Shoulder Impingement
What is Shoulder Impingement
The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keep it stable. The tendons of the rotator cuff pass underneath a bony area on their way to attaching to the top of the humerus. As the tendons become inflamed or irritated, they can become frayed during shoulder movements. This problem is called rotator cuff tendonitis, or impingement syndrome.
Shoulder Impingement Causes:
- Sleeping on the same arm at night
- Repeated overhead activity
- Poor control or coordination of your shoulder and shoulder blade muscles
- Poor posture.
Shoulder Impingement Treatment
Treating tendonitis or impingement involves resting the shoulder and avoiding activities that cause pain.
Stage 1 – up to one week
Reduce pain and swelling by applying ice and compression 60 minutes every 2 hours while avoiding overhead and painful activities.
Stage 2 – second week or longer
Use pain as a guide to determine how much activity is enough. Gently increase shoulder range of motion and begin light stretching and postural correction exercises.
Recommended Exercises
Codmans
Shift your body weight in circles to allow your injured arm to swing in circles freely. Your injured arm should be fully relaxed 30 clockwise, 30 counter clockwise
Active Assistive Flexion
In the standing position and holding wand/cane with both arms as shown, raise it up allowing your unaffected arm to push up your affected arm. 10 reps 3 sets
Active Assistive Abduction
While holding a wand/cane palm face up on the injured side and palm face down on the uninjured side, slowly raise up your injured arm to the side. 10 reps 3 sets
Active Assistive ER/IR
In the standing position, hold a wand/cane with both hands keeping your elbows bent. Rock your hands and wand side to side. Your affected arm should be partially relaxed while your unaffected arm does most of the work. 10 reps 3 sets
Sleeper Stretch
Lying with the affected arm on the bottom. Your affected arm should be bent with forearm pointed upwards. Next, use your unaffected arm to gently push forearm towards the table or bed. Hold 10 sec Sets 10
Corner Stretch High
At a corner of a wall, place your arms on the walls with elbows bent as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest. Hold 30 sec 3 reps
Corner Stretch Low
At a corner of a wall, place your arms downward as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest and/or shoulders. Hold 30 sec 3 reps
Hold Ups
Stand with knees straight while leaning into wall with hands in hold-up position, keep head, shoulder, and lower back flat against the wall. Slide the backs of both hands up the wall toward each other Reps 10 Sets 3
Scapular Retractions
Draw your shoulder blades back and down. Hold 3 sec Reps 10 Sets 3
Elastic Rows
Holding elastic band with both hands, draw back the band as you bend your elbows. Keep your elbows near the side of your body. Reps 10 Sets 3
Prone T’s
Lying on stomach, lift arms and shoulders making the shape of a “T”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3
Prone Y’s
Lying on stomach, Lift arms and shoulders making the shape of a “Y”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3
Ball Circles
While standing and holding a ball on a wall, lean into the ball and roll the ball in small circles. Reps 10 Sets 3
Rotator Cuff Tears
Your rotator cuff is a key part of your shoulder, made up of four muscles that help keep your upper arm bone firmly in your shoulder socket. However, the rotator cuff is also prone to tearing that could worsen over time and require orthopaedic treatment.
Causes of a Rotator Cuff Tear
Rotator cuff tears generally fall into two categories: acute and chronic. An acute rotator cuff tear is caused by a quick, jerking motion with explosive force. This is common in contact sports, like football and basketball, as well as other high-intensity activities, such as crossfit and weightlifting.
Chronic rotator cuff tears are much more common and occur when a patient has some degree of impingement syndrome that causes the rotator cuff to weaken over time. This often occurs naturally as part of aging.
Signs of a Rotator Cuff Tear
With an acute rotator cuff tear, the patient will generally hear a tearing or popping sound during an explosive physical movement.
Chronic rotator cuff tears happen gradually over time. The patient may feel weakness when lifting objects over their head or away from their body. Pain in the shoulder may wake them during the night and make a popping sound as they roll over in bed.
Treatment for a Rotator Cuff Tear
We begin our rotator cuff injury treatments are conservatively as possible. Diagnosis of the injury would involve an office visit and a physical evaluation, where we will assess the severity of the injury. An MRI or x-ray may be required to confirm the diagnosis.
