Harlan Selesnick, M.D
 
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Elbow Shoulder

JOCK Doc's Elbow Shoulder Questions

Question

Hi Harlan. I was doing bicep preacher curls in the gym yesterday and my bicep popped up to near my shoulder. I guess you can call this a torn bicep. I will see a doctor tomorrow night and was wondering if this is a common injury in weight lifters and if this injury is relatively simple to cure. I have a little discomfort but nothing major, so I hope it's minor. It looks a lot worse than it feels. Your feedback would be appreciated. Lenny

Answer

It is common for men who are weight training to injure their bicep tendon. If one tears (ruptures) the bicep near their shoulder (long head) although a deformity may be present permanently, one can usually regain about 90% of biceps function and strength. However, if the biceps is torn at the attachment below the elbow this usually requires surgery or else 50% of biceps strength and function could be lost. I recommend you see an orthopedic surgeon so a correct diagnosis can be made as a time delay can effect optimal treatment.


The Jock Doc

Question

My son is a pitcher in college and has pain in the back of his shoulder between his shoulder and armpit. He is okay if he doesn't make a throwing motion, but when he does throw he feels a burning sensation in his shoulder joint. Is this serious should we see a doctor? He had shoulder arthroscopic surgery about two years ago when a small piece of tissue was cut out in the back of the shoulder joint. He has started to do shoulder exercises with the trainer. Darrell

Answer

I recommend your son see an orthopedic surgeon. It is possible your son may have a form of instability, a new labral cartilage tear, an injury to the rotator cuff, or a nerve injury. His doctor will perform a physical exam and may order an MRI scan. It is important that a correct diagnosis be made and appropriate treatment rendered so your son can continue to throw at a high level. The Jock Doc


Question

I was in a car accident on February 6, 1999. I had a right fractured clavicle and used a bone growth stimulator from March until June. I required an orif of clavicle with a bone graft. I have had numerous tomograms with he most recent in January 2000 saying there were mild signs of healing. I am having a bad burning sensation in the deltoid muscle and tricep region. I am wondering is this a sign of healing or something bad? I recently started physical therapy two weeks ago doing strengthening exercises per doctor's order. I am having a lot of pain with the physical therapy but I just keep thinking maybe this is pain due to the bone knitting together. My neurologist thinks I possibly have TOS due to my signs and symptoms, but my orthopaedic surgeon says no due to EMG. I get very upset because my doctor won't answer my questions. I was using a bone stimulator until my last tomo, but the doctor says I don't need it. I am considering another opinion. What is your input on this issue. I am having bad pain. I am also a nurse and am disabled at present. My doctor says I cannot perform any lifting due to this injury. He says I need to find another occ. Also, will I ever be pain free with this type of injury? Shawna

Answer

There are a variety of types and locations of clavicle fractures. Generally, once the clavicle heals there should be good function and little pain. Your problem sounds complex and is difficult to offer a more informed opinion without seeing you and the x-rays. Since, you are not yet doing well I think a 2nd opinion is a good idea from an orthopedic surgeon in your area. The Jock Doc


Question

Hi, I'm 15, and in a month I am having arthroscopic surgery on my shoulder to tighten my capsule. I am a competitive fast windmill pitcher in softball, and I was wondering how the surgery would affect my pitching. One of my two doctors told me I can never pitch, or play again, and the second doctor told me I can just play, and not pitch. So I'm asking you, in your professional experience, have you seen players come back with this type of surgery, or would it be unwise to push my shoulder and subject it to stretching again? Thanks for your time. Michelle

Answer

Athletes with multidirectional instability (loose jointed shoulders) may benefit from a capsular shrinkage procedure (thermal capsulography). This is an arthroscopic procedure designed to tighten the shoulder capsule. If successful many athletes can return to their sport and even return to pitching. However, the success of the surgery depends upon the degree of the instability, associated damage in the shoulder, and hard work with post op rehab. Your surgeon is the best one to tell you the true likelihood of success. The Jock Doc


Question

I'm 30 years old and have dislocated my left shoulder twice. The first time was in the spring of 1994 and the second time was a few days ago (Jan. 2000). Both times was while skiing. Both times required trips to the hospital to have the injury reduced. Both were anterior dislocations caused by bracing a fall with an outstretched arm. Now that it's happened twice would I likely be a good candidate for surgery? I participate in a number of sports and have lifted weights for 16 years but working out hasn't seemed to increase my shoulder's stability. Dave Carr

Answer

Once a shoulder has dislocated twice it is very likely that it will happen again. I recommend you see an orthopedic surgeon who will likely order a high resolution MRI scan to help determine the extent of the damage and whether surgery is necessary and if it can be successfully be performed arthroscopically or requires an open procedure. The Jock Doc


