of clavicle fractures?

Orthopedic specialists classify clavicle fractures, based on where the break occurs along the bone. The types of collarbone fractures are:

• Midshaft – The break or fracture occurs in the middle of the bone. This is the most common type of clavicle fracture.
• Distal or Lateral – The break occurs near the shoulder at the furthest part of the bone
• Medial – The break occurs near the neck at the center of the body. Medial clavicle fractures are rare and occur close to the sternum.

What are the symptoms of a clavicle fracture?

Clavicle fractures are typically very painful. Symptoms include:

• Sharp pain at time of injury
• Pain when moving the arm
• Inability to lift the arm
• Swelling, bruising and tenderness on the collarbone
• A bump or deformity over the fracture
• Crepitus (grinding or crunching sound with movement)
• Downward shoulder sag

How is a clavicle fracture or broken collarbone diagnosed?

The experts at BICMD can diagnose a clavicle fracture or broken collarbone through our state-of-the-art telemedicine visit. A thorough patient history, as well as the incidents that led up to the injury will be discussed. A review of an x-ray will confirm the diagnosis and sometimes a CT Scan or an MRI Scan may be requested for the physician to visualize any soft tissue damage.

What is the treatment for a clavicle fracture?

Non-surgical treatment:

Many clavicle fractures can be treated non-surgically by wearing a sling to immobilize the arm and to keep the shoulder from moving. Medication may be prescribed to help with the pain and to promote healing. Ice, rest and immobilization are important until the fracture heals. Physical therapy is not recommended until the break is healed. This can be verified with a follow-up x-ray or CT Scan.

Surgical treatment:

If the bones have moved out of their normal position, or if the clavicle has fracture in pieces, surgery may be required. The goal of surgery for a broken collarbone is to realign the collarbone and hold it in its correct anatomical position until healing can occur. There are different surgical procedures and materials used to repair a clavicle fracture and can include:

Procedure:

• ORIF – Open Reduction and Internal Fixation – Describes the process of restoring the bone back to the proper position and holding it in place with special hardware.

Materials:

• Plates and Screws – Surgical materials that may be used to hold the fracture in place
• Pins and Screws – Surgical materials used to hold a more severe fracture in place. Sometimes the pins or screws cause irritation and can be removed after the bone heals.

How long does it take a clavicle fracture to heal?

The bones of a broken clavicles or a broken collarbone take time to heal or “knit.” A patient’s age, health, activity level and underlying health conditions can play a part in healing and recovery time. Diabetic patients typically take longer to heal, where children can heal in a little as 3-6 weeks. The average adult in good health takes between 6-8 weeks to heal. Physical therapy is then recommended to regain strength of the arm and shoulder. Full recovery after a clavicle fracture and the return to contact sports is usually 4-6 months.

For more information on a clavicle fracture or a broken collarbone, or to obtain an expert 2^nd opinion before having a surgical procedure, please contact our orthopedic shoulder surgeons and specialists, by clicking on “Get Started”.  You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What does a rotator cuff tear feel like?

Rotator cuff tears are painful and usually cause a dull ache in the shoulder which worsens with activity and use. The symptoms will vary, depending on how much damage has occurred and if one or several of the tendons have been injured. Patients should seek a second opinion if they experience pain when sleeping on the affected side; weakness in the arm; and difficulty with daily activities such as dressing or reaching behind your back. Our orthopedic shoulder experts are the “Best in Class” and have years of experience when diagnosing rotator cuff injuries. It is important to obtain a second opinion before undergoing any kind of shoulder repair surgery so you can plan for the best possible outcome.

What is a rotator cuff tear?

The rotator cuff is a group of muscles and tendons that work together in the shoulder to keep the head of the humerus (upper arm bone) within the glenoid (shoulder socket). The rotator cuff allows a large range of motion for the shoulder, giving it strength while rotating, turning, and lifting. If one or more of these muscle-tendons becomes damaged, or if the tendon tears off of the bone, it is called a rotator cuff tear.

Does my injured rotator cuff need surgery?

Not all rotator cuff injuries require surgery. In fact, many incomplete tears can heal on their own with ice, rest, activity modification, NSAIDS (non-steroidal anti-inflammatory drugs), and physical therapy.

