Shoulder injuries are common in both recreational and professional athletes, and are frequently caused by sports activities that involve excessive, repetitive overhead motion, such as swimming, tennis, pitching and weightlifting.
NJ Shoulder Doctors and Surgery
Shoulder injuries and shoulder pain can be caused by sudden acute trauma, can come on gradually or over time, or can follow an acute injury which has not healed properly. These injuries fall into three basic types:
While many shoulder injuries can be addressed with preventive measures, like physical therapy or conditioning, they can also require both non-invasive and surgical remedies. The experts at NJOI can diagnose as well as treat NJ shoulder injuries. In addition to pain, other symptoms of shoulder problems include stiffness or instability, popping or clicking, and weakness. Anyone with shoulder pain lasting more than a few weeks should seek medical attention.
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The same anatomy that makes the shoulder the most flexible joint in the body also makes it the most vulnerable. Because the shoulder allows people to rotate their arms in so many positions, this also lends to that joint’s instability and potential injury. Early diagnosis of shoulder problems is critical. While NJOI surgeons will initially attempt to provide the least invasive and non-surgical solutions, failure of those early measures to resolve a shoulder joint injury or condition can lead to substantial worsening of the condition.
The rotator cuff is comprised of four tendons and related muscles, which stabilize the shoulder joint and provide the ability to raise and rotate the arm. If non-surgical methods do not improve shoulder strength and movement or alleviate pain, surgery may be used. Shoulder impingement syndrome is a common cause of shoulder pain. It occurs when tendons or bursa in the shoulder cause this impingement. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Examples include overhead chores or sports, such as lifting, reaching, swimming or tennis. Other risk factors include bone and joint abnormalities. With shoulder impingement syndrome, pain is persistent and affects everyday motions and activities, such as reaching overhead for objects or putting on a coat or shirt. Over time, impingement syndrome can lead to inflammation of the rotator cuff tendons (tendonitis) and bursa (bursitis), which may lead to tearing of the rotator cuff tendons. One procedure, called debridement, can help. It entails removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves. This makes more room for the rotator cuff tendon so it is not pinched or irritated. If necessary, this procedure includes shaving bone or removing bone spurs. In patients who have a significant tear of the rotator cuff, the sports-medicine trained orthopaedic surgeons perform advanced arthroscopic rotator cuff repair techniques to restore the tendons to their anatomical insertion. Bicep tenodesis is the surgical repair of an injured or degenerative tendon through the use of screws and suture. The biceps tendon connects the biceps muscle to the bone. The tendon passes from the muscle, through the rotator cuff, into the shoulder joint, and attaches to the socket of the shoulder joint. Biceps tendon problems may include inflammation and irritation of the tendon, a detachment of the biceps tendon from the socket of the shoulder (a SLAP tear), or tendon problems together with a rotator cuff tear. A biceps tenodesis is a procedure that cuts the normal attachment of the biceps tendon on the shoulder socket and reattaches the tendon to the bone of the humerus (arm bone). In essence, this moves the attachment of the biceps tendon to a position out of the way of the shoulder joint. One of the most cited studies on the topic of biceps tenodesis is from the American Journal of Sports Medicine in 2009. The authors reported that in athletes with labral tears, the results of biceps tenodesis were superior to SLAP repairs. *http://www.ncbi.nlm.nih.gov/
The shoulder joint includes three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid. The head of the upper arm bone is usually much larger than the socket, and a soft fibrous tissue rim called the labrum surrounds the socket to help stabilize the joint. The rim deepens the socket by up to 50% so that the head of the upper arm bone fits better. In addition, it serves as an attachment site for several ligaments. The complex multi-directional ball-and-socket joint which characterizes the shoulder allows movement in many directions. Shoulder instability and dislocation occur when the shoulder capsule is stretched or torn, and/or when the labrum is detached from the glenoid. The level of shoulder instability is increased the more the labrum is stretched or torn, and can lead to the shoulder slipping or becoming dislocated. Labral tears are often caused by a direct injury to the shoulder, such as falling on an outstretched arm. The labrum can also become torn from overuse–the wear and tear caused by any activity. An injured labrum can lead to shoulder instability. The extra motion of the humerus within the socket causes additional damage to the labrum. Tears can be located either above (superior) or below (inferior) the middle of the glenoid socket. Frayed edges and loose parts are corrected with arthroscopy, in a procedure called labral debridement. If the tear is larger, the labral tear may need to be repaired, rather than an area simply removed. SLAP is an acronym that stands for “Superior Labral tear from Anterior to Posterior”. A SLAP is a tear of the rim above the middle of the socket that may also involve the biceps tendon. SLAP lesions require careful treatment by fellowship-trained sports medicine surgeons to provide optimal outcomes in the variety of patients in whom this injury occurs. A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion, (named after English orthopedist Arthur Bankart.) This is the most common form of ligament injury. Surgical repair requires that the torn tissue be sewn back to the rim of the socket.
