Treatment for Shoulder and Elbow Injuries in West Palm Beach, FL

Shoulder Conditions and Injuries

Here at Palm Beach Sports Medicine we specialize in injuries to the shoulder. Our fellowship trained surgeons have done extensive training in treating a variety of shoulder injuries. Aside from traumatic fractures of the shoulder (most often seen in the ER), here are some common shoulder injuries that we deal with daily in our office. Our treatment always begins with the least invasive and most conservative pathways. We pride ourselves in providing the gold standard of care to everyone that comes through our office.

Rotator Cuff Tear

The rotator cuff is a group of muscles and tendons surrounding the top of the humerus (upper arm bone) that allow for movement of the shoulder—especially overhead. A tear may result from a single traumatic blow to the shoulder (such as a motor vehicle accident or a fall from a ladder) but is much more likely to come from activities in which the arm makes repetitive overhead motions, such as swimming, golf and tennis. A partial rotator cuff tear may cause pain when the arm is lifted away from the body and a complete tear can make it difficult to raise the arm at all. Both types of tears cause pain, and can cause difficulty sleeping.

Treatment:

Treatment for a rotator cuff tear depends on the injury’s cause and severity. Conservative treatment includes rest, anti-inflammatory medications, injections and physical therapy. Some rotator cuff tears require surgical repair. A majority of rotator cuff repairs are performed arthroscopically. Sometimes a torn rotator cuff cannot be repaired, yet these patients still have several options such as a reverse total shoulder replacement to restore function and decrease pain.

Shoulder Arthritis

Arthritis is a common condition that can affect all joints in the human body. Arthritis results in the loss of the smooth cartilage surface that covers the ends of the bone in a joint. (Think Teflon on a frying pan.) When cartilage loss occurs in the shoulder (glenohumeral joint) patients often experience pain, loss of motion, and functional limitations. The most common type of arthritis is osteoarthritis. Shoulder osteoarthritis results in the gradual destruction of the articular cartilage of the humeral head and glenoid. Compared to hip and knee arthritis, osteoarthritis of the glenohumeral joint (the ball and socket of the shoulder) is less common. It usually presents in patients after age 55. It presents less commonly in younger patients as a result of excessive use, after prior surgery for shoulder dislocations, or severe shoulder fractures.

Treatment:

The initial treatment of glenohumeral osteoarthritis consists of physical therapy, oral anti- inflammatory medications, PRP injection and activity modification. When non-operative treatment fails and a patient’s symptoms are intolerable, surgery is indicated. Most patients undergo replacement surgery because of shoulder pain. Anatomic total shoulder replacement requires a good rotator cuff. There are some patients with osteoarthritis who have severe glenoid bone deformities and/or rotator cuff tearing who are treated with a revere total shoulder replacement. Younger, active patients sometimes benefit from limited operations such as resurfacings-- which still allows the patient to perform all activities without limitations after surgery.

Shoulder Instability

The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with a shallow socket (glenoid cavity) of the shoulder blade (scapula). Shoulder instability happens when the ball of the shoulder isn’t retrained properly and therefore slides out of the shoulder socket-- either partially or fully. An unstable shoulder can happen for various reasons. The most common type of instability comes from tearing of the labrum and the inferior glenohumeral ligament. This type of tear is called a Bankart tear and often occurs with anterior shoulder dislocations. The bone around the shoulder can also break causing loss of bone on the cup or denting of the humeral head after it perches on the cup in the dislocated position. These are called a Bony Bankart and a Hill Sachs lesion. Both often need to be addressed by the surgeon if present.

Treatment:

Some patients who dislocate their shoulder fully recover after an injury and do not have recurrent instability, particularly those that are older and not active in sporting activities. Non-surgical treatment for shoulder instability includes a course of physical therapy, activity modification and anti-inflammatory medications. Young people, especially athletes, are susceptible to recurrent dislocations and subluxations and often require surgery. An unstable shoulder joint can be repaired by reattaching the torn capsule to the glenoid rim with sutures and bone anchors. Bony injuries can be addressed with grafts as needed.

Shoulder Injuries

Shoulder Conditions and Injuries

Rotator Cuff Tear

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Shoulder Arthritis

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Shoulder Instability

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