Archives des Shoulder - Dr Majed Issa https://drmajedissa.com/en/category/shoulder-en/ Chirurgien Orthopédique et Traumatologue Sun, 08 Sep 2024 12:51:21 +0000 en-GB hourly 1 https://wordpress.org/?v=6.9.4 https://drmajedissa.com/wp-content/uploads/2021/10/cropped-Logo-docteur-majed-issa-bleu-e1690128320683-32x32.png Archives des Shoulder - Dr Majed Issa https://drmajedissa.com/en/category/shoulder-en/ 32 32 SHOULDER INSTABILITY https://drmajedissa.com/en/shoulder-instability/ Tue, 06 Feb 2024 11:42:36 +0000 https://drmajedissa.com/?p=9252 Shoulder instability is a condition where the upper arm bone (humerus) does not stay properly centered in the shoulder socket (glenoid), leading to a partial or complete dislocation. This can cause pain, weakness, and difficulty moving the shoulder. Whether caused by injury, repetitive motion, or naturally loose joints, shoulder instability can significantly affect your daily life. This guide will help you understand the causes, how doctors diagnose it, and the treatment options available. What Causes Shoulder Instability? Several factors can lead to shoulder instability, and it’s important to understand what might have caused yours: 1. Traumatic Injury: A fall, a direct blow to the shoulder, or an accident can force the shoulder out of place. This kind of injury often tears the labrum (a ring of cartilage around the socket) or damages the bone. If you’ve dislocated your shoulder in an accident, this is likely the cause.2. Repetitive Strain: Some activities, especially sports that involve a lot of overhead motions like swimming, baseball, or volleyball, can cause wear and tear over time. These repetitive movements can stretch the ligaments (the bands of tissue that hold the bones together), making the shoulder unstable.3. Loose Joints (Congenital Laxity): Some people are born with naturally loose or flexible joints, a condition known as hypermobility. This can make the shoulder more prone to slipping out of place, even with minor movements or activities.4. Previous Surgeries: If you’ve had surgery on your shoulder before, especially for rotator cuff problems or other issues, it might have changed the way your shoulder works. Sometimes, this can lead to instability afterward. How Is ShoulderInstability Diagnosed? Diagnosing shoulder instability involves several steps, starting with aconversation with your doctor about your symptoms and how the problem started.This is followed by a physical examination and various imaging tests to get aclear picture of what’s going on inside your shoulder. 1. Talking with Your Doctor and Physical Examination: Your doctor will ask about any injuries you’ve had, what activities you do, andwhat kind of symptoms you’re experiencing. Do you feel like your shoulder mightslip out of place? Is there pain or weakness? Understanding your history is thefirst step. During the physical exam, your doctor will move your shoulder in differentdirections and perform specific tests. These might include: – Apprehension Test: Your doctor will gently move your arm into a positionwhere the shoulder could dislocate, checking if you feel any discomfort or fearof dislocation.– Relocation Test: This follows the apprehension test and involves applyinggentle pressure to see if it reduces the feeling of instability.– Sulcus Sign: This test checks for a gap under your shoulder joint, which canindicate that the shoulder is too loose. 2. Imaging Studies: After the physical exam, your doctor will likely recommend some imaging teststo look inside your shoulder. These tests are crucial for understanding theextent of the injury and planning the best treatment. – X-rays: This is usually the first test done. X-rays help show if there’s anydamage to the bones, like fractures or changes in the shape of the shouldersocket. – MRI (Magnetic Resonance Imaging): An MRI provides detailed images of the softtissues in your shoulder, including the labrum, ligaments, and muscles. Thistest is very useful for detecting tears in the labrum or rotator cuff. – CT (Computed Tomography): If there’s a concern about bone loss or damage tothe shape of the bones, a CT scan might be used. This test gives a 3D view ofthe shoulder, which is helpful for planning surgery if needed. – Arthroscanner (MR Arthrography): The arthroscanner is a special type of MRIthat involves injecting a contrast dye into your shoulder joint before takingthe images. This dye helps to highlight any tears or other problems inside thejoint. The arthroscanner is particularly useful for seeing small tears in thelabrum or ligaments that might not show up on a regular MRI. It gives doctors avery clear picture of the joint, which is important for making an accuratediagnosis and deciding on the best treatment approach. What Are the Treatment Options? Treatment for shoulder instability depends on how severe the problem is, what caused it, and your overall health and activity level. Some people can manage the condition with physical therapy and lifestyle changes, while others may need surgery. 1. Non-Surgical Treatments: – Physical Therapy: The main treatment for shoulder instability is physical therapy. A therapist will guide you through exercises to strengthen the muscles around your shoulder, particularly the rotator cuff and the muscles that stabilize the shoulder blade (scapula). Stronger muscles help keep the shoulder in place and reduce the chance of dislocation. – Activity Changes: Depending on what’s causing your shoulder instability, you might need to adjust your activities. If you’re an athlete, this could mean modifying how you play your sport to avoid positions that put your shoulder at risk. – Bracing: Sometimes, wearing a shoulder brace during activities can provide extra support. This can be particularly helpful if your shoulder tends to dislocate during specific movements. 2. Surgical Treatments: If physical therapy and other non-surgical treatments don’t work, or if your shoulder instability is severe, surgery might be necessary. Several surgical options can help stabilize your shoulder: – Arthroscopic Bankart Repair: This is a common surgery for repairing a torn labrum (the cartilage that surrounds the socket). During the procedure, the surgeon reattaches the torn labrum to the socket, restoring stability to the joint. – Latarjet Procedure: If there’s significant bone loss in the shoulder socket, the Latarjet procedure might be recommended. This surgery involves transferring a piece of bone from another part of your shoulder to the socket to provide extra support and prevent future dislocations. – Capsular Shift or Plication: For people with loose joints or multidirectional instability (where the shoulder can slip in multiple directions), surgery might focus on tightening the joint capsule (the tissue that surrounds the joint) to limit excessive movement. – Rotator Cuff Repair: If your shoulder instability is related to a rotator cuff tear, surgery may be needed to repair the tear. Fixing the