Shoulder arthroplasty is the reconstruction or replacement of a damaged, malformed or degenerated joint. The goal of this surgery is to restore optimum function, defined as the return of the shoulder’s stability, smoothness and strength. This is done by addressing issues in the soft tissue surrounding the joint as well as the release of adhesions (scar tissue).
If a more conservative procedure is possible, the surgeons at NJOI may perform shoulder resurfacing. This is technically a partial shoulder replacement in which a cap is used to cover the head of the humerus (top of arm bone). This is a less invasive procedure than a total shoulder replacement surgery, usually requiring a smaller incision and less bone removal. While it can negate or delay the need for total shoulder replacement, should that more substantial procedure be required, shoulder resurfacing allows for an easier, less invasive procedure for a subsequent full shoulder replacement.
No rotator cuff tear is ever uniform. The painful condition can occur with a wide range of possibilities and severities of the tear itself. There are often times where a rotator cuff tear requires unique intervention unlike traditional surgical methods. Superior capsular reconstruction is a cutting-edge procedure where large, full-thickness rotator cuff tears can be repaired. Normally, this type of tear is far too retracted for reattachment. The procedure totally replaces the superior capsule with a tendon graft to eliminate the development of increased rotator cuff pain and arthritis.
A total shoulder replacement is usually the solution for painful osteoarthritis or rheumatoid arthritis in the shoulder joint, but also rarely for severe trauma caused by a shoulder fracture. These shoulder conditions cause the wearing away of the normally smooth cartilage surfaces of the shoulder, which permit the ball and socket of the joint to smoothly glide against one another. This lack of cartilage leads to what is commonly referred as a “bone on bone” joint pain. Thus, new surfaces can restore comfort in the joint. Many patients achieve restored function as well, allowing them to return to their activities: from everyday tasks to physical labor and sports and fitness activities.
This procedure is for patients with large rotator cuff tears who have developed a complex type of shoulder arthritis called “cuff tear arthropathy.” For these patients, conventional total shoulder replacement may result in residual pain and limited motion, while reverse total shoulder replacement may be a better option. A conventional shoulder replacement device is designed to duplicate the normal anatomy of the shoulder with the use of a plastic cup for the shoulder socket and a metal ball for the upper arm bone (humerus). In a reverse total shoulder replacement, the socket and metal ball are switched: the metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus. A reverse total shoulder replacement works better for those with cuff tear arthropathy because it relies on different muscles to move the arm. A conventional replacement device also engages the rotator cuff (which runs from the upper arm to the shoulder blade) muscles to function properly. In a patient with a large rotator cuff tear and cuff tear arthropathy, the rotator cuff muscles, which provide power for the shoulder’s range of motion, no longer function properly. The reverse total shoulder replacement relies on the deltoid muscle, the rounded shoulder muscle, instead of the rotator cuff, to power and position the arm.
The NJ shoulder specialists at The New Jersey Orthopaedic Institute are experienced in both surgical and non-surgical interventions of bursitis, tendonitis, rotator cuff tears, instability, fractures, and many other shoulder conditions and shoulder pain. Contact us today to schedule an appointment. Serving patients in Wayne, Clifton, Butler, Bridgewater, Morristown and surrounding areas in New Jersey.
Meet The Team
Vincent K. McInerney, M.D.
Founding member, Vincent K. McInerney, M.D., graduated from Rutgers New Jersey Medical School in 1977 with honors as one of the top medical students in his class.
Anthony Festa, M.D.
Dr. Anthony Festa is an orthopaedic surgeon in his seventh year of practice at the New Jersey Orthopaedic Institute.
Anthony J. Scillia, M.D.
Anthony J. Scillia M.D. is a board certified orthopaedic surgeon with subspecialty certification in sports medicine.
Robert M. Palacios, M.D.
SPORTS MEDICINE PHYSICIAN
Dr. Robert Palacios is board-certified and fellowship trained, and has been specializing in outpatient orthopedics and sports medicine for over two decades.
Craig Wright, M.D.
ORTHOPAEDIC TRAUMA SURGEON
Craig Wright, MD joins New Jersey Orthopaedic Institute by way of Totowa, NJ where he was born and raised.
"Doctors and staff very knowledgeable. Staff very friendly and helpful. Procedure I had went well and staff at surgical center very nice. My procedure went very smoothly. Follow up by staff impressive. Neat office; inviting. Would definitely recommend Dr. Festa to anyone in need of such services."
"Hurt my hand in work. Came here thru my company. Happy with the Doctor and the Service. Good Location. Would recommend to others."