Injuries Around Shoulder

Overview of Shoulder Injuries

The shoulder is one of the most complex and mobile joints in the human body, consisting of multiple bones, joints, muscles, and connective tissues working together. This complexity, combined with the shoulder's extensive range of motion, makes it susceptible to various injuries and conditions. Dr. Abhishek Saxena specializes in diagnosing and treating the full spectrum of shoulder disorders, providing patients with comprehensive care tailored to their specific condition and lifestyle needs.

Common Shoulder Conditions

Shoulder Bursitis

Bursitis is inflammation of the bursa, small fluid-filled sacs that cushion and reduce friction between tissues in the shoulder. When these become inflamed, typically due to repetitive movements, injury, or age-related changes, they can cause pain and limited mobility.

• Symptoms: Pain on the outer shoulder that may worsen at night, tenderness to touch, and pain with certain movements, especially overhead activities.
• Treatment: Often responds well to conservative measures like rest, anti-inflammatory medications, physical therapy, and sometimes corticosteroid injections. Severe cases may require surgical intervention to remove the inflamed bursa.

Shoulder Tendinitis

Tendinitis involves inflammation or irritation of the tendons, the thick fibrous cords that attach muscles to bones. In the shoulder, this commonly affects the rotator cuff or biceps tendons.

• Symptoms: Pain that develops gradually, is worse with overhead activities, may radiate from the front of the shoulder down the arm, and is often accompanied by weakness.
• Treatment: Similar to bursitis, treatment typically includes activity modification, anti-inflammatory medications, physical therapy, and sometimes injections. Persistent cases may require surgical intervention, particularly if there is a partial tear of the tendon.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder involves thickening and tightening of the shoulder capsule, the connective tissue surrounding the shoulder joint. This leads to progressive stiffness and significantly reduced range of motion.

• Phases:
  • Freezing phase: Gradual onset of pain and loss of motion (2-9 months)
  • Frozen phase: Less pain but significant stiffness (4-12 months)
  • Thawing phase: Gradual improvement in motion (5-24 months)
• Risk Factors: More common in women, people 40-60 years old, and those with diabetes, thyroid disorders, or after periods of immobilization.
• Treatment: Physical therapy, home stretching programs, anti-inflammatory medications, and sometimes injections. In resistant cases, manipulation under anesthesia or arthroscopic release of the tight capsule may be necessary.

AC Joint Injuries

The acromioclavicular (AC) joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). Injuries to this joint are often called "separated shoulder."

• Causes: Typically result from a fall directly onto the shoulder, a direct blow, or a fall on an outstretched hand.
• Grades: Classified into six grades (I-VI) based on severity, with higher grades indicating greater displacement and more ligament damage.
• Treatment: Lower-grade injuries (I-II) usually heal with conservative management including rest, ice, pain medications, and a sling. Higher-grade injuries (IV-VI) often require surgical reconstruction, while grade III injuries may be treated either conservatively or surgically depending on the patient's activity level and symptoms.

SLAP Tears

Superior Labrum Anterior to Posterior (SLAP) tears affect the labrum, a ring of cartilage that surrounds the socket of the shoulder joint, specifically at the point where the biceps tendon attaches.

• Causes: Acute trauma (fall on an outstretched arm), repetitive overhead activities (throwing sports), or degenerative changes with age.
• Symptoms: Deep, aching pain within the shoulder, clicking or catching sensations, pain with specific movements (especially overhead), and reduced throwing velocity in athletes.
• Treatment: May include physical therapy, activity modification, and anti-inflammatory medications. Surgical repair through arthroscopy may be necessary for active individuals or those with persistent symptoms.

Shoulder Instability

Instability occurs when the humeral head (ball) moves excessively or dislocates from the glenoid (socket). This can range from subtle looseness to complete dislocation.

• Types:
  • Anterior (forward) - most common
  • Posterior (backward)
  • Multidirectional (multiple directions)
• Symptoms: Feelings of the shoulder "giving way," pain with certain arm positions, recurrent dislocations, and apprehension with certain movements.
• Treatment: Physical therapy to strengthen the rotator cuff and stabilizing muscles is the first-line treatment. For recurrent instability, surgical repair of the labrum and capsule (Bankart repair or capsular shift) may be necessary, typically performed arthroscopically.

Diagnostic Approach

Dr. Saxena employs a comprehensive approach to diagnose shoulder conditions:

• Detailed History: Understanding the onset, duration, and nature of symptoms, as well as aggravating and relieving factors.
• Physical Examination: Evaluating range of motion, strength, stability, and performing specific tests to identify particular shoulder conditions.
• Imaging Studies:
  • X-rays: To evaluate bone structure, alignment, and detect arthritis or fractures
  • MRI: Provides detailed images of soft tissues including muscles, tendons, labrum, and cartilage
  • MR Arthrogram: Enhanced MRI with contrast injected into the joint for better visualization of labral tears and subtle injuries
  • Ultrasound: Dynamic imaging useful for evaluating tendons and detecting fluid collections
  • CT Scan: Sometimes used for complex bone issues or pre-surgical planning
• Diagnostic Injections: Can help differentiate between various pain sources and confirm specific diagnoses.

