SHOULDER
Doctor Emilio López-Vidriero is a shoulder superspecialist through the University of Ottawa, Canada. In this section you can consult the different shoulder injuries and their treatments, both conservative and surgical.
SHOULDER INJURIES
The shoulder is one of the most mobile joints in the body. It has a great tendency to suffer injuries in sports in which you throw, hit or move in a repetitive manner. It is also very susceptible to dislocation. The ideal thing is to diagnose the injury as soon as possible and to be able to treat it without surgery. If necessary, performing surgery tailored to the sport and the athlete is crucial for success.
Pain in the anterior region of the shoulder. What can it be?
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Biceps tendon injury. Long portion. With or without breakage. Typical of athletes.
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Rotator cuff tendon injury: supraspinous, infraspinatus and subscapular. With or without breakage. With or without calcifications. It usually hurts at night.
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Anterior shoulder dislocation: the shoulder ball is dislodged due to a fall with the arms open or alone.
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Acromioclavicular dislocation: the roof of the shoulder is dislodged due to a fall with the arm stuck to the body. The clavicle moves upwards.
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Frozen shoulder in phase 1 and 2. You can’t move your shoulder and it hurts a lot. Typical of diabetics.
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Shoulder osteoarthritis: cartilage is worn, causing pain and reducing mobility.
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Cervical disc herniation: it can be associated with tingling and loss of strength.
Pain in the posterior region of the shoulder. What can it be?
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Injury to the rotator cuff tendons: infraspinatus and round. With or without breakage. Typical of pitchers.
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Posterior dislocation of the shoulder: the ball is pulled back. Typical of bikers.
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Suprascapular nerve injury: poorly localized pain. Typical of tennists and volleyball players.
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Shoulder osteoarthritis: cartilage is worn, causing pain and reducing mobility.
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Cervical disc herniation: it can be associated with tingling and loss of strength.
Lack of shoulder mobility. What can it be?
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Serious cuff tendon injury: the patient cannot move it (active) but the doctor can (passive).
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Frozen shoulder: neither the patient (active) nor the doctor (passive) can move it.
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Nerve injuries: cervical hernias in the suprascapular nerve and in the long thoracic nerve. They can be accompanied by a tingling sensation (paraesthesia).
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Shoulder osteoarthritis: cartilage is worn, causing pain and reducing mobility.
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Cervical disc herniation: it can be associated with tingling and loss of strength.
The shoulder has left its place. What can it be?
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Anterior dislocation of the shoulder: the ball goes forward because of a blow (traumatic) or spontaneous (atraumatic).
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Posterior dislocation of the shoulder: the ball is pulled back. Difficult to diagnose.
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Upward dislocation of the clavicle: typical of bicycle, snowboard, and falls with the arms stuck to the body. A key is is touched at the top.
Rotator cuff injuries
The tendons which move the shoulder are called the rotator cuff. They are called that way because both their anatomy and their function is joint and helps in elevations and rotations, although there are four different muscles.
Your injury usually causes pain in the anterior shoulder region, especially with activities above the head. It typically hurts at night and incapacitates sleep and rest.
If the injury is mild or calcifying, it can be treated with infiltrations for pain control and physiotherapy. If there is a partial breakage we use regenerative therapies. And if it is completely broken, then surgery is necessary , diferring regarding age and function.
SLAP lesions
These are injuries within the shoulder, of the impeller that stabilizes in the upper part, where the biceps are anchored. They are typical of high-speed pitchers and tennis players, and they can also occur by traction like paratroopers when the parachute is opened. These lesions have been overdiagnosed over the course of the last few years, confusing diagnoses with many patients, originating unnecessary surgical treatments which create other difficult problems to treat.
Our treatment protocol is to always to try not to operate by treating individually with a good diagnosis, physiotherapy and therapeutic exercises which have given us very good results. If this were to fail, surgery is performed as an arthroscopy with special individualized techniques, taking into account the sports gesture.