Question

I have a shoulder problem that is causing me pain. My doctor says that I may need a "mumford or Mumfer procedure." Can you tell me what that is.. Thank you. Dave

Answer

A Mumford procedure is done for chronic pain at the acromioclavicular joint. Where the collar bone meets the shoulder can become painful due to trauma, weight training, or arthritis. If non surgical treatment fails, then the orthopedic surgeon will resect the outside part of the clavicle "Mumford" procedure. This surgery is usually effective in relieving pain and can be performed either arthroscopically or with an open incision. The Jock Doc

Question

I am the 18 year old basketball player who has written before. Currently, I have had my second corticosteroid shot by Dr. Miceli from Boston Childrens Hospital. To date with no relief!!! FU appointment saw Dr. M's nurse and was told may take up to 12 weeks to see results. Have another FU appointment in 2 weeks! Dr. M had diagnosed an iliosopsis tentonitis and therefore the shots, which usually work according to articles published by him. You mentioned something about a neurologist and a possible obturator nerve entrapment or hip labral tear. Will or are these two possibilities shown on MRI's and/or need to be seen by a neurologist in order to be diagnosed? In either the Boston or New York area, who would you recommend I see for a neurologic workup, further advise, suggestions, etc....... Again, your suggestions are appreciated. Jeanne

Answer

It is still possible that you may respond to the cortisone injections. If you don not then a neurologic consultation may help. I do not know any neurologists well enough in those cities to recommend any one specialist. A high resolution MRI scan may show a labral tear but will not show a nerve entrapment. The Jock Doc


Question

I had arthroscopic shoulder surgery a week and a half ago for shoulder instability. I don't intentionally move my shoulder and keep it in the sling, but this morning when I was rolling over in bed it felt like my shoulder was slipping. I am scared that the surgery was unsuccessful and that I'll have to have surgery again. I have an appointment with my doctor in several days, but is there any way to tell if the shoulder is okay before I go to see my doctor? Katherine

Answer

Most of the time if you are in your sling it is unlikely that you damaged the repair. However, there is no ay to know for sure what you are feeling without you being checked by your doctor. - The Jock Doc


Question

Is arthroscopic treatment of a dislocated shoulder a viable option compared to open surgery? Have you heard of a "new" procedure where an RF probe is used to heat shrink the capsule. Also what is the difference in recovery time for an arthroscopic procedure vs. open surgery? Thanks. Shawn

Answer

The decision as to whether arthroscopic surgery alone verses an open surgical stabilization procedure is best depends on several factors. The age of the patient, the number of times dislocations occur, the quality of the labral cartilage tissue, the degree of instabilities, and the size of the Hill Sachs lesion (defect in the ball part of the shoulder) all are factors in determining the success rate of arthroscopic surgery. Recently, a thermal shrinkage procedure to reduce the size of the stretched out shoulder capsule has been added to the arthroscopic procedure to further enhance the success rate. I recommend you discuss the options with your orthopedic surgeon as to what has the best chance of success of your type of dislocation. The Jock Doc


Question

I read that you're the team doctor of the Heat. I'm sure you'll be able to answer my question then. Three weeks ago, I had arthroscopic shoulder surgery in Louisville, Kentucky. As far as I know, the Bankart procedure was all that was done, although my doctor did say he did everything necessary to get my shoulder back to the way it ""should be"". So far, everything is going great. I'm an avid basketball player - that's what got me to this point. I know there was some bone damage done, but I don't know the specifics. I guess there was nothing to fix that. And now for my question...thanks for reading this - I know it's long. One time I saw a b-ball player on T.V. wearing some type of brace on his shoulder. The announcer said that he had dislocated his shoulder. Does a brace exist that helps to prevent re-dislocating one's shoulder? I'd greatly appreciate any information about this. Also, do you have any other advice for my recovery from a basketball doctors point of view. Thank you so much. Tim

Answer

Many patients with an unstable shoulder can have an arthroscopic repair known as a Bankart procedure. The surgeon restores the normal shoulder anatomy by repairing the labral cartilage and stretched out ligaments and capsule. A large bony defect of the ball part of the shoulder (Hill Sachs Lesion) can decrease the chance of successful arthroscopic repair and in these patients an open surgical stabilization procedure is performed. After these surgeries the patient is usually in a sling for 4 weeks followed by several months of rehab to regain good motion and strength of the shoulder. However, in an effort to allow for adequate healing, the athlete usually cannot return to contact or throwing sports for at least 6 months. Although shoulder harnesses exist and can be obtained from your physical therapist these many times are not effective in protecting the shoulder and are rarely used in basketball players. The Jock Doc


