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Sports-related shoulder injuries are a lesser-known risk of sports which can sideline a player for an extended period of time. These types of injuries are very common in sports that apply stress to the shoulder. This is because there are several sports that require strength, speed, and endurance from the shoulder. Unfortunately, the shoulder joint is unstable due to its structure, which makes it more susceptible to injury in cases where repeated physical demand is placed on the joint. There are a variety of sports-related shoulder injuries that can occur, some of which are minor and others that are major. Minor shoulder injuries can include sprains, strains, bruising, bursitis, bone spurs, and muscular imbalances. Major shoulder injuries can include:
A shoulder dislocation occurs when the humerus “pops” out of the shoulder socket (scapula). The acromioclavicular joint (ACJ) composed of the clavicle and scapula can also be dislocated if the clavicle is separated. These injuries are commonly seen in football, or other sports that involve repetitive falls onto the shoulder.
The rotator cuff is composed of several tendons that are responsible for the shoulder’s movement. Sports such as baseball, swimming, or tennis that require repetitive arms swings, especially those that are overhand, can eventually cause a rotator cuff to tear. Other sports such as volleyball, weightlifting, and rock climbing that cause stress to the rotator cuff can also cause tears.
In addition to tearing, the rotator cuff can also become impinged. This occurs when one or more of the tendons becomes injured and swells, which then causes the tendon to get pinched by the shoulder joint. Rotator cuff impingement reduces blood flow to the tendons and can result in more tendon damage that can eventually lead to tearing.
Superior Labral Antero-Posterior (SLAP) tears affect the labrum, which is the cartilage that lines the socket portion of the shoulder joint. SLAP tears are commonly associated with sports that involve throwing, heavy lifting, or tackling. Most SLAP tears develop slowly over time, however they can also be caused by a single, powerful impact. One key indicator of a SLAP tear is weakness and/or looseness felt in the shoulder joint.
The shoulder joint is composed of various soft tissue structures such as ligaments, tendons, and muscles, all of which are responsible for movement. However, this construction limits joint stability, which is why shoulder injuries are common.
You may have a sports-related shoulder injury if you experience one or more of the following symptoms:
However, it is important to consult with your doctor to obtain an official diagnosis. To determine if you have a shoulder injury, schedule a consultation with Dearborn & Associates today.
At Dearborn & Associates, we begin the diagnosis process by first obtaining a history of your symptoms and health over the past several years. We will ask you about your symptoms, as well as what activities have been affected by the pain.
Your doctor will then perform a physical exam of your shoulder and take x-rays and additional imaging such as a CT and/or MRI of the joint. X-rays can evaluate the bone structure, while a CT or an MRI may be performed to evaluate the soft tissues around the joint.
At Dearborn & Associates, your individual treatment plan will depend on a number of factors, including the type and severity of your injury. Shoulder injuries may be treated using one or more of the following:
Severe shoulder injuries, as well as those that do not respond well to non-surgical treatments, may require shoulder surgery.
Schedule a consultation with Dearborn & Associates in Menlo Park today to see how we can help you with sports-related shoulder injuries!
Shoulder arthritis, more formally known as glenohumeral arthritis, is characterized by damaged cartilage surfaces within the ball and socket joint of the shoulder. The shoulder joint is both extremely mobile and complex. It is made up of various bones, ligaments, tendons, and muscles that are responsible for its movement. Shoulder osteoarthritis occurs when the cartilage in between the bones wears down, causing the top of the humerus bone to grind against the glenoid (socket). This ultimately causes bone spurs to form within the joint, which further restricts fluid and comfortable movement. Eventually, movement becomes significantly decreased as a result of bone spurs.
Shoulder osteoarthritis affects around 20% of the older population and is responsible for more than 120,000 shoulder replacement surgeries each year.
If you have been experiencing shoulder pain, you may be wondering if you are affected by shoulder osteoarthritis. While only a shoulder specialist can accurately diagnose shoulder osteoarthritis, some signs that you may be affected include:
To determine if you have shoulder osteoarthritis and to discuss your options, schedule a consultation with Dearborn & Associates today.