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Shoulder instability is a condition where the upper arm bone (humerus) does not stay properly centered in the shoulder socket (glenoid), leading to a partial or complete dislocation. This can cause pain, weakness, and difficulty moving the shoulder. Whether caused by injury, repetitive motion, or naturally loose joints, shoulder instability can significantly affect your daily life. This guide will help you understand the causes, how doctors diagnose it, and the treatment options available.


What Causes Shoulder Instability?

Several factors can lead to shoulder instability, and it’s important to understand what might have caused yours:

1. Traumatic Injury: A fall, a direct blow to the shoulder, or an accident can force the shoulder out of place. This kind of injury often tears the labrum (a ring of cartilage around the socket) or damages the bone. If you’ve dislocated your shoulder in an accident, this is likely the cause.
2. Repetitive Strain: Some activities, especially sports that involve a lot of overhead motions like swimming, baseball, or volleyball, can cause wear and tear over time. These repetitive movements can stretch the ligaments (the bands of tissue that hold the bones together), making the shoulder unstable.
3. Loose Joints (Congenital Laxity): Some people are born with naturally loose or flexible joints, a condition known as hypermobility. This can make the shoulder more prone to slipping out of place, even with minor movements or activities.
4. Previous Surgeries: If you’ve had surgery on your shoulder before, especially for rotator cuff problems or other issues, it might have changed the way your shoulder works. Sometimes, this can lead to instability afterward.

How Is Shoulder
Instability Diagnosed?

Diagnosing shoulder instability involves several steps, starting with a
conversation with your doctor about your symptoms and how the problem started.
This is followed by a physical examination and various imaging tests to get a
clear picture of what’s going on inside your shoulder.

1. Talking with Your Doctor and Physical Examination:

Your doctor will ask about any injuries you’ve had, what activities you do, and
what kind of symptoms you’re experiencing. Do you feel like your shoulder might
slip out of place? Is there pain or weakness? Understanding your history is the
first step.

During the physical exam, your doctor will move your shoulder in different
directions and perform specific tests. These might include:

– Apprehension Test: Your doctor will gently move your arm into a position
where the shoulder could dislocate, checking if you feel any discomfort or fear
of dislocation.
– Relocation Test: This follows the apprehension test and involves applying
gentle pressure to see if it reduces the feeling of instability.
– Sulcus Sign: This test checks for a gap under your shoulder joint, which can
indicate that the shoulder is too loose.

