Category Archives: Shoulder Conditions

The shoulder is a highly active joint that offers the greatest range of motion in the human body.  We rely on the shoulder joint to help us perform countless everyday activities, so when shoulder pain and shoulder weakness prevents us from completing simple tasks, medical treatment is usually recommended. Degenerative diseases and other common conditions of the shoulder, such as arthritis, bursitis, and tendonitis can create pain and weakness for patients, and if left untreated, can lead to bigger problems. Direct trauma to the shoulder, such as a sternoclavicular joint injury or dislocation, often requires surgical intervention.  Dr. Anz is skilled to treat a number of shoulder conditions, and when surgery is recommended, you can depend on his entire team to offer the best care and surgical approach to treat and manage your injury.

Shoulder injuries are usually classified in three common areas:  athletic injuries, traumatic injuries, and degenerative and arthritic conditions.

Subacromial Impingement

In many individuals, repetitive use of the shoulder can result in painful symptoms that make everyday activities difficult to perform. Subacromial impingement is one specific condition that affects adults, most commonly over the age of 30, and refers to the pinching (impingement) of the tendons of the rotator cuff between the humeral head and the acromion process of the shoulder blade. Irritation of the surrounding tendons leads to inflammation of the bursa which results in shoulder pain, and the inability to move the arm above the shoulder.  As the inflammation progresses, the symptoms become more severe and will occur more frequently.

In some cases, subacromial impingement may be associated with biceps tendonitis and/or rotator cuff tearing. Another factor that may cause shoulder impingement is weakness of the muscles around the shoulder blade, which cause it to sit in an inappropriate position and may predispose patients to the condition.  In addition, some patients have an abnormal shape to their bone, or have had a previous shoulder injury, both of which may be predisposed an individual to developing subacromial impingement.

Symptoms

The primary symptom associated with subacromial impingement is a sharp, piercing pain felt on the front of the shoulder with any type of overhead activity.  If the arm is resting, pain may not necessarily be felt, however, the arm will experience overall weakness making it difficult to use the affected arm for chores or activities.

Diagnosis

Dr. Anz will conduct a thorough physical examination that will include tests to check for pain level and mobility of the shoulder. Physical exam tests to assess for impingement include the impingement tests of Neer and Hawkins.  While shoulder impingement is relatively easy to diagnose based on the physical exam, Dr. Anz will require an X-ray and potentially a MRI to rule out if any other condition that may cause or contribute to the shoulder pain.

Treatment

In cases of subacromial impingement Dr. Anz will first recommend conservative treatment measures which consist of anti-inflammatories, rest, and physical therapy.  In many cases, these treatments are effective and surgery will not be needed. In cases with continued pain, an injection of corticosteroids to the subacromial bursa may help alleviate pain and allow the patient to make progress with physical therapy and accomplish longstanding relief.

Surgical Treatment

In more serious cases of subacromial impingement, Dr. Anz may recommend a surgical treatment. Arthroscopic shoulder surgery is often used to correct this condition. This surgery is performed through several very small keyhole incisions through which a camera and special surgical instruments are inserted. During this operation, Dr. Anz will assess the rotator cuff to make sure there is no injury. The area of inflammation in the subacromial bursa is then removed. The bone spurs causing the pinching are also removed and the entire area is smoothed down to allow normal, pain-free motion. In complex cases of impingement, Dr. Anz may also treat other conditions that will present themselves once he is inside the shoulder joint.  These can also be addressed during the surgery, and may include arthritis between the clavicle and the acromion, as well as inflammation of the biceps tendon.

Post-Operative

Following surgery, Dr. Anz may request that the arm be kept in a shoulder sling for a period of time to allow healing.  Soon after, he will prescribe a thorough rehabilitation program. This program is a combined effort between the patient, Dr. Anz, and the physical therapist and will introduce exercises, strengthening moves, and active range of motion in time. It typically takes 2 to 4 months to achieve complete relief of pain, but in patients who presented complex cases, full recovery may take up to a full year.