If the rotator cuff is sprained, but not torn:
- Oral or injection anti-inflammatories will be given to reduce pain and swelling
- A physical therapy regimen will be prescribed to restore shoulder mobility
If the rotator cuff is torn:
- An arthroscopic repair of the rotator cuff will be necessary
- This is a minimally invasive procedure where two small incisions are made and the tendon is bonded back to the bone
- In the meantime, oral or injection anti-inflammatories will be given to reduce pain and swelling
- During recovery, a physical therapy regimen will be prescribed to restore shoulder mobility
Watch the video below for a detailed look at how Dr. Melander repairs a torn rotator cuff.
Not all rotator cuff tears are created equal. Depending on the location and severity of the tear, recovery times may vary anywhere from three to six months. During that time, the patient will wear a shoulder sling and go through physical therapy.
Rotator Cuff Injury Prevention
Rotator cuff tears are increasingly common as people age, but there are still a number of ways to prevent injury, such as:
- Stretching your shoulders before and after any intense physical activity
- Practicing good posture
- Avoiding sleeping on your shoulder
- Refraining from smoking
In addition to the actions listed above, there are several exercises you can do at home to reduce shoulder impingement syndrome and alleviate shoulder pain.
Schedule a Consultation
If you believe you’ve suffered a rotator cuff injury, schedule a consultation with Dr. Melander right away. Our sports medicine experts will evaluate the severity of the injury, provide treatment options and get you back to full strength as quickly as possible.
Shoulder Instability
What is Shoulder Instability
The head of the humerus fits into a shallow socket in your shoulder blade called the glenoid. Strong connective tissue and other ligaments, tendons, and muscles of the shoulder provide stability to the joint. When this system becomes loose or torn the shoulder becomes unstable.
Shoulder Instability Causes:
Shoulder dislocation
Often caused by severe injury or trauma. With a dislocation the ligaments in the front are injured and often leads to continued dislocations.
Repetitive Strain
Shoulder instability can also be resultant of increased laxity due to anatomical reasons or repetitive overhead motion. Looser ligaments make maintaining shoulder instability difficult.
Multidirectional Instability
In a small number of patients the shoulder can become unstable without a history of injury or repetitive strain.
Shoulder Instability Exercises
Perform each exercise 1-2 x’s per day, gradually increasing weight and sets.
Recommended Exercises
Corner Stretch High
At a corner of a wall, place your arms on the walls with elbows bent as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest. Hold 30 sec 3 reps
Corner Stretch Low
At a corner of a wall, place your arms downward as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest and/or shoulders. Hold 30 sec 3 reps
Ball Circles
While standing and holding a ball on a wall, lean into the ball and roll the ball in small circles. Reps 10 Sets 3
Hold Ups
Stand with knees straight while leaning into wall with hands in hold-up position, keep head, shoulder, and lower back flat against the wall. Slide the backs of both hands up the wall toward each other Reps 10 Sets 3
Prone T’s
Lying on stomach, lift arms and shoulders making the shape of a “T”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3
Prone Y’s
Lying on stomach, Lift arms and shoulders making the shape of a “Y”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3
Elastic Band Abduction
While holding an elastic band at your side, draw up your arm to the side keeping your elbow straight. Reps 10 Sets 3
Elastic Band Flexion
While holding an elastic band at your side, draw up your arm up in front of you while keeping your elbow straight. Reps 10 Sets 3
Elastic Band Diagonal
While holding an elastic band across the lower half of your body, pull the band upwards and outwards to your opposite side. Your hand should start with the thumb-down and end with the thumb-up. Reps 10 Sets 3
Elastic Band IR
While holding an elastic band at your side with your elbow bent, start with your hand away from your stomach, then pull the band towards your stomach. Keep your elbow near your side the entire time. Reps 10 Sets 3
Elastic Rows
Holding elastic band with both hands, draw back the band as you bend your elbows. Keep your elbows near the side of your body. Reps 10 Sets 3
Elastic Band ER
While holding an elastic band at your side with your elbow bent, start with your hand near your stomach and then pull the band away. Keep your elbow at your side the entire time. Reps 10 Sets 3
Scapular Retractions
Draw your shoulder blades back and down. Hold 3 sec Reps 10 Sets 3
Shoulder Tendonitis
What is Shoulder Tendonitis
The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keep it stable. The tendons of the rotator cuff pass underneath a bony area on their way to attaching to the top of the humerus. As the tendons become inflamed or irritated, they can become frayed during shoulder movements. This problem is called rotator cuff tendonitis, or impingement syndrome.