Different shoulder injuries can have similar symptoms. Rotator cuff tears have similar symptoms with another shoulder injury called a SLAP tear. SLAP tears occur when the cartilage surrounding the shoulder socket tears or becomes damaged. Shoulder bursitis, also called subacromial bursitis can also cause similar symptoms as a rotator cuff injury. The shoulder is a complicated joint and it is important to receive the proper diagnosis and treatment plan. Seeking a second opinion from our experts can save time, energy and money. At BICMD we have the country’s best orthopedic experts who were at the top of their class and can give patients an expert opinion on a number of shoulder conditions.

How is a Rotator Cuff Repair done?

Patients who have failed to experience relief from conservative measures, or for those who have received our expert evaluation and require a rotator cuff repair, typically have this surgery performed arthroscopically. Arthroscopic rotator cuff repair uses a specialized camera, called an arthroscope, and small, specialized instruments, inserted into the shoulder through small incisions. The repair is done within the shoulder joint and is also called minimally invasive rotator cuff repair. The procedure involves reattaching the tendon to the head of the humerus. Different types of tears are handled differently and can include:

• Debridement – Done with a partial tear, where the tissue is trimmed and smoothed.
• Biceps Tenodesis – Can be done in conjunction with a rotator cuff repair. The goal is to find the torn biceps tendon and reattach it to the humerus, allowing it to regain its strength and function.
• Rotator Cuff Repair – The goal is to sew the torn tendon back to the bone where it was originally detached. Strong sutures are sewn through the tendon and surgical anchors, attached to the bone, secure the tendon. It is important for the damaged tendon to be sewn back in its original anatomic position.
  • Double Row Rotator Cuff Repair – The term “double row” refers to the method the surgeon uses to secure the rotator cuff to the bone. Double row fixation is done with a double row of sutures. Double row rotator cuff repair takes more time, but studies have shown the technique results in significantly less re-tear rates. The repaired tendon also has increased load ability, avoiding repair failure.

What are the risks or complications of a rotator cuff repair?

A torn rotator cuff that goes unrepaired can have long-range problems leading to permanent loss of motion, shoulder weakness and progressive degeneration of the shoulder joint. A mis-diagnosis can also cause complications if other shoulder structures are involved. It is important to receive the best-possible diagnosis for your specific shoulder condition. Our experts at BICMD have years of experience in diagnosing and treating shoulder injuries, including rotator cuff tears. They can offer the best treatment plan for your shoulder injury.

How long is the recovery after a rotator cuff repair?

The recovery time following arthroscopic rotator cuff repair can vary depending on the patient’s health, age and type of rotator cuff tear. Active, healthy individuals can expect a full recovery in about 6 months which includes:

• Shoulder immobilization immediately following surgery.
• Passive range of motion (PROM) exercises for 3 to 6 weeks.
• Active range of motion exercises from week 6 to about week 8.
• Physical therapy from week 8 to 12 weeks, depending on the patient’s progress and size of repair.
• Patients experience increased strength and range of motion, with full recovery in about 6 months.

For more information on arthroscopic rotator cuff repair, or to have your shoulder pain evaluated and receive a second opinion, please click on “Get Started” to reach one of our orthopedic telemedicine experts.

A fracture of any of the bones in the shoulder which can impair mobility and cause severe pain. Shoulder fractures occur as a result of trauma or injury to the shoulder from a fall, sports injury, car accident or any direct blow to the shoulder.

The scapula, also known as the shoulder blade, is the large triangle-shaped bone of the shoulder that connects the torso to the arm. Fractures of the scapula are relatively rare, but they can occur as a result of high-impact sports, a car accident, or falling from a height. Most shoulder fractures can be successfully treated with non-surgical methods. In the case that the broken scapula is not only broken but pushed out of place, surgery may be necessary to restore correct positioning.

For more information or to obtain an expert 2^nd opinion before having a surgical procedure, please contact our orthopedic shoulder surgeons and specialists, by clicking on “Get Started”.  You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

This list contains some of our most commonly seen conditions, but it is by no means exhaustive. Our shoulder doctors handle the same wide variety of conditions that an in-person physician would.

If a shoulder condition or injury is keeping you from enjoying the freedom of a pain-free life, our physicians are committed to helping you feel better.

Click on “Get Started” to reach one of our orthopedic telemedicine experts.