For more information on subacromial impingement, or to discuss your shoulder pain and shoulder injury with Dr. Adam Anz, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Sternoclavicular Joint Injuries

The sternoclavicular (SC) joint is a major joint of the upper body that is formed by the articulation of the collarbone (clavicle) and the center of the chest (manubrium). Most of the SC joint’s strength and stability originates from the joint capsule and supporting ligaments. SC joint injuries are often due to a direct blow or blunt force trauma that occurs to the collarbone. These injuries can also result from a traumatic landing to the shoulder area (such as in football). SC joint injuries are typically associated with a disruption of the supporting ligaments.

A sternoclavicular (SC) joint injury is relatively uncommon, but when it occurs, the affected ligaments are stretched or torn (partially or completely) causing the joint to become disrupted. Sternoclavicular joint injuries are graded into 3 types ranging from a first-degree injury that involves a simple sprain or stretching of the ligaments, to a second-degree injury where a portion of the clavicle becomes subluxated. In the most severe cases (a third degree SC joint injury), a complete rupture typically occurs between the sternoclavicular and costoclavicular ligaments, which permits the clavicle to completely dislocate from the manubrium.

Symptoms

The most common symptoms from an SC joint injury include:

  • Severe pain at or around the SC joint at the time of injury and afterwards
  • Bruising in the area
  • Difficulty swallowing, difficulty breathing, a sense of fullness around the neck or a feeling of choking sensation due to posterior displacement of the medial clavicle
  • Cracking noises, popping sounds
  • A feeling of instability where the clavicle feels like it “moves” during activities

Diagnostic Testing

Dr. Anz will conduct a thorough examination of the shoulder blade and collarbone. He will test for tenderness and pain, and evaluate the overall range of motion of the arm and shoulder. In some cases, he will be able to see if a dislocation or other major disruption has occurred, but an X-ray will usually confirm his diagnosis. Because ligaments and other soft tissue structures are typically involved with these injuries, he may also order an MRI to take a more in-depth look at this area.

Treatment

Non-Surgical

Surgery is not necessary for most SC joint injuries. Initial treatment consists of ice, pain medication and sling immobilization. Return to activity is based on type of sport and the position played, the arm injured (dominant versus non-dominant), and the severity of the sprain. In more acute cases, a reduction (or relocation) of the SC joint can be attempted by sedating the patient and pulling gently on the arm, manipulating it back into its normal position. This may allow the SC joint to ‘pop’ back into position.

Surgical

Operative treatment is reserved for patients who experience major trauma to the bones and ligaments of the SC joint. Dr. Anz will choose the type of surgery based on the exact injury, but in many cases will opt for a stabilization procedure that will allow him to reattach or repair any loose or torn ligaments of the SC joint. Without this stabilization procedure, a patient is a risk for future dislocations and/or subluxations, as well as the onset of arthritis.

Post-Op Recovery

Following surgery for an SC joint injury, it is critical that patients follow the prescribed post-op rehabilitation program as set forth by Dr. Anz. These guidelines will be broken down into phases and will be conducted with a therapist, and at home. Most patients are able to resume normal activities within 3-6 months; sports and other high impact activities may take longer.

For more information on sternoclavicular joint injuries or for additional resources on the other shoulder related injuries and conditions, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Shoulder Fractures

Fractures that occur within the structure of the shoulder joint can appear as a break or a crack in the bone on an X-ray. A shoulder fracture is generally classified based on which bone (clavicle, humerus, or scapula) is involved. A shoulder fracture can occur when sudden force, impact, or trauma has been sustained to the shoulder joint. Hard falls during sporting events or motor vehicle trauma are examples of possible causes of fractures in the shoulder.

There are 3 distinct bones within the shoulder that could sustain a fracture: The collarbone (clavicle) is the most common place where a fracture may exist; the upper arm bone (proximal humerus) can be fractured and is often related to poor bone density; a fracture of the shoulder blade (scapula) is less common, but usually occurs during a high-energy impact.

Fractures are classified as being displaced or non-displaced. In a non-displaced fracture, the broken pieces line up on each side of the break. Displaced fractures, in which the pieces on either side of the break are out of line, may require some type of manipulation to restore normal anatomy. Occasionally the rotator cuff muscles are injured or torn at the same time as the fracture, which can further complicate the treatment.

Symptoms

Shoulder fractures are usually characterized by pain with motion or palpation of the shoulder. Other symptoms include swelling or bruising of the shoulder area, a bump or bulge at the site of the break, or an inability to move the arm without pain.