2. Imaging Studies:

After the physical exam, your doctor will likely recommend some imaging tests
to look inside your shoulder. These tests are crucial for understanding the
extent of the injury and planning the best treatment.

– X-rays: This is usually the first test done. X-rays help show if there’s any
damage to the bones, like fractures or changes in the shape of the shoulder
socket.

– MRI (Magnetic Resonance Imaging): An MRI provides detailed images of the soft
tissues in your shoulder, including the labrum, ligaments, and muscles. This
test is very useful for detecting tears in the labrum or rotator cuff.

– CT (Computed Tomography): If there’s a concern about bone loss or damage to
the shape of the bones, a CT scan might be used. This test gives a 3D view of
the shoulder, which is helpful for planning surgery if needed.

– Arthroscanner (MR Arthrography): The arthroscanner is a special type of MRI
that involves injecting a contrast dye into your shoulder joint before taking
the images. This dye helps to highlight any tears or other problems inside the
joint. The arthroscanner is particularly useful for seeing small tears in the
labrum or ligaments that might not show up on a regular MRI. It gives doctors a
very clear picture of the joint, which is important for making an accurate
diagnosis and deciding on the best treatment approach.

What Are the
Treatment Options?

Treatment for shoulder instability depends on how severe the problem is, what
caused it, and your overall health and activity level. Some people can manage
the condition with physical therapy and lifestyle changes, while others may
need surgery.

1. Non-Surgical Treatments:

– Physical Therapy: The main treatment for shoulder instability is physical
therapy. A therapist will guide you through exercises to strengthen the muscles
around your shoulder, particularly the rotator cuff and the muscles that
stabilize the shoulder blade (scapula). Stronger muscles help keep the shoulder
in place and reduce the chance of dislocation.

– Activity Changes: Depending on what’s causing your shoulder instability, you
might need to adjust your activities. If you’re an athlete, this could mean
modifying how you play your sport to avoid positions that put your shoulder at
risk.

– Bracing: Sometimes, wearing a shoulder brace during activities can provide
extra support. This can be particularly helpful if your shoulder tends to
dislocate during specific movements.

2. Surgical Treatments:

If physical therapy and other non-surgical treatments don’t work, or if your
shoulder instability is severe, surgery might be necessary. Several surgical
options can help stabilize your shoulder:

– Arthroscopic Bankart Repair: This is a common surgery for repairing a torn
labrum (the cartilage that surrounds the socket). During the procedure, the
surgeon reattaches the torn labrum to the socket, restoring stability to the
joint.

– Latarjet Procedure: If there’s significant bone loss in the shoulder socket,
the Latarjet procedure might be recommended. This surgery involves transferring
a piece of bone from another part of your shoulder to the socket to provide
extra support and prevent future dislocations.

– Capsular Shift or Plication: For people with loose joints or multidirectional
instability (where the shoulder can slip in multiple directions), surgery might
focus on tightening the joint capsule (the tissue that surrounds the joint) to
limit excessive movement.

– Rotator Cuff Repair: If your shoulder instability is related to a rotator
cuff tear, surgery may be needed to repair the tear. Fixing the rotator cuff
can help restore the shoulder’s stability and function.

Recovery After Surgery:

After surgery, you’ll need to keep your shoulder in a sling for a few weeks to
protect it while it heals. Physical therapy will then be a key part of your
recovery. Your therapist will help you regain movement and strength in your
shoulder. Full recovery can take several months, but with proper
rehabilitation, most people regain good function and return to their normal
activities.

The capsule and labrum are loaded onto a suture and then reattached to the bone using small anchors called sutures (Bankart Procedure)
The Latharjet procedure is the grafting of a bone block on the anterior edge of the shoulder joint, preventing further dislocations

L’article SHOULDER INSTABILITY est apparu en premier sur Dr Majed Issa.