Question

I am a 30 year old male. It has been determined by an MRI that I have at least a partial tear in my rotator cuff tendon. Two of the three doctors I have seen believe in cutting me open, while the last doctor I seen said he would do it arthroscopically. In your opinion, what is better at getting the job done right? Robert

Answer

Most orthopedic surgeons prefer to approach shoulder surgery with an exam of the shoulder under anesthesia to assess range of motion and stability. Then an arthroscopic exam is performed. Many rotator cuff problems can be handled arthroscopically. Occasionally the rotator cuff tear is to large to fix with the "scope" and then the surgeon will proceed with an open incision and repair. I recommend you choose the orthopedic surgeon you feel most comfortable with. The Jock Doc


Question

I am a 21 year old gymnast plagued by frequent subluxations of my shoulder (around 3 a week when training). I saw an orthopedic surgeon about a year ago and he took some x-rays and said he couldn't determine the cause of the subluxations. He said he wouldn't do an MRI because they weren't reliable and he could only give a diagnosis by doing arthroscopic surgery. I have quit training and my shoulder has stayed in place for almost a year but I still have some pain and discomfort at times and I sometimes get the grinding sensation that I feel before my shoulder "pops out." Should I get a second opinion? Holly

Answer

I recommend you see another orthopedic surgeon for an examination and to obtain a high resolution MRI scan. It is likely you have torn your labral cartilage which is important in shoulder stability. Also many gymnasts have loose shoulders "multidirectional instability." These sometimes can be treated with a rehab program, but depending upon your exam could require arthroscopic or open shoulder stabilization procedures. The Jock Doc


Question

i'm an 19 competitive swimmer, and I had arthroscopic surgery on my shoulder in mid June. The doc fixed a labrium tear, tightened my capsule, and shaved some bone. I was wondering, in your experience, how long does it take after this type of surgery to get back completely in one's sports? And how long before bothering/pain in the shoulder will go away? Christine

Answer

Labral cartilage repairs to improve shoulder stability and function can take up to 1 year to heal. Therefore it is not unusual for you to still be having symptoms. If you are still concerned however, I recommend you get a second orthopedic opinion to make certain that you are progressing at an appropriate pace. The Jock Doc


Question

I'm 32 years old and I've had chronic separations of my shoulder. I want to have surgery done and I want to know what the chance of the shoulder coming out again, and the time period that it takes to get back to normal after surgery. Bryan

Answer

The joint above the shoulder (acromioclavicular joint) is the one that can be separated usually by a fall on the point of the shoulder such as falling off a bike or being tackled in football. It sounds like your problem is subluxation of the shoulders (sliding in and out of place). This is an injury to the ball and socket part of the joint (glenohumeral joint).. Many patients with unstable shoulders can respond to a rehab program aimed at strengthening to improve stability. The successful results with surgery are best for patients who can not slide the shoulders in and out of place voluntarily. I recommend you discuss your shoulders with an orthopedic surgeon with shoulder experience to help determine the best treatment for yourself. The Jock Doc


Question

My 14 year old son has been diagnosed with a tear of the sub-scapular tendon . We've done ice, Advil, rest and the doctor says surgery is the answer but this is a rare tendon to tear and I am concerned with the unfamiliarity of surgery on this tendon. Any comments or advice? Buffy

Answer

The subscapularis tendon is an important internal rotator of the shoulder. It is unusual to tear this tendon, particularly in a 14 year old. An MRI scan can be very helpful in confirming this diagnosis. If in fact the diagnosis is correct and since your son has also failed non surgical treatment, then surgery is likely necessary to achieve a near normal shoulder. The Jock Doc


Question

I am a 38 year old male who has, unfortunately dislocated my shoulder many times, (probably at least 10 times in the last 5 years), I know I will probably have to have surgery, but until I was just curious as to what causes the painful muscle spasms that occur while the shoulder is out and would the fact that I have had so many dislocations lessen the likely hood of surgery being effective. Chris

Answer

It is important to establish exactly what is wrong with your shoulder before I can answer as to the likelihood of success with surgery. Is their a large defect on the ball of the shoulder (Hill Sachs defect) ? Is the rotator cuff torn? What is the condition of the labral cartilage? Is arthritis present? Is the shoulder unstable in more then one direction? Your orthopedic surgeon can answer these questions with the physical exam, x-rays, and possibly a MRI. Most patients, however, can achieve very good results with surgery to stabilize the shoulder. Also, the pain associated with dislocations is due to a number of causes such as tearing of the labrum, tearing of the joint capsule, the muscles contracting abnormally, and pressure on the nerve receptors. The Jock Doc