Diagnostic Testing

A physical examination reveals pain over the bone, and often swelling or bruising is present. X-rays typically show the fracture. However, in more serious cases, 3-D imaging, such as CT scans or MRIs are often ordered to get a better picture of the fracture pattern.

Treatment

Non-Surgical

Many fractures can be treated without surgery, and heal in about 4 months. Many shoulder fractures can be treated with a simple sling and limited use of the shoulder until the pain and inflammation has subsided. By immobilizing the shoulder, the bone is allowed to heal, and once it has healed enough, physical therapy is typically ordered to regain motion and strength.

Surgical

The need to surgically repair a shoulder fracture depends upon your age, activity level, and the severity of your injury. Some fractures are better treated with surgery because they may carry a high risk of arthritis if left alone. There are many different types of surgery for different types of fractures including percutaneous pinning (placing pins in the bone to secure them back in place); open reduction internal fixation (ORIF—which involves opening up the fracture, realigning the bones, and putting a plate and screws in place to hold them together); and shoulder hemiarthroplasty – replacing the shoulder if the fractures are in too many pieces.

Post-Op

After any fracture surgery, proper rest and rehabilitation is critical to good success and improvement of pain and function. Dr. Anz will prescribe a very detailed physical therapy program that, if performed consistently and successfully, will help rehabilitate the injured arm. Most patients can resume normal activities within six months following surgery.

For additional information on shoulder fractures or to learn more about treatment for this shoulder condition, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Scapulothoracic Bursitis (Snapping Scapula)

The scapulothoracic joint is located in an area where the shoulder blade (scapula) meets and moves along the chest wall. The motion of the scapula is normally smooth because of the underlying scapulothoracic bursa, a fluid filled sac that aids in the movement of the scapula against the ribcage. If the bursa becomes inflamed from injury or overuse, a condition known as scapulothoracic bursitis may develop.

Scapulothoracic bursitis, also referred to as snapping scapula syndrome, is most often seen in young athletes who participate in repetitive overhead activities. However, the condition may develop in patients of any age. This syndrome is fairly rare and can also occur in individuals who sit or stand in a abnormal position for long periods of time and/or in patients whose shoulder movement was altered for long periods of time, such as in the setting of a shoulder injury.

Symptoms

Symptoms associated with a snapping scapula include pain located near the middle of the upper back (the top inside border of the shoulder blade) with movement of the shoulder. During shoulder movement, snapping, grating, and/or grinding noise is present. This is often accompanied by a dull ache in the shoulder blade and ribcage area. These symptoms may steadily progress with time.

Diagnosis

The most common physical exam finding in patients with this problem includes a grinding or snapping sensation over the inner aspect of the shoulder blade when the arm is moved. Dr. Anz will perform movement tests involving the shoulder joint to assess these symptoms. If he suspects that scapulothoracic bursitis is the condition causing the symptoms, he will most likely require an X-ray and MRI to confirm his diagnosis and to rule out any alternative abnormality. Once snapping scapula has been diagnosed, Dr. Anz will begin discussing treatments options according to the severity of the injury.

Treatment

Dr. Anz will prescribe a course of physical therapy to improve shoulder kinetics as the first line treatment for this condition. To manage pain during this recovery process, he may use a corticosteroid injection to the scapulothoracic bursa to relieve pain and allow further progress with physical therapy. Rehabilitation will focus on restoring normal scapular motion, eliminating positions which cause symptoms, and strengthening the musculature around the shoulder blade.

Surgical Treatments

If conservative treatments fail to ease the symptoms of snapping scapula syndrome and restore shoulder function, Dr. Anz may recommend surgery. In most cases, a minimally invasive arthroscopic approach can be used. This involves tiny keyhole incisions, a miniature camera, and surgical tools to assess and treat the bursitis. During the surgery, Dr. Anz will remove the inflamed scapulothoracic bursa, as well as areas of bone which may be attributing to the bursitis. These procedures are typically successful in relieving pain, eradicating symptoms of rubbing and snapping, and removing the areas of inflammation to restore shoulder motion.