At Dearborn & Associates, we begin the diagnosis process by first obtaining a history of your symptoms and health over the past several years. We will ask you how pain has been progressing, as well as what activities have been affected by the pain. We will also ask you about any past or present shoulder conditions that may increase your risk of shoulder osteoarthritis.
Your doctor will then perform a physical exam of your shoulder and take x-rays of the joint to determine if joint irregularities, bone spurs, or bone erosion is present. In some cases, additional imaging may be required. For example, a CT scan may be performed to determine the extent of bone loss in the glenoid bone, while an MRI may be performed to evaluate the soft tissues around the joint.
At Dearborn & Associates, your individual treatment plan will depend on a number of factors, including your current health and the severity of your case. Mild osteoarthritis is usually treated with rest, strengthening exercises, and non-steroidal anti-inflammatory medications. Moderate cases can be treated using one or more of the following:
Severe cases of shoulder osteoarthritis, as well as those that do not respond well to non-surgical treatments, may require shoulder replacement surgery. During shoulder replacement surgery, the damaged cartilage and joint components are removed and replaced with prosthetics that allow for proper movement. After surgery, the shoulder will be immobilized for about 6 weeks, then physical therapy will be used to rehabilitate the soft tissues. In most cases, recovery takes about 4-6 months.
Schedule a consultation with Dearborn & Associates in Menlo Park & Fremont, CA today to see how we can help you with shoulder osteoarthritis!
Shoulder instability refers to a condition in which the soft tissue components of the shoulder joint have become stretched, torn, or detached, resulting in the regular subluxation or dislocation of the shoulder joint.
There are various causes of shoulder instability such as:
These causes can contribute to shoulder instability in one of two ways: traumatic (injury) or atraumatic.
Traumatic shoulder instability develops when an injury causes the shoulder to dislocate. This type of instability is commonly seen in younger people who play sports. It can develop when there is a lack of support from the labrum and ligaments. The severity of chronic instability is dependent on the type and severity of the initial injury.
Caused by a general looseness in the shoulder that eventually causes subluxations or dislocations. This type of instability is more common in older adults and typically occurs after a long period of wear and tear on the shoulder joint.
When the femoral head is pushed completely out of the glenoid, this is known as a dislocation. When the femoral head is only pushed partially out of the glenoid and returns on its own, this is known as subluxation.
In cases where the shoulder has become dislocated, it causes specific symptoms that are hard to miss. These can include:
If you are experiencing any of these symptoms, it is best to see a doctor at Dearborn & Associates as soon as possible for an evaluation.
At Dearborn & Associates, our doctors can visually recognize a dislocated shoulder almost immediately. Some cases can be harder to diagnose, especially if the shoulder spontaneously relocates, or reduces, itself. X-ray or MRI imaging may be used to diagnose a dislocation, check for fractures, or assess the condition of the labrum and ligaments within the joint.
The first step to treating shoulder instability is to reduce the joint. This is when the doctor pushes or pulls on the arm in a controlled manner, guiding the shoulder back into its socket. This is typically achieved with a quick and specific thrust. The period following a reduction will usually consist of immobilization for 4 weeks, followed by physical therapy.
For recurrent cases of shoulder instability, physical therapy is generally recommended to strengthen the rotator cuff and periscapular muscles to improve joint stability. Although physical therapy is effective for treating some cases, other cases may require surgical intervention.
Surgical intervention for shoulder instability is generally performed using an arthroscopic technique known as Bankart Repair. The goal of shoulder instability surgery is to stabilize the shoulder, while preserving as much motion as possible. With that being said, however, shoulder instability surgery can cause some loss of motion.
Schedule a consultation with Dearborn & Associates in Menlo Park today to see how we can help with your shoulder instability.
Shoulder fractures can affect one of three bones within the shoulder: the scapula, clavicle, or humerus. Scapula fractures are rare, but can occur as a result of sports or car accidents. Clavicle fractures generally occur as a result of a fall, direct hit, contact sport accident, or car accident. Humerus fractures affect the humeral head (the ball of the joint) at the top of the bone. Proximal humerus fractures are the most common type of shoulder fracture and have the greatest effect on the joint. Other types of humerus fractures affect the middle portion of the humerus (humeral shaft fracture) or the bottom end of the humerus (distal humerus fracture).
