Shoulder Instability Or Dislocations

shoulder instability anatomy

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Shoulder is the most mobile joint of the body. This allows you to lift your arm, rotate your arm and lift your arm over your head. It’s possible to have a greater range of motion with less stability.

How

Shoulder instability

This happens when the humerus head (the upper arm bone) is forced out of the shoulder’s cavity. Usually this happens as a result of a sudden traumatic injury.

Once the shoulder is dislocated, the shoulder is vulnerable to repeat. When the shoulder is loose and slips several times, it’s called a chronic shoulder instability.

The shoulder is made of 3 bones : humerus (upper arm bone), scapula (shoulder blade) and clavicle (collarbone).

Dislocation shoulder

shoulder dislocation anatomy

This may be partial, which means that the arm’s ball partially comes out from the cavity. This is called a subluxation. This can be complete which means that the arm’s ball comes out completely from the cavity.

Symptoms

Symptoms of chronic shoulder instability are :

  • Pain caused by the shoulder injury

  • Repeated shoulder’s dislocation

  • Repeated instance of the shoulder giving out

  • A persistent sensation of the shoulder that is loose, slipping out of the joint or hanging.

Diagnosis

Specific tests help assess shoulder instability (including general relaxation of ligaments). A doctor may prescribe imaging tests such as X-rays, CT Scan or MRI to confirm the diagnosis and identify other problems.

Treatment

First, chronic shoulder instability treated with nonsurgical options. If these options don’t relieve pain and instability, surgery may be needed.

Nonsurgical treatment

shoulder dislocation treatment non surgical

Generally, it often takes several months of nonsurgical treatment before success can be assessed. Nonsurgical treatments includes :

  • Activity modification

  • Non-steroidal anti-inflammatory medication

  • Physical therapy

Surgical treatment

shoulder dislocation treatment surgery bankart repair

Often, surgery is often required to repair torn or stretched ligaments so that they can maintain the shoulder joint in place.

Bankart lesions (tearing of the front labrum from the cavity) can be repaired surgically using suture anchors to reattach the ligaments to the bone.

Arthroscopy => Soft tissues of the shoulder can be repaired using tiny instruments and small incisions. It’s a procedure that is done the same day or outpatient. Arthroscopy is a minimally invasive surgery. The surgeon examines the inside of the shoulder with a small camera and performs the operation with special instruments.

Open surgery => These are patients who require open surgical intervention. This involves making a wider incision on the shoulder and performing the repair under direct visualization.

Rehabilitation

After surgery, the shoulder can be temporarily immobilized with a sling. When the sling is removed, it’s essential to do ligament rehabilitation exercises. These exercises improve the range of motion of the shoulder and avoid scarring during ligament healing. Thereafter, exercises for strengthening the shoulder will be added in the rehabilitation program.

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Articular Cartilage Injuries

articular cartilage injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interessted in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Definition

Articular cartilage is difficult to understand because there are 3 types of cartilages in the body : articular of hyaline cartilage (covers joint surfaces), fibrocartilage (knee meniscus, vertebral disk) and elastic cartilage (outer ear). These cartilage’s types differ in their structure, elasticity and strength.

Articular cartilage is a complex element, it’s a living tissue that is on the joint’s surface. The function is to provide a low friction surface to allow the joint to withstand weight loads through the range of motion needed to perform activity of daily living. To put it simply, articular cartilage is a very thin shock absorber. It’s built in 5 distinct layers and each layer has a structural and biochemical difference.

Injury

articular cartilage injury

Articular cartilage injury may be due to trauma or progressive degeneration (wear and tear). This can be mechanical destruction, a direct blow or other trauma. The healing of articular cartilage cells depends on the severity of the damage and the location of the lesion. Articular cartilage has no direct blood supply so it has very little ability to repair itself. It the lesion penetrates the bone under the cartilage, the bone provides blood in the area which improves the chances of healing.

Mechanical degeneration (wear and tear) of articular cartilage occurs with progressive loss of normal cartilage structure and function. This loss begins with the softening of the cartilage, then progresses to fragmentation. As the loss of articular cartilage lining continue, the underlying bone no longer has any protections against normal wear and tear of daily life and begins to get damaged leading to osteoarthritis.

In many cases, a patient experiences knee swelling and vague pain. At this stage, continuous physical activity isn’t possible. If a loose body is present, words such as « locking » or « catching » might be used to explain the problem. With wear and tear , the patient often experiences stiffness, decreased range of motion, joint pain and/or swelling.

Diagnostic

The physician examines the knee to look for a decrease in range of motion, pain along the joint line, swelling, fluid on the knee, abnormal alignment of the joint’s bones, and ligament or meniscal injury.