Advances regarding shoulder injuries
In this video we sum up the latest advances in shoulder surgery in recent years.
Shoulder dislocation
The shoulder joint is made up of the balls of the humerus and the concavity of the glena, a relationship similar to that of a golf ball and a tee. When the ball goes out it is usually forward and downward but it can happen in any direction.
If it doesn’t incapacitate much during daily life and there are no large lesions in either bone, the treatment is with individualized physiotherapy and therapeutic exercise to strengthen the muscles that allow the ball to remain in place. If the injuries are severe or conservative treatment fails then treatment must be surgical using minimally invasive individualized techniques according to the needs of the patients and their sports.
Acromioclavicular dislocation
The separation of the clavicle is mostly upwards and a lump is felt on the skin that can be pressed down (key sign). If the separation is slight, it is treated with physical therapy and specific individualized rehabilitation, paying special attention to the mobility of the shoulder blade (scapular diskinesis). If the separation is severe, then it should be operated to maintain the optimal function of the shoulders. We do this through arthroscopy because it is a minimally invasive technique that also allows treatment of other injuries inside the shoulder (30%) which sometimes occur with the same blow.
Frozen shoulder
When you feel pain and can’t move your shoulder (active mobility) and the doctor also can’t move the patient’s shoulder (passive mobility). It occurs as a defense mechanism for the shoulder closing in pain. It runs in three typical phases, each one lasting between three and six months.
In phase 1 the shoulder is freezing: it hurts a lot and has a great lack of mobility. In this phase one should not operate because it makes the symptoms worse. We treat it with ultrasound guided infiltrations that control pain and with individualized and home physiotherapy.
In phase 2 the shoulder has frozen: it hurts a little and continues with a great lack of mobility. In this phase we insist on forced individualized physiotherapy, and it is usually curative. If the patient’s quality of life is greatly diminished then arthroscopic surgery solves the problem with a high success rate.
In phase 3 the shoulder defrosts: it no longer hurts and it regains its mobility. Therefore, the patient is cured.
Athlete’s shoulder
We describe our findings and contributions in the process of understanding the shoulder depending on the sport. Usually the pitcher’s shoulder has been descibed in the USA in baseball players. And our athletes, tennis players, swimmers, windsurfers, etc. have characteristics that differentiate them. Treating them like a baseball player is a common mistake that can generate more problems than solutions. We have described different diagnoses and therefore specific treatments for each sport.
Shoulder osteoarthritis
It corresponds to the wear of the cartilage covering the joint and it allows the ball of the humerus to slide with the concavity of the shoulder blade. It can occur due to the passage of time, overuse or some trauma that wears it out. It generates pain and decreases mobility. In the early stages or in patients who do not want to operate we use very precise infiltrations thanks to ultrasound, with substances which control pain or regenerative therapies with plasma rich in growth factors. Always accompanied by an individualized physiotherapeutic protocol and therapeutic exercise. When surgery is necessary, the joint is replaced by a metal prosthesis with interposed plastic (polyethylene). With a high success rate for pain control and mobility.
Suprascapular nerve neuropathy
A typical atrophy occurs which consists of thinning of the musculature on the shoulder blade. It can be accompanied by neuropathic pain, burning or internal hard to locate pain on the posterior part of the shoulder. It is typical of tennis and volleyball players. It is also described by us in swimmers and windsurfers. If treatment is diagnosed early , it consists in improving the technique, individualized physiotherapy with our own protocol and targeted therapeutic exercise. If minimally invasive endoscopic surgery by neurolysis is diagnosed late, it is very effective, as our research group has shown.
Sometimes it can occur due to paralabral cyst generated by a posterior SLAP injury. Surgery in this case is sealing the labrum with sutures in addition to nerve decompression.
Professionalism and honesty
Our commitment is to make our extensive experience and professionalism available to all our patients, offering personalized attention to achieve a complete recovery which, depending on each injury, allows our patients to return to their activities in the shortest possible amount of time.