Post-Operative

Dr. Anz will require patients to adhere to a strict rehabilitation program following arthroscopic surgery. Detailed guidelines, rehabilitation progression, and expectations for each of his patients will be outlined so that a full recovery can be achieved. Therapy is a vital part of the recovery process following a shoulder injury and is a partnership between the patient, Dr. Anz, and the physical therapy team.

For more information on snapping scapula syndrome or for additional resources on shoulder pain or scapulothoracic bursitis symptoms, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Rotator Cuff Injuries

Rotator cuff injuries are a very common cause of shoulder dysfunction in both young and old patients. The rotator cuff is comprised of a group of four muscle-tendon units that surround the shoulder joint and allow for overhead motion of the arm. The muscles and tendons that make up the rotator cuff also help stabilize the shoulder joint. A rotator cuff injury can occur when any of these muscle-tendon units become damaged. This is typically characterized by a separation or “tearing” of the tendon attachment off of the humerus. This can occur due to a number of factors, including:

  • Acute injury – Such as a hard hit or traumatic fall sustained in a sport or car accident
  • Chronic overuse – Continuous, repetitive movement that occurs with athletic training in activities such as baseball (pitching) or performing overhead movements like in tennis or swimming. On the job lifting of heavy objects can also lead to overuse.
  • Gradual aging – the degeneration of the muscles or tendons over time and normal wear and tear can cause a breakdown of collagen, thus making the tendons and muscles more prone to degeneration and injury.

When any of these risk factors are present, the rotator cuff may be at risk for a tear. Certain other conditions, such as impingement and tendonitis, can also contribute to tearing of the rotator cuff. These tears result in a significant amount of shoulder pain, weakness, and limited range of motion. The severity of the injury may range from a mild strain with associated inflammation to a partial or complete tear that might require surgery.

Symptoms

The symptoms of a rotator cuff injury arise from the inflammation that accompanies the structural damage. The most common symptom is pain over the top of the shoulder and arm. In some patients, the pain can descend down the arm towards the elbow. This pain is evident at rest and may interfere with sleep at night, especially when lying on the affected shoulder.

Another common symptom typically associated with a rotator cuff injury includes weakness of the shoulder in combination with pain, causing difficulty in lifting the arm up in overhead motions or performing seemingly simple tasks such as getting dressed or reaching up to grasp an object.

 Diagnostic Testing

Dr. Anz will conduct a thorough examination and will observe the shoulder joint to look for deformities, muscle wasting, or weakness of the affected rotator cuff muscles. He will touch and manipulate the bones and muscles that make up the shoulder joint to find areas of tenderness or pain. He will carefully check overall mobility and strength. In addition, a variety of tests may be utilized to determine which of the muscles or tendons of the rotator cuff is damaged including X-rays (to look at the joint) or an MRI (to assess the soft tissue and cartilage).

Treatment

Most rotator cuff injuries can initially be treated without surgery. The success of non-surgical treatment options depends on the type of rotator cuff injury (acute versus more established), the size of the tear as determined by the diagnostic tests, and the activities of the patient.

Non-surgical

The goal of treatment is to reduce inflammation and strengthen the uninjured muscles around the shoulder to compensate for the torn or injured muscles or tendons. Some conditions may be easily treated with a combination of ice and heat, rest and diminished use of the shoulder for a determined amount of time. Anti-inflammatory medications (NSAIDs) can also help.

Some patients may require the assistance of a physical therapist to help strengthen the muscle and increase flexibility through a special exercise program. Dr. Anz may inject a steroid, such as cortisone, into the area of inflammation if the pain persists. The cortisone shot is designed to act only in the area where it is injected and has a potent anti-inflammatory effect.

Surgical

The need to surgically repair a rotator cuff injury depends upon your age, activity level, and the severity of your injury. Dr. Anz strives to achieve maximum recovery with minimal surgery and often prefers an arthroscopic treatment approach:

Arthroscopic Rotator Cuff Repair

An arthroscopic rotator cuff repair is done through a series of small incisions. Dr. Anz utilizes a small camera to view the damaged tissue on a large television screen. He is then able to insert small instruments into the joint to achieve the repair. The advantage of arthroscopic surgery is that there is usually less pain and a faster return to normal activities.

Post-Op

A rehabilitation program will be prescribed at your first post-operative visit with Dr. Anz. This will usually entail a period of rest and minimal rehab to allow the repair to heal. After healing is achieved, a more aggressive regimen is prescribed with the goal of regaining motion and strength.