]]> SHOULDER PROSTHESIS https://drmajedissa.com/en/shoulder-prosthesis/ Mon, 05 Feb 2024 19:23:05 +0000 https://drmajedissa.com/?p=9240 For proper functioning, the shoulder requires integrity of the bony surfaces as well as good function of the deltoid muscle (which gives the shoulder its contour) and the muscles of the rotator cuff that attach to the tuberosities of the humerus. The placement of a shoulder prosthesis may be necessary in cases of significant cartilage wear (osteoarthritis), complex shoulder fractures, or severe and irreparable damage to the rotator cuff tendons. BONE SURFACE WEAR (OSTEOARTHRITIS) : Shoulder osteoarthritis is less common than in the hip or knee, but it can be highly disabling, causing pain and limited shoulder movement. Sometimes, only the humeral head is affected, as in the case of osteonecrosis. FRACTURES : In the case of certain complex shoulder fractures, the blood supply to the humeral head is compromised (interrupted blood flow to the humeral head). In such cases, shoulder replacement surgery may be recommended along with the reconstruction of the tuberosities to which the rotator cuff muscles attach. MASSIVE ROTATOR CUFF TEAR : It most often occurs in elderly individuals and is accompanied by an upward displacement of the humeral head under the acromion, resulting in an inability to raise the arm. If the rotator cuff tear is not repairable, then total reverse shoulder replacement surgery may be considered. Additional tests are necessary to support the diagnosis. This typically involves shoulder X-rays and a shoulder CT scan (sometimes a CT scan with contrast injection: arthrogram). Medical treatment is always indicated (except in cases of fracture) and involves rehabilitation to maintain shoulder mobility and muscle strength, taking painkillers or anti-inflammatories, and possibly receiving injections. If unsuccessful, surgical treatment is then considered. Total shoulder replacement involves replacing the worn joint surfaces with prosthetic components. The goal of this intervention is to provide lasting pain relief and restore strength and mobility to the shoulder. There are two main types of shoulder prostheses: anatomical and reverse prostheses. ANATOMIC PROSTHESIS : This type of prosthesis is used in cases of shoulder arthritis or osteonecrosis of the humeral head. In this case, the rotator cuff tendons are intact, and the intervention aims to replicate the anatomy by placing a metal sphere to replace the humeral head and a polyethylene cup to replace the glenoid of the scapula. Shoulder anatomical prosthesis TOTAL REVERSE PROSTHESIS : This prosthesis is called “reverse” because the spherical part of the prosthesis is positioned on the scapula and the concave part on the humerus. This type of prosthesis is used in cases of significant and non-repairable rotator cuff tears, or in cases of prosthesis revision (prosthesis replacement), or when the glenoid of the scapula is severely deformed. For this type of surgery, a hospital stay of 1 to 2 days is required. Postoperatively, the arm is immobilized in a splint for a period of 4 to 6 weeks, but rehabilitation begins the day after the operation. This rehabilitation involves self-rehabilitation movements that the patient performs alone at home and conventional physiotherapy sessions. Reverse shoulder prosthesis For this type of procedure, hospitalization for 1 to 2 days is necessary. Postoperatively, the arm is immobilized in a splint for a period of 4 to 6 weeks, but rehabilitation begins the day after the operation. This rehabilitation program is based on self-rehabilitation movements that the patient performs independently at home, as well as conventional physiotherapy sessions.

L’article SHOULDER PROSTHESIS est apparu en premier sur Dr Majed Issa.

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For proper functioning, the shoulder requires integrity of the bony surfaces as well as good function of the deltoid muscle (which gives the shoulder its contour) and the muscles of the rotator cuff that attach to the tuberosities of the humerus. The placement of a shoulder prosthesis may be necessary in cases of significant cartilage wear (osteoarthritis), complex shoulder fractures, or severe and irreparable damage to the rotator cuff tendons.

BONE SURFACE WEAR (OSTEOARTHRITIS) :

Shoulder osteoarthritis is less common than in the hip or knee, but it can be highly disabling, causing pain and limited shoulder movement. Sometimes, only the humeral head is affected, as in the case of osteonecrosis.

FRACTURES :

In the case of certain complex shoulder fractures, the blood supply to the humeral head is compromised (interrupted blood flow to the humeral head). In such cases, shoulder replacement surgery may be recommended along with the reconstruction of the tuberosities to which the rotator cuff muscles attach.

MASSIVE ROTATOR CUFF TEAR :

It most often occurs in elderly individuals and is accompanied by an upward displacement of the humeral head under the acromion, resulting in an inability to raise the arm. If the rotator cuff tear is not repairable, then total reverse shoulder replacement surgery may be considered.

Additional tests are necessary to support the diagnosis. This typically involves shoulder X-rays and a shoulder CT scan (sometimes a CT scan with contrast injection: arthrogram).