Shoulder Tendonitis Causes
- Sleeping on the same arm at night
- Repeated overhead activity
- Poor control or coordination of your shoulder and shoulder blade muscles
- Poor posture.
Shoulder Tendonitis Treatment
Treating tendonitis or impingement involves resting the shoulder and avoiding activities that cause pain
Stage 1 – up to one week
Reduce pain and swelling by applying ice and compression 60 minutes every 2 hours while avoiding overhead and painful activities.
Stage 2 – second week or longer
Use pain as a guide to determine how much activity is enough. Gently increase shoulder range of motion and begin light stretching and postural correction exercises.
Recommended Exercises
Corner Stretch High
At a corner of a wall, place your arms on the walls with elbows bent as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest. Hold 30 sec 3 reps
Corner Stretch Low
At a corner of a wall, place your arms downward as shown. Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest and/or shoulders. Hold 30 sec 3 reps
Ball Circles
While standing and holding a ball on a wall, lean into the ball and roll the ball in small circles. Reps 10 Sets 3
Hold Ups
Stand with knees straight while leaning into wall with hands in hold-up position, keep head, shoulder, and lower back flat against the wall. Slide the backs of both hands up the wall toward each other Reps 10 Sets 3
Prone T’s
Lying on stomach, lift arms and shoulders making the shape of a “T”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3
Prone Y’s
Lying on stomach, Lift arms and shoulders making the shape of a “Y”. Keep chin slightly tucked and squeeze shoulder blades together. Reps 10 Sets 3
Elastic Band Abduction
While holding an elastic band at your side, draw up your arm to the side keeping your elbow straight. Reps 10 Sets 3
Elastic Band Flexion
While holding an elastic band at your side, draw up your arm up in front of you while keeping your elbow straight. Reps 10 Sets 3
Elastic Band Diagonal
While holding an elastic band across the lower half of your body, pull the band upwards and outwards to your opposite side. Your hand should start with the thumb-down and end with the thumb-up. Reps 10 Sets 3
Elastic Band IR
While holding an elastic band at your side with your elbow bent, start with your hand away from your stomach, then pull the band towards your stomach. Keep your elbow near your side the entire time. Reps 10 Sets 3
Elastic Rows
Holding elastic band with both hands, draw back the band as you bend your elbows. Keep your elbows near the side of your body. Reps 10 Sets 3
Elastic Band ER
While holding an elastic band at your side with your elbow bent, start with your hand near your stomach and then pull the band away. Keep your elbow at your side the entire time. Reps 10 Sets 3
Scapular Retractions
Draw your shoulder blades back and down. Hold 3 sec Reps 10 Sets 3
Labral Tears: Hip and Shoulder
The labrum refers to pieces of protective cartilage found in your hips and shoulders. In these ball-and-socket joints, the labrum surrounds the socket to provide stability. Both the hip and shoulder joints are critical to any physical activity, often making them a target for injuries like labral tears.
Labral Tear Causes
Labral tears typically occur in conjunction with a traumatic shoulder dislocation. This could be as a result of forceful contact, like a linebacker in football, or a severe fall, like a worker who falls down on a slippery floor. In young people, specifically young women, the labrum may also tear as a result of instability in the shoulder or hip. This is common in both swimmers and volleyball players.
Labral Tear Symptoms
In the case of a shoulder labral tear, the patient will likely experience pain around the joint, especially during movement. Even when stationary, the joint may feel unstable. The shoulder joint may also suffer from recurrent dislocation, meaning the pain comes and goes.