Question

Is swelling in the lower neck right side and across the top of the shoulder normal post-op symptoms? I fell on my right shoulder 06/27/98 and had surgery on 11/04/98.I was diagnoised with a partial thickness tear of the right rotator cuff.Any information you could send me would be appreciated. Stan

Answer

Swelling of the neck, shoulder and arm are common after arthroscopic surgery of the shoulder. The major swelling resolves after a couple of days. Complete resolution of swelling can take several weeks. The Jock Doc


Question

My 12 year old daughter had an MRI and was diagnosed with a small tear in the Rotator Cuff from softball pitching. She is starting PT but our concern is, can this heal without surgery? Everything I've read says it can't but others have said that because of her age, there is a good possibility of it healing. Have you any information on this happening to someone so young? She wants so badly to be able to play softball again. Thank you. Darlene

Answer

Injuries to the rotator cuff in 12 year olds are very uncommon. However, a small tear may do well without surgical intervention and may in fact heal. I agree with your doctor who recommends trying conservative treatment such as physical therapy and modification of your daughters activity. It is also possible that the MRI may not be entirely accurate and that your daughter could have sustained a stress fracture of the shoulder that will heal with time or a labral cartilage injury which is common in the throwing athlete. I recommend you follow your orthopedists advice and hopefully your daughter will be back pitching very soon. The Jock Doc


Question

My son has a Hill-Sachs Lesion from recurrent dislocations. What are the current surgical options for repair and prognosis for success? Thank you. Ira

Answer

Unfortunately patients who have several dislocations are likely to continue having recurrent dislocations unless the problem is fixed with surgery. Depending on the size of the Hill Sachs lesion, your son's age, the number of dislocations, and the quality of the torn labral cartilage tissue, will determine whether this problem can be fixed successfully arthroscopically (unlikely) or with an open surgical repair. Our understanding of shoulder instabilities have improved dramatically in the last ten years and it is very likely that your son could achieve a good result with surgical treatment. The Jock Doc

Question

I have been Dx. with a paralabral cyst in my shoulder following a subluxation, could you describe this further because my doctor was not very articulate. Thanks. Erik

Answer

Your doctor is right in that by repairing your meniscal cartilage damage the swelling in the joint will decrease and the cyst may resolve itself. However, it usually requires about 4 to 6 weeks to return to your normal workout routine. The doctor will likely recommend post op rehab to hasten your recovery. Usually you can be without crutches in 1 -2 days and back to work in a mostly sitting capacity in a couple of days. The Jock Doc


Question

I am a 22 y/o male with multidirectional instability. I continue to play baseball with a great deal of work before and after throwing to make sure the RC does not fatigue I am interested in what surgical technique you use for this pathology as I have had symptoms since 93, and I am looking for a more permanent solution. Jeffery

Answer

Patient's with multidirectional instability "a loose shoulder joint" are usually effectively treated with rehab and an exercise program to relieve symptoms. Since your symptoms have persisted for 6 years you may require surgical treatment to help your problem. First, I usually order an MRI scan to determine whether other damage exists in the shoulder that would effect the choice of the surgical procedure. Up until the last few years, patients with significant multidirectional instability were treated with an open capsular shift reconstructive procedure to correct the problem. However, patients had a long rehab program post op and many times had difficulty regaining full shoulder motion. In select patients with instability we now perform an arthroscopic procedure called a thermal capsuloraphy that tightens the shoulder joint with easier post op recovery. I recommend you return to your orthopedic surgeon to further discuss your treatment options. The Jock Doc


Question

I have a medical problem and I'm very worried about it. I have dislocated my left shoulder 3 times in my life: The first time, I was 18 years old and I fell during a football game. The second time, last august, I dislocated my shoulder jumping into a swimming pool. The third time was this year in July during a football game.

Please tell me the best way to prevent future dislocations so I can continue my sport life (I also like body building, and I heard from one of my friends that body building could solve this problem, is this true?). I heard also that there is a shoulder surgery, but the doctor told me that after the operation my shoulder would not be 100% fit and it could stop my sport life. Please advise me Doctor.

Information About Me : I'm male, 25 years old, height 167cm, weight 59 kg. Abdullah

Answer

When a shoulder is dislocated usually the shoulder capsule and Labrum(cartilage) are torn. These usually do not heal by themselves. Although a strengthening program emphasizing the shoulder internal rotators may be helpful in preventing future dislocations for some patients, in your case where the shoulder has dislocated 3 times it is unlikely to be very effective. An MRI scan may be helpful in determining the extent of the damage to your shoulder. It may help show whether your shoulder can be stabilized with arthroscopic surgery alone, or whether an open surgical procedure may be necessary. Most patients can achieve an excellent result with surgery and return to their competitive sports. The Jock Doc

 
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