Medical treatment is always indicated (except in cases of fracture) and involves rehabilitation to maintain shoulder mobility and muscle strength, taking painkillers or anti-inflammatories, and possibly receiving injections. If unsuccessful, surgical treatment is then considered.

Total shoulder replacement involves replacing the worn joint surfaces with prosthetic components. The goal of this intervention is to provide lasting pain relief and restore strength and mobility to the shoulder. There are two main types of shoulder prostheses: anatomical and reverse prostheses.

ANATOMIC PROSTHESIS :

This type of prosthesis is used in cases of shoulder arthritis or osteonecrosis of the humeral head.

In this case, the rotator cuff tendons are intact, and the intervention aims to replicate the anatomy by placing a metal sphere to replace the humeral head and a polyethylene cup to replace the glenoid of the scapula.

Shoulder anatomical prosthesis

TOTAL REVERSE PROSTHESIS :

This prosthesis is called “reverse” because the spherical part of the prosthesis is positioned on the scapula and the concave part on the humerus. This type of prosthesis is used in cases of significant and non-repairable rotator cuff tears, or in cases of prosthesis revision (prosthesis replacement), or when the glenoid of the scapula is severely deformed. For this type of surgery, a hospital stay of 1 to 2 days is required.

Postoperatively, the arm is immobilized in a splint for a period of 4 to 6 weeks, but rehabilitation begins the day after the operation. This rehabilitation involves self-rehabilitation movements that the patient performs alone at home and conventional physiotherapy sessions.

Reverse shoulder prosthesis

For this type of procedure, hospitalization for 1 to 2 days is necessary. Postoperatively, the arm is immobilized in a splint for a period of 4 to 6 weeks, but rehabilitation begins the day after the operation.

This rehabilitation program is based on self-rehabilitation movements that the patient performs independently at home, as well as conventional physiotherapy sessions.

L’article SHOULDER PROSTHESIS est apparu en premier sur Dr Majed Issa.

]]> ROTATOR CUFF TEAR https://drmajedissa.com/en/rotator-cuff-tear/ Sun, 04 Feb 2024 16:12:37 +0000 https://drmajedissa.com/?p=9124 THE CONDITION : The rotator cuff of the shoulder consists of five tendons: the supraspinatus, the infraspinatus, the subscapularis, the long head of the biceps, and the teres minor. Together, these tendons form a continuous sheet that covers the head of the humerus like a “cuff.” They slide back and forth under the acromion, the bone of the shoulder blade. The rotator cuff provides the shoulder with a wide range of motion, including forward elevation, abduction, adduction, external rotation, and internal rotation. With age, and especially with certain occupational activities, sports, or repetitive awkward positions, these tendons can become inflamed and progressively wear out. Two mechanisms often evolve concurrently: Biological degeneration of the tendon tissue itself (intrinsic wear). Repetitive mechanical rubbing of the tendons against the edge of the acromion, known as subacromial impingement. Gradually, micro-tears develop within the tendons (tendinopathy), which can progress over the long term to a partial or complete rupture of the affected tendon. The rupture can occur slowly and progressively or very quickly, spontaneously or after trauma. It is more likely to occur when the tendon is degenerative. ​ On the other hand, a very violent trauma is required to rupture a healthy tendon, such as in young athletes, for example. In most cases, these situations require prompt surgical repair. DIAGNOSIS : The diagnosis of rotator cuff tendinopathy is primarily clinical. Clinical examination helps detect tendon pain or rupture, as well as other possible causes of pain. The initial imaging tests often performed are X-rays. They can reveal, among other things, small “flakes” of calcium, corresponding to intratendinous calcifications, which indicate tendon degeneration. MRI (Magnetic Resonance Imaging) is very effective at visualizing soft tissues, including the tendons of the rotator cuff. Several classifications are used to assess the severity and chronicity of the condition, taking into account the quality of the tendon tissue, the corresponding muscle, joint cartilage, the degree of retraction of a ruptured tendon, and more. Arthroscopy (scanner preceded by the injection of a contrast agent into the joint) is also a valuable tool that can help us make a more comprehensive diagnosis.   TREATMENT: Surgical intervention for rotator cuff tendinopathy is not always necessary. Many patients with partial tears can experience functional improvement and reduced pain with well-conducted non-surgical treatment. Non-surgical treatments, often used concurrently, typically span over several months and require serious commitment from the patient. These non-surgical treatments may include: Relative rest for your shoulder to allow the tendon time to heal. This may involve modifying some activities, carefully selecting sports, and avoiding repetitive harmful habits. Physical therapy with stretching and selective strengthening of specific shoulder muscles. Pain relievers and anti-inflammatory medications (NSAIDs) to minimize pain and inflammation. Corticosteroid injections to reduce inflammation and pain. Platelet-Rich Plasma (PRP) injections to promote healing.   Surgical Treatment : Surgical intervention is proposed if you have a large or transfixing tear, or if non-surgical methods are insufficient to heal a partial tear. The surgery is most often performed arthroscopically, with 3 or 4 small skin incisions, each approximately 1 cm in size. In the majority of cases, this is an outpatient surgery. You will return home on the same day with immobilization using a Dujarrier-type sling for 2 to 6 weeks, depending on the case. Post-operative rehabilitation begins at 2-3 weeks. It starts with passive movements in the first month, followed gradually by gentle active movements. Most patients regain shoulder function and strength within three to six months after surgery, but full recovery can take up to 12-18 months. PROGNOSIS AND PREVENTION : Surgical repair yields very good results in over 75% of cases. ​Movement precautions and careful selection of types of activity remain essential, even after successful tendon repair. Just because a tendon has healed well does not mean it cannot be damaged again, especially if repetitive harmful movements are resumed. WHEN SHOULD I CONSULT ? You should consult if you experience: Chronic pain in the shoulder and arm. Pain that worsens at night or interferes with sleep. Redness, swelling, or tenderness in the shoulder joint area. Motor weakness in the shoulder or arm.