Rehabilitation after surgery is as important as the surgical repair itself. Without proper rehab, the chance of full recovery is diminished. Patients are advised to be good to the shoulder as the rotator cuff heals by avoiding extra and unnecessary physical stress.

For more information on rotator cuff injuries, or for additional resources on shoulder injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Labral and SLAP Tears

The labrum is a type of cartilage found in the shoulder that surrounds the socket (glenoid) and has two primary functions: 1) to deepen the socket so that the ball of the shoulder stays in place; and 2) the Labrum acts as an attachment site for other structures, such as the biceps tendon or shoulder ligaments. When there is an injury to the shoulder, such as a dislocation, the labrum can be peeled off of the rim of the socket (glenoid).

Labral tears can occur for a variety of reasons and there is a number of ways that this injury can affect a patient. The most serious is when the labrum is torn completely away from the bone. This acute, traumatic injury is often associated with a dislocation or subluxation of the shoulder. Another labrum injury is associated with a tear within the substance of the labrum itself. When this degenerative condition occurs, the labrum is left with an unsmooth, rough edge. This condition is usually found in older patients. A tear can also occur in the area where the biceps tendon attaches to the upper end of the socket (SLAP tear).

A SLAP Tear (Superior Labrum Anterior Posterior) refers to a specific type of labral tear in the shoulder, which is located at the top of the shoulder socket (glenoid) and involves the attachment site of the biceps tendon. Acute trauma and overuse are often the causes of this specific type of labrum injury.

Symptoms

A SLAP tear is often accompanied by pain deep in the shoulder, stiffness, a popping or clicking sensation or feeling of instability. Decreased range of motion or strength can also be present.

Diagnostic Testing

Dr. Anz will conduct a thorough examination and perform a physical examination to help determine whether or not you have a SLAP tear. During the evaluation, Dr. Anz will determine if the tear is associated with any type of pre-existing instability to the shoulder or if it’s from a particular traumatic event. X-rays will rule out any fractures or bone-related issues. Typically, an MRI is most effective in diagnosing a tear.

Treatment

Several key factors play a role in the decision-making process regarding treatment of a tear, including age, type of tear, and athletic profile.

Non-surgical

Initially, patients are directed to rest and ice the area, along with taking anti-inflammatory medications followed by a course of physical therapy.

Surgical

When non-surgical treatments fail, arthroscopic surgery of the shoulder is typically recommended. Generally speaking, there are three surgical options for a SLAP tear

 

  • Debridement: During a debridement procedure, Dr. Padelecki will smooth out the torn labrum during an arthroscopic surgical approach. This option is only suitable for stable SLAP lesions that do not seem to involve the biceps tendon.
  •  SLAP Repair: A SLAP repair is an arthroscopic procedure that uses anchors with sutures attached to secure the torn labrum down to the shoulder socket. A SLAP repair is the most common procedure done for symptomatic SLAP lesions and is typically reserved for young patients with an otherwise healthy shoulder who want to remain athletically active.
  • Biceps tenodesis: A biceps tenodesis cuts the biceps tendon from where it attaches to the labrum, and reattaches it to another area. By decreasing the forces that pull on the SLAP region, the symptoms will be alleviated. A biceps tenodesis can either be performed arthroscopically, or through a small incision.

Post-Op

A rehabilitation program will be prescribed at your first post-operative visit with Dr. Anz. Rehabilitation after surgery is extremely important, especially in athletic individuals who are seeking to get back into regular activity. Without proper rehab, the chance of full recovery is diminished and shoulder stiffness can occur.

For additional information on labral and slap tears, or to learn more about arthroscopic shoulder surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by inflammation and stiffness in the shoulder joint which can restrict motion and cause chronic pain. Also referred to as “stiff shoulder”, this condition develops when the soft tissue of the shoulder joint begins to thicken and contract as a result of the formation of scar tissue. The scar tissue (referred to as “adhesions”) creates the loss of motion. The condition usually comes on slowly, but generally worsens over time. With the right treatment, frozen shoulder usually can be corrected and the symptoms alleviated.