Treatment Philosophy

Dr. Abhishek Saxena's approach to treating shoulder injuries is guided by several principles:

• Individualized Care: Treatment plans are tailored to each patient's specific condition, age, activity level, goals, and overall health.
• Conservative First: Non-surgical approaches are typically tried before considering surgical intervention, except in cases where early surgery provides clear benefits.
• Evidence-Based Practices: All treatment recommendations are based on the latest research and clinical evidence.
• Comprehensive Approach: Addressing not just the primary shoulder problem but also any contributing factors such as posture, muscle imbalances, or movement patterns.
• Minimally Invasive Techniques: When surgery is necessary, arthroscopic and other minimally invasive approaches are used whenever possible to reduce recovery time and complications.

Non-Surgical Treatment Options

Many shoulder conditions respond well to conservative management:

• Rest and Activity Modification: Temporarily avoiding activities that aggravate symptoms to allow healing.
• Physical Therapy: Customized exercise programs to improve range of motion, strength, and proper movement patterns. This is a cornerstone of treatment for most shoulder conditions.
• Anti-inflammatory Medications: NSAIDs and other medications to reduce pain and inflammation.
• Therapeutic Injections:
  • Corticosteroid injections to reduce inflammation
  • Hyaluronic acid for arthritic conditions
  • Platelet-Rich Plasma (PRP) therapy to promote healing in tendons and other tissues
• Bracing or Immobilization: When appropriate, to protect the shoulder during the healing process.
• Massage and Manual Therapy: To address soft tissue restrictions and improve mobility.
• Ultrasound, Electrical Stimulation, and Other Modalities: May help reduce pain and promote healing in some cases.

Surgical Treatment Options

When conservative treatment doesn't provide adequate relief, or for certain conditions where surgery offers the best outcome, Dr. Saxena offers various surgical interventions:

• Arthroscopic Procedures:
  • Subacromial decompression for impingement syndrome
  • Labral repairs for SLAP tears and instability
  • Capsular release for frozen shoulder
  • Biceps tenodesis or tenotomy for biceps tendon problems
  • Debridement of inflamed tissue or damaged cartilage
• AC Joint Procedures:
  • Distal clavicle excision for arthritic AC joints
  • Reconstruction for high-grade AC separations
• Instability Repairs:
  • Bankart repair for anterior instability
  • Capsular shift for multidirectional instability
  • Bone augmentation procedures (Latarjet) for significant bone loss
• Fracture Fixation: Surgical repair of clavicle, scapula, or proximal humerus fractures using plates, screws, or specialized implants.
• Shoulder Replacement: For advanced arthritis or complex fractures, including:
  • Total shoulder replacement
  • Reverse total shoulder replacement
  • Partial (hemiarthroplasty) replacement

Most of these procedures are performed arthroscopically or through minimally invasive techniques, resulting in smaller incisions, less pain, and faster recovery compared to traditional open surgery.

Advanced Techniques and Technologies

Dr. Saxena utilizes the latest advancements in shoulder surgery:

• High-Definition Arthroscopy: Provides exceptional visualization of all shoulder structures, allowing for precise diagnosis and treatment.
• Advanced Fixation Methods: Including knotless anchors, all-suture anchors, and specialized suture configurations for stronger repairs.
• Biological Augmentation: Application of growth factors, stem cells, or other biologics to enhance healing when appropriate.
• Computer-Assisted Navigation: For complex cases requiring precise implant positioning.
• Patient-Specific Instrumentation: Custom guides based on the patient's anatomy for certain procedures.
• Innovative Implant Designs: Including anatomic and reverse shoulder replacement systems with improved longevity and function.

Rehabilitation and Recovery

Proper rehabilitation is crucial for optimal outcomes after shoulder treatments:

• Customized Protocols: Rehabilitation plans are tailored to the specific condition and procedure, with clear progression criteria.
• Phased Approach: Typically progressing through protection, range of motion, strengthening, and return to function phases.
• Collaboration: Close communication between Dr. Saxena, physical therapists, and patients ensures coordinated care.
• Patient Education: Clear guidance on activities, restrictions, exercises, and what to expect throughout recovery.
• Monitoring: Regular follow-up appointments to assess progress and adjust treatment plans as needed.

Recovery times vary significantly depending on the condition and treatment:

• Minor arthroscopic procedures: Return to normal activities within 4-6 weeks
• Labral and instability repairs: 3-6 months for full recovery
• Shoulder replacements: 3-6 months for basic function, with continued improvement for up to a year

Prevention of Shoulder Injuries

Dr. Saxena emphasizes prevention strategies for those at risk of shoulder problems:

• Proper Technique: Learning and maintaining correct form during sports, exercise, and occupational activities.
• Balanced Strengthening: Developing appropriate strength in all the muscles around the shoulder, including the often-neglected posterior rotator cuff.
• Flexibility: Maintaining good mobility in the shoulder, neck, and upper back.
• Progressive Training: Gradually increasing activity intensity, especially with overhead sports or occupations.
• Proper Warm-up: Thorough preparation before demanding shoulder activities.
• Posture Awareness: Maintaining good posture during daily activities, work, and sleep.
• Early Intervention: Addressing minor symptoms before they become major problems.

For athletes and workers with high shoulder demands, Dr. Saxena can provide sport or occupation-specific recommendations to reduce injury risk.