L’article ROTATOR CUFF TEAR est apparu en premier sur Dr Majed Issa.

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THE CONDITION :

The rotator cuff of the shoulder consists of five tendons: the supraspinatus, the infraspinatus, the subscapularis, the long head of the biceps, and the teres minor. Together, these tendons form a continuous sheet that covers the head of the humerus like a “cuff.” They slide back and forth under the acromion, the bone of the shoulder blade.

The rotator cuff provides the shoulder with a wide range of motion, including forward elevation, abduction, adduction, external rotation, and internal rotation.

With age, and especially with certain occupational activities, sports, or repetitive awkward positions, these tendons can become inflamed and progressively wear out.

Two mechanisms often evolve concurrently:

  1. Biological degeneration of the tendon tissue itself (intrinsic wear).
  2. Repetitive mechanical rubbing of the tendons against the edge of the acromion, known as subacromial impingement.

Gradually, micro-tears develop within the tendons (tendinopathy), which can progress over the long term to a partial or complete rupture of the affected tendon. The rupture can occur slowly and progressively or very quickly, spontaneously or after trauma. It is more likely to occur when the tendon is degenerative.

​

On the other hand, a very violent trauma is required to rupture a healthy tendon, such as in young athletes, for example. In most cases, these situations require prompt surgical repair.

DIAGNOSIS :

The diagnosis of rotator cuff tendinopathy is primarily clinical. Clinical examination helps detect tendon pain or rupture, as well as other possible causes of pain.

The initial imaging tests often performed are X-rays. They can reveal, among other things, small “flakes” of calcium, corresponding to intratendinous calcifications, which indicate tendon degeneration.

MRI (Magnetic Resonance Imaging) is very effective at visualizing soft tissues, including the tendons of the rotator cuff. Several classifications are used to assess the severity and chronicity of the condition, taking into account the quality of the tendon tissue, the corresponding muscle, joint cartilage, the degree of retraction of a ruptured tendon, and more.

Arthroscopy (scanner preceded by the injection of a contrast agent into the joint) is also a valuable tool that can help us make a more comprehensive diagnosis.

 

TREATMENT:

Surgical intervention for rotator cuff tendinopathy is not always necessary. Many patients with partial tears can experience functional improvement and reduced pain with well-conducted non-surgical treatment.