When it comes to shoulder fractures, clavicle and humerus fractures are far more common than scapula fractures. This is because the scapula is protected by the chest and supported within several strong muscles.
Since shoulder fractures can affect different bones, you may experience different symptoms depending on what bone is affected. While all shoulder fractures generally cause pain and swelling, here are symptoms that are specific to the type of fracture:
To determine if you have a shoulder fracture, schedule a consultation with Dearborn & Associates today.
At Dearborn & Associates, diagnose shoulder fractures by performing a physical exam of your shoulder and taking x-rays of the three bones that make up the shoulder.
At Dearborn & Associates, your individual treatment plan will depend on a number of factors, including your current health, as well as the location and severity of your fracture. At a glance, here is how shoulder fractures may be treated:
Ultimately, however, your doctor will decide on a treatment plan that is appropriate for your situation. They will discuss their treatment recommendations with you and answer any questions you may have.
Schedule a consultation with Dearborn & Associates in Menlo Park and Fremont, CA today to see how we can help with shoulder fractures.
Hip arthritis is inflammation of the joint which frequently causes pain, stiffness, and limitations in activities. There are many possible causes of pain in the hip region, including back pain, bursitis, tendonitis, and other things unique to your physiology and health history. Chronic pain specific to the hip joint most commonly involves damage to the cartilage. As a ball-and-socket type joint, the hip provides many degrees of motion. This broad range of movements requires diffuse healthy cartilage to allow painless and smooth motion.
As cartilage deteriorates in the hip joint, the underlying bone becomes exposed. The irregular surfaces and the inflammation associated with bone moving against bone, leads to pain and stiffness. The ball in socket joint becomes more like a square peg in a round hole. Pain typically occurs in the groin or on the side of the hip.
Occasionally, hip pathology will present as knee pain. As hip arthritis progresses, limping and leg length discrepancies may worsen. A hip examination and radiograph is the most common method of diagnosing hip arthritis.
Other pathologies such as avascular necrosis or congenital hip dysplasia can also be diagnosed in a similar fashion. Nonoperative treatments can temporarily make symptoms more tolerable, but typically the arthritis and associated pain progresses.
Arthritis refers to inflammation, pain, swelling, or stiffness in a joint which is most frequently caused by wear and tear in the cartilage surface of bones. When this occurs, knee arthritis tends to progress. The knee is a naturally hard-working joint, but its function can be compromised by body weight, and other physiological stresses, which can accelerate such wear patterns.
Many times, knee deformities ensue causing the legs to become either bowed or knock-kneed. These deformities alter leg weight-bearing distribution and can also contribute to the progression of arthritis.
KNEE ANATOMY
The knee joint provides motion in the lower leg to perform activities such as walking, climbing, pivoting, and bending. This flexibility inflicts many forces and stresses across the knee joint. The ability to maintain these functions requires the knee to be comprised of numerous tissue types:
Bones
Cartilage
Ligaments
Muscles/tendons
These components of the knee work in conjunction to provide smooth, painless, and stable knee motion for everyday activities. However, injury to any of these parts of the knee can lead to pain.
CAUSES OF KNEE PAIN
Acute knee pain may begin after an identifiable cause or may be of recent or sudden onset. The most common acute knee injury types are:
Acute knee pain is most commonly treated nonoperatively with rest, ice, elevation, and anti-inflammatory medications.
Pain which does not resolve is considered chronic pain. While there are multiple possible causes of chronic pain, osteoarthritis (the wear and tear of cartilage) is the most common cause.
Evaluation by a physician with radiographic studies is the most reliable method of diagnosing arthritis.
As cartilage is lost at the end of bones, the underlying bone is exposed. Motion in the joint now causes pain, swelling, stiffness, and sometimes catching or locking. Prior trauma or inflammatory arthritides can also damage cartilage, and the end result is similar. As the condition progresses, daily activities become more difficult to complete and lifestyles are limited.