In the case of a labral tear in the hip, the patient may experience pain around the hip during normal activities, such as walking. The patient may also hear mechanical sounds during movement, such as a clicking or popping sound.
Labral Tear Treatment
For all labral tears, Dr. Melander begins diagnosis with a full physical exam. From there, Dr. Melander may use x-ray imaging to get a clearer picture of the tear and prescribe an MRI, if necessary.
For shoulder labral tears, Dr. Melander may use the Apprehension Relocation test to gauge the joint’s integrity during diagnosis. Treatment for shoulder labral tears varies depending on the injury’s severity. For most tears, Dr. Melander typically recommends a shoulder arthroscopy with a labral repair. Watch the video below to see how Dr. Melander performs a trimming of a torn shoulder labrum.
For hip labral tears, Dr. Melander may diagnose the injury by applying the FADIR test, which tests for flexion, adduction and internal rotation. Much like shoulder labral tears, he may treat the hip injury with a minimally invasive arthroscopic procedure. For tears caused by impingement, treatment may involve an osteoplasty in which Dr. Melander shaves down the femoral neck of the joint in order to alleviate pain.
Labral Tear Recovery
Both shoulder and hip labral tear treatments require 3-4 weeks in a sling or brace, during which the patient should avoid physical activity. For shoulder labral tears, athletes may expect to return to their sports within 3-4 months. Athletes suffering from a labral tear in the hip require a slightly longer recovery time, and may require 3-6 months before returning to their sports.
Labral Tear Prevention
Aside from wearing protective gear and completing stretching regimens, the best way to prevent labral tears is to keep the joint’s surrounding muscles in good shape. For shoulders, patients should follow workout routines that keep the rotator cuff engaged. Exercises involving the hips and gluteus muscles will help prevent labral tears in the hip. However, some labral tears are due to variances in human anatomy, meaning they aren’t entirely preventable.
Schedule a Consultation
If you’re feeling a recurring pain in your hip or shoulders, schedule an appointment with Dr. Melander’s sports medicine team for an exam. If your injury is due to a labral tear, our team will develop a treatment plan that repairs the torn labrum and returns you to your normal activity levels as quickly as possible.
Orthobiologics
One of the fastest-growing areas of orthopaedic treatment is orthobiologics. For certain, minor injuries, orthobiologics have proven to be a safe, effective solution that accelerate the body’s natural healing process. Let’s take a closer look.
Orthobiologics Definition
Orthobiologics refers to the application of biologic treatment for musculoskeletal injuries. The orthobiologic substances are derived from the body’s own cells, proteins and growth factors. When injected into the site of an injury, orthobiologics have a good chance of reducing inflammation and creating an environment more conducive to healing.
When Are Orthobiologics Used?
Dr. Melander typically recommends orthobiologic treatment for tendon, ligament and cartilage injuries. It is considered a hybrid between conservative and surgical treatment. Dr. Melander may recommend it as an intermediate step before surgery, or as a temporary relief for chronic conditions, such as arthritis. In some cases, orthobiologics may delay major treatments, such as a joint replacement.
Where Do Orthobiologics Come From?
Orthobiologics are usually created from two sources: platelet-rich plasma (PRP) and pluripotent stem cells, and occasionally stromal fat cells. PRP cells are drawn from your own blood and contain the critical growth factors necessary to enhance healing. Stem cells, on the other hand, are usually harvested from the bone marrow or pelvis or from a donor. In theory, these cells assist with the rebuilding of the damaged tissue.
Outlook on Orthobiologics
Although orthobiologics have provided relief for several patients experiencing joint pain, science has yet to completely validate them as a reliable treatment option, however, there is growing evidence that orthobiologics can work exactly as intended. That said, the treatment is quite promising and may be right for some patients experiencing specific types of pain. Dr. Melander will be able to evaluate your injury and recommend the best course of action.
Schedule a Consultation
If you are experiencing joint pain and are interested in orthobiologic treatment, schedule an appointment with Dr. Melander and the sports medicine team. If he determines you are a good candidate for orthobiologics, he will develop a treatment plan that restores you to full health as quickly as possible.