Cartilage lesions are difficult to diagnose and it’s possible that the use of magnetic resonance imaging (MRI) or arthroscopy may be necessary. Plain X- rays don’t usually diagnose articular cartilage problems but they used to rule out other abnormalities.

Treatment

articular cartilage injury treatment

 

Articular cartilage injury that doesn’t penetrate the bone doesn’t repair itself. A lesion that penetrates the bone can heal but the type of cartilage created is structurally unorganized and doesn’t work as well as the original cartilage.

Lesion less than 2 cm have the best prognosis and the best treatment options. These options are arthroscopic surgery using techniques to remove damaged cartilage and increase blood flow from the underlying bone (drilling, pick procedure or microfracture ).

For smaller lesion of articular cartilage surgery is not required.

For larger lesion, it’s necessary to transplant the articular cartilage from another area of the body. Talk to your doctor or specialist to have more information about the decision to have a surgical operation.

For patients with osteoarthritis, non-surgical treatment consists of physical therapy, lifestyle modification (for example reducing activity), bracing, supportive devices, oral and injection drugs (like non-steroidal inflammatory drugs, cartilage protective drugs) and medical management.

Surgical options depend on the severity of osteoarthritis and may provide a reduction in symptoms that are usually short-lived. Total osteoarthritis may relieve the symptom of advanced osteoarthritis but this usually requires a change in the lifestyle and/or level of activity of the patient.

Statistics

Based on published studies, the overall prevalence of articular cartilage injury in the knee is 36% among all athlete and 59% among asymptomatic basketball players and runners.

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-Steph

Acromioclavicular Joint Injury

acromioclavicular joint injury

What’s up ? This is THE stephane ANDRE. With my training, I’m interested in biomechanics to avoid injuries. I read « Sport Medicine Media Guide » and I learned some good stuff.

Acromioclavicular joint is a joint between the clavicle and the scapula. Acromion is a continuation of the scapular spine and hooks over anteriorly. It articulate with the clavicle (collar bone ) to form the acromioclavicular joint.

Problems types

The most common problems are arthritis, fracture and separation. Arthritis is characterized by a loss of joint’s cartilage. Arthritis of acromioclavicular joint is common with weight lifter, especially with bench press and a little less with shoulder press. When there is a problem with the rotator cuff, it’s possible that there is also acromioclavicular joint’s arthritis.

Acromioclavicular separation

acromioclavicular joint injury type grade

When there is an acromioclavicular joint separation, it means that the ligament that connects the acromion and clavicle is damaged and that the 2 structures don’t align properly. Separation’s state can be weak or severe, that is why there is a system of « grade » according to which ligament is torn and the severity of the tear.

Grade I Injury – This is the weakest damage and the acromioclavicular joint is still aligned.

Grade II Injury – This is an average damage. Ligaments are only stretched but not fully torn. In case of stress (physical effort), the acromioclavicular joint becomes painful and unstable.

Grade III Inury – This is a serious damage. Ligaments are completely torn and the collar bone is no longer attached to the scapula, which creates a visible deformity.

Treatment of acromioclavicular joint arthritis

If the rest, ice, medications and change of the training program (changing the exercises) don’t work, the next step is a shot of cortisone. A shot of cortisone in the joint may have calmed the pain and may be permanently swollen. As each individual is unique, the effects may vary and it’s possible that it doesn’t swell permanently.

If non-surgical methods fail, it’s possible to perform a surgical operation. The pain is localized at the bones end that make contact with each other and the goal of the operation is to remove some of the end of the clavicle. This ambulatory surgery can be done with a small incision of 1 inch (2.5 cm) long or with the arthroscopy technique with 2-3 incisions. The results and recovery of these 2 surgical techniques are about the same. Most patients have a full movement by 6 weeks and can return to do sport by 12 weeks.

Treatment for acromioclavicular separation

Separation can create very painful injuries, so the first thing to do is to decrease the pain. Hold the arm in a sling, put ice and pack the shoulder for 20-30 minutes every 2 hours as needed. Acetaminophen and non-steroidal anti-inflammatory medications can also help calm the pain.

When the pain begins to subside, it’s important to move the fingers, wrists and elbow (and eventually the shoulders) in order to avoid having stiff or « frozen » shoulder. The length of time needed to regain complete movement and function depends on the severity or injury’s grade.

Recovery from Grade I acromioclavicular separation usually takes 10-14 days while Grade III takes 6-8 weeks.

When surgery

Grade I and II separations require very rarely surgery. With a Grade III injury, after surgery, it’s possible to have full body physical activity with some restrictions.

Statistics

  • More males than females suffer acromioclavicular joint injuries

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-Steph