Non-surgical treatments, often used concurrently, typically span over several months and require serious commitment from the patient. These non-surgical treatments may include:

  1. Relative rest for your shoulder to allow the tendon time to heal. This may involve modifying some activities, carefully selecting sports, and avoiding repetitive harmful habits.
  2. Physical therapy with stretching and selective strengthening of specific shoulder muscles.
  3. Pain relievers and anti-inflammatory medications (NSAIDs) to minimize pain and inflammation.
  4. Corticosteroid injections to reduce inflammation and pain.
  5. Platelet-Rich Plasma (PRP) injections to promote healing.
 

Surgical Treatment :

Surgical intervention is proposed if you have a large or transfixing tear, or if non-surgical methods are insufficient to heal a partial tear.

The surgery is most often performed arthroscopically, with 3 or 4 small skin incisions, each approximately 1 cm in size.

In the majority of cases, this is an outpatient surgery. You will return home on the same day with immobilization using a Dujarrier-type sling for 2 to 6 weeks, depending on the case.

Post-operative rehabilitation begins at 2-3 weeks. It starts with passive movements in the first month, followed gradually by gentle active movements.

Most patients regain shoulder function and strength within three to six months after surgery, but full recovery can take up to 12-18 months.

PROGNOSIS AND PREVENTION :

Surgical repair yields very good results in over 75% of cases. ​Movement precautions and careful selection of types of activity remain essential, even after successful tendon repair.

Just because a tendon has healed well does not mean it cannot be damaged again, especially if repetitive harmful movements are resumed.

WHEN SHOULD I CONSULT ?

You should consult if you experience:

  1. Chronic pain in the shoulder and arm.
  2. Pain that worsens at night or interferes with sleep.
  3. Redness, swelling, or tenderness in the shoulder joint area.
  4. Motor weakness in the shoulder or arm.

L’article ROTATOR CUFF TEAR est apparu en premier sur Dr Majed Issa.

]]> ACROMIOCLAVICULAR DISLOCATION https://drmajedissa.com/en/acromioclavicular-dislocation/ Sun, 04 Feb 2024 15:53:16 +0000 https://drmajedissa.com/?p=9102 It is a small, nearly immobile joint located between the acromion and the clavicle. It acts as a rigid hanger, with which the clavicle “supports” the weight of the arm and the scapula. A fracture of the clavicle or an acromioclavicular dislocation disrupts this rigid hanger. Due to its weight, the arm “falls” downward and is only held by the soft tissues that connect it to the chest. In cases of mild to moderate acromioclavicular dislocations, such injuries can be treated with appropriate immobilization followed by rehabilitation. In severe cases (displaced fractures or acromioclavicular dislocations), it is necessary to realign the acromioclavicular hanger and secure it rigidly enough (using screws, pins, ligament reconstruction, etc.). For acute acromioclavicular dislocations occurring within the last 3 weeks, outpatient fixation using pins and a non-absorbable bone suture allows for the healing of torn ligaments. The arm is immobilized in a sling for 6 weeks, and the pins are removed at the end of this period. In the case of a chronic dislocation, the ligaments no longer have the ability to heal on their own. In such cases, ligament reconstruction is performed. The new ligaments are fixed to the bone using anchors (similar to tiny harpoons in the bone) or endobuttons. Post-operative recovery is similar for acute and chronic dislocations.

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It is a small, nearly immobile joint located between the acromion and the clavicle. It acts as a rigid hanger, with which the clavicle “supports” the weight of the arm and the scapula.

A fracture of the clavicle or an acromioclavicular dislocation disrupts this rigid hanger. Due to its weight, the arm “falls” downward and is only held by the soft tissues that connect it to the chest.

In cases of mild to moderate acromioclavicular dislocations, such injuries can be treated with appropriate immobilization followed by rehabilitation.

In severe cases (displaced fractures or acromioclavicular dislocations), it is necessary to realign the acromioclavicular hanger and secure it rigidly enough (using screws, pins, ligament reconstruction, etc.).

For acute acromioclavicular dislocations occurring within the last 3 weeks, outpatient fixation using pins and a non-absorbable bone suture allows for the healing of torn ligaments. The arm is immobilized in a sling for 6 weeks, and the pins are removed at the end of this period.

In the case of a chronic dislocation, the ligaments no longer have the ability to heal on their own. In such cases, ligament reconstruction is performed. The new ligaments are fixed to the bone using anchors (similar to tiny harpoons in the bone) or endobuttons.

Post-operative recovery is similar for acute and chronic dislocations.

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