Because the arthritic process cannot be reversed, eventually joint replacement options may be necessary.
As reliable as joint replacement surgery can be, a variety of problems can occur which creates trouble for the joint replacement patient. We’ll go through a few of the most common issues and outline the general treatment algorithms below, but if you or someone you love is experiencing problems with a previously replaced hip or knee, we recommend a thorough in-person evaluation. Such a consultation begins with the patient gathering some critical information dating back to the time of the original surgery. The items we need include:
It’s important we receive this pertinent information before your consultation so we will be best prepared to answer your questions during your visit.
Dislocation
All hip implants, including hip resurfacing devices, can dislocate. Fortunately, the rates of dislocation are declining. Dislocations are termed either anterior or posterior, based on the route the ball takes to come out of the joint. The surgical technique used often predicts the direction of potential instability, but not always. If one of the anterior approaches to the hip is employed (direct anterior, modified Watson Jones, anterolateral, direct lateral), the risk of anterior dislocation after surgery is around 1% overall. The chance of a posterior dislocation is small if an anterior approach was used. Conversely, if a posterior approach is used (mini-posterior, standard posterior), the anterior dislocation risk is very small and most dislocations will be posterior. The actual risk of a posterior dislocation is dependent on many factors, however, if a capsular repair is done after the implants are placed, the chance is less than 1% both in our experience and as reported by others:
The treatment for a hip that repeatedly dislocates usually involves revision surgery. In many cases, the position of the implants can be improved to prevent recurrent problems. Repairing the capsule and careful attention to postoperative precautions maximize the chances of success. If hip instability appears many years after a replacement, this can be due to major wear of the artificial bearing. Placement of a new bearing is the easiest revision operation to recover from. This being said, further dislocation problems do occur after revision surgery and sometimes require the use of constrained liner devices in which the ball snaps into the socket component.
Loose Implants
Sometimes implants that were originally solidly attached become loose, either due to cracking of bone cement or proliferation of wear debris. Early loosening of implants usually reflects failure of bone-ingrowth into porous coating, due to either inadequate early stability or poor bone blood supply. Intra-operative fractures can contribute to this problem, as can smoking and other health risks. Implant loosening requires revision surgery to correct the problem. If there is bone loss associated with the fixation failure, the surgery to correct the situation may be extensive and the recovery lengthy.
Leg Length Inequality
All patients should understand that determining and achieving equal leg lengths in total hip replacement surgery is not an exact science. Occasionally, the leg lengths are not exactly what the patient or we would desire. This is usually because achieving equal leg lengths needs to take a back seat to obtaining a stable hip. Our data suggests that we achieve leg lengths within 5 mm of being equal in 90% of our patients. When the leg lengths are not equal after the operation, it is sometimes necessary to wear a lift in the heel of the shoe. A lift is required in about 5% of cases.
Our record with leg lengths requires substantial preoperative thought as well as intra-operative wisdom on the part of the surgeon. At times, lack of planning and/or inexperience results in a noticeable discrepancy. This problem may be partially correctable if addressed early, but it is difficult to rectify after the passage of more than a few months. The conservative treatment involves the use of a shoe lift. If the opposite hip requires surgery, a leg length inequality can be solved at that time.
Corrosion and Cobalt Ion Release
Sometimes the metal implants used in hip replacements can release metal ions into the hip joint. Titanium is well-tolerated but some ions such as cobalt are not. The cobalt ions are picked up by the body’s scavenger cells and they become overly active, digesting tissue and bone inside the hip joint. Sometimes the damage can be extensive and irreparable. The primary symptoms are new pain and/or stiffness in a replaced hip. This issue has proven to be a major problem with metal against metal bearings, but it occurs with metal-on-plastic bearings as well if corrosion occurs at the junction between the metal head and the neck of the femoral component. Fortunately, excessive cobalt can be detected by a simple blood test and usually the problem is rectified by revising the metal head to a ceramic version. Dr. Dearborn has extensive experience treating this particular problem in patients with a variety of implant types and has presented our clinical research on this topic around the globe.
Chronic Pain
The cause of pain after hip replacement surgery, in the absence of problems evident on x-rays, can be difficult to find. Obtaining the history and careful physical examination in the office are very important in this situation. Infection is the first potential source of pain to rule out, which is typically accomplished via blood tests and removal of fluid for analysis. If infection is confirmed, further surgery is usually required. In many cases, initial removal of the implants is required in order to resolve the infection.
Other causes of hip pain in the presence of satisfactory appearing x-rays, include stiff uncemented femoral components and various soft tissue sources. Injection of local anesthetic and steroid medication into structures such as the iliopsoas tendon sheath can be both diagnostic and therapeutic. In some cases, tendons can rub over the edges of prominent implants, and revision surgery is required to remove the source of the impingement.
Stiffness
In most cases, knee range-of-motion is improved after a total knee replacement. Patients who obtain less than 90 degrees of knee flexion are uniformly dissatisfied after surgery. Risk factors for postoperative stiffness include below average preoperative motion, intra-operative technical factors, and postoperative pain management difficulties.
The treatment for unsatisfactory knee motion involves further surgery. Scar tissue must be removed and in some cases the implants need to be revised. Evaluation in the office will be necessary to discover the cause of the poor motion which will, in turn, guide the treatment.
Bearing Wear
Over time, polyethylene bearings are subject to wear and potential failure. If there is no implant loosening or damage to the metal bearing, exchange of the worn liner can be the straightforward solution. In certain severe, chronic wear situations, metal against metal contact can occur, resulting in metal bearing damage and the shedding of metallic debris. Complete implant exchange is usually required in this setting, which often leads to bone loss necessitating the use of special revision implants.
Loose Implants
Sometimes implants that were originally solidly attached become loose, either due to cracking of bone cement or proliferation of wear debris. Implant loosening requires revision surgery to correct the problem. If there is bone loss associated with the fixation failure, the surgery to correct the situation may be extensive and the recovery more lengthy than for a simple liner exchange.
Chronic Pain
The cause of pain after knee replacement surgery, in the absence of problems evident on x-rays, can be difficult to find. Obtaining the history and careful physical examination in the office are very important in this situation. Infection is the first potential source of pain to rule out, which is typically accomplished via blood tests and removal of fluid for analysis. If infection is confirmed, further surgery is usually required. In many cases, initial removal of the implants is required in order to resolve the infection. Other causes of knee pain, in the presence of satisfactory appearing x-rays, can be elusive and difficult to treat. In some cases, tendons or ligaments can rub over the edges of prominent implants, and revision surgery is required to remove the source of the impingement.
Patellofemoral replacement is a specialized type of partial knee replacement that addresses isolated wear between the back of the patella (kneecap) and the front of the femur (thigh bone). Although patellofemoral replacements are not as common as other types of knee replacements, they offer many benefits to those with wear limited to the front of the knee. These benefits include less invasive surgery that preserves healthy bones and ligaments, faster recovery, less blood loss, and a more normal feeling knee with better range of motion. A patellofemoral knee replacement can also be easily converted into a total knee replacement if necessary.
Patellofemoral replacement addresses arthritis around the kneecap that typically only affects the undersurface of the kneecap. It is not ideal for individuals who have inflammatory or crystalline arthritis, or those with wear elsewhere in the knee. Patients with patellofemoral arthritis can walk well on flat surfaces but have trouble on inclines, stairs and rising from a chair. To determine if you are an ideal candidate for a patellofemoral knee replacement, schedule a consultation with Dearborn & Associates, the Bay Area leaders in patellofemoral surgery.
At Dearborn & Associates, your patellofemoral knee replacement will be performed under spinal anesthesia with a specialized nerve block in the thigh. You may elect to have sedation as well. The procedure takes less than 45 minutes. There are three main steps to a patellofemoral knee replacement:
After your operation, you can expect to spend about an hour in the recovery room area, until the spinal anesthetic wears off. Within a few hours, one of our physical therapists will have you up and moving as they show you post-operative exercises and techniques for everyday tasks. You will be ready to go home 4-5 hours after surgery.
During your recovery process, a walker or cane will be needed initially. You may also desire a cooling unit to help with postoperative discomfort. You can expect to have a physical therapist come to your house to assist you with an exercise program to promote proper healing. Follow up visits are also usually scheduled at the 2-week, 6-week, and 3-month marks.
In most cases, you should be able to walk independently within 2 weeks after surgery. At the 6-week mark, you will be able to resume most of your regular activities.
Schedule a consultation with Dearborn & Associates in Menlo Park and Fremont, CA today to see if a patellofemoral knee replacement is the right treatment for you!
A partial knee replacement, more formally known as a unicompartmental knee arthroplasty (UKA), is a surgical procedure that removes damaged tissue from one compartment of the knee joint. The goal of the surgery is to relieve pain and improve function in that particular compartment, while preserving bones and ligaments in other parts of the joint. Partial knee replacements are less invasive than total knee replacements, result in less blood loss, and have a quicker recovery time. They are also associated with better range of motion in the knee post-surgery. After recovery, knees with partial replacements feel more like normal knees than those with total knee replacements.
The knee joint contains three compartments. The medial compartment is on the inside of the knee, the lateral compartment is on the outside of the knee, and the patellofemoral compartment is in the front of the knee between the femur and the patella (kneecap).
Partial knee replacements are an appropriate treatment for people who have arthritis or osteonecrosis in only one compartment of the knee who are no longer experiencing relief from non-surgical treatment options. Intact cruciate ligaments (ACL and PCL) and sparing of the patellofemoral joint are additional requirements. Partial knee replacement is not appropriate for patients with inflammatory arthritis or those with failed osteotomy procedures.
To determine if you are an ideal candidate for a partial knee replacement, schedule a consultation with Dearborn & Associates, the Bay Area leader in partial and total knee replacement surgery.
At Dearborn & Associates, your partial knee replacement will be performed under spinal anesthesia with a specialized nerve block in the thigh. You may elect to have sedation as well. The procedure takes less than an hour. Our partial knee replacement procedures are performed using a minimally-invasive technique that limits trauma to the surrounding structures and promotes faster recovery times. There are three main steps to a partial knee replacement:
After your operation, you can expect to spend about an hour in the recovery room area, until the spinal anesthetic wears off. Within a few hours, one of our physical therapists will have you up and moving as they show you post-operative exercises and techniques for everyday tasks. You will be ready to go home 4-5 hours after surgery.
During your recovery process, a walker or cane will be needed initially. You may also desire a cooling unit to help with postoperative discomfort. You can expect to have a physical therapist come to your house to assist you with an exercise program to promote proper healing. Follow up visits are also usually scheduled at the 2-week, 6-week, and 3-month marks.
In most cases, you should be able to walk independently within 2 weeks after surgery. At the 6-week mark, you will be able to resume most of your regular activities.
Schedule a consultation with Dearborn & Associates in Menlo Park & Fremont, CA today to see if a partial knee replacement is the right treatment for you!
A total knee replacement replaces a worn knee joint, which can be equated to replacing worn tires with new tires. This is the most effective way to treat severe knee arthritis.
After your operation, you can expect to spend about an hour in the recovery room area, until the spinal anesthetic wears off. Within a few hours, one of our physical therapists will have you up and moving as they show you post-operative exercises and techniques for everyday tasks. You will be ready to go home 4-5 hours after surgery.
During your recovery process, a walker or cane will be needed initially. You may also desire a cooling unit to help with postoperative discomfort. You can expect to have a physical therapist come to your house to assist you with an exercise program to promote proper healing. Follow up visits are also usually scheduled at the 2-week, 6-week, and 3-month marks.
In most cases, you should be able to walk independently within 2 weeks after surgery. At the 6-week mark, you will be able to resume most of your regular activities.
Schedule a consultation with Dearborn & Associates in Menlo Park & Fremont, CA today to see if total knee replacement is the right treatment for you!
This pamphlet describes knee replacement surgery in detail, including the potential risks and complications. It is required reading for my knee patients prior to surgery and has a section on minimally invasive knee replacement.