Symptoms

The most common symptom of frozen shoulder is pain, which is typically described as dull or aching. It is worse early in the course of the disease and is usually located over the outer shoulder area and sometimes the upper arm. Limited mobility, shoulder weakness, and loss of movement of the joint are also major symptoms associated with frozen shoulder.

Diagnostic Testing

Dr. Anz may suspect frozen shoulder during a routine examination and after questioning of your past medical history. An X-ray or an MRI may be performed to see whether symptoms are from another condition such as arthritis, rotator cuff tear, or a broken bone.

Treatment

Non-Surgical

Treatment for frozen shoulder usually starts with basic activities including rest, ice, and medication. Physical therapy is often very effective in treating frozen shoulder, especially when combined with steroid injection. These treatments should help the return of motion and function to the shoulder.

Surgical

If conservative treatments are not curing the frozen shoulder over a period of time, Dr. Anz will perform arthroscopic shoulder surgery to repair the condition. Prior to surgery, he may attempt a manipulation procedure under anesthesia, where he will force the shoulder joint to move, causing the capsule and scar tissue to stretch or tear. This releases the adhesions and increases range of motion. During arthroscopic surgery, Dr. Anz will attempt to cut some of the tight tissues around the shoulder and relieve the pressure.

Post-Op

Following arthroscopic shoulder surgery, patients will need to adhere to a rehabilitation program as instructed by Dr. Anz. This will involve specific exercises and movements over a distinct period of time. It’s in the patient’s best interest to complete rehab and work with Dr. Anz towards a complete recovery.

For additional resources on available treatment for frozen shoulder, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Dislocated Shoulder and Shoulder Instability

The shoulder joint offers the largest range of motion in the human body. Made up of three bones: the humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone), it is often susceptible to injury because of this great scope of mobility. The shoulder joint is a ball and socket type joint, allowing individuals to perform activities over their head, in front and in back of their body, and using the full rotation that is needed for sports that involve throwing, serving, or overhead function.

The shoulder relies heavily on many soft tissue structures to provide stability: including the muscles surrounding as well as ligaments and the glenoid labrum. With a shoulder dislocation these structures can become injured which may affect subsequent shoulder stability. With a shoulder dislocation, the ball and socket (the humeral head and glenoid) become separated and are not in contact, with the humeral head moving forwards, backwards or downward.

Dislocated shoulders are a common injury among athletes. Individuals who compete in contact and tackling sports such as football, hockey, and rugby are at a higher risk of a dislocation event than non-contact sports. Outside of sports, a traumatic event such as a hard fall can also create this injury. When a young active adult suffers from a dislocation caused by trauma, the risk of a repeat dislocation or future shoulder instability is high.

Symptoms

Symptoms of a shoulder dislocation will vary depending on the severity of the dislocation. Most patients will here a popping sound or sensation, followed by immediate pain. A loss of range of motion will also occur.

Diagnosis

Most individuals who suffer from a shoulder dislocation often have the injury reduced in an Emergency Room, requiring a physician or trainer to maneuver the joint back into place. While this offers a quick fix for the dislocation itself, a thorough physical examination, followed by an X-ray is necessary to evaluate the injury. A MRI should may follow to assess the ligaments and labrum of the shoulder to see if they may have been damaged. Dr. Anz will assess the injury and discuss treatment options and expectations.

Treatment

Treatment for a shoulder dislocation will depend on the severity of the injury. Dr. Anz will take into account the activity level of the patient, including age, number of previous dislocations, and future goals when determining the proper treatment course. If non-surgical treatment is thought to be the best solution, Dr. Anz will recommend ice, rest, immobilization in a sling and physical therapy to help strengthen the nearby structures of the shoulder joint.

Surgical Treatment

Depending on the extent of injury and the number of times of instability, Dr. Anz may recommend surgery. Recurrent dislocations may cause further injury which may increase the chance of further shoulder instability. Arthroscopic surgery can be used to repair the glenoid labrum in episodes of shoulder instability. In some instances, open surgery may be necessary to repair structures and restore stability.

Post-Operative

Following surgery, Dr. Anz will prescribe a thorough rehabilitation program design to restore full function of the shoulder joint. It’s important for patients to understand that for a full recovery, rehab is necessary so that range of motion, strength, and overall mobility can be achieved over time. Most patients are able to resume normal activities within 4-6 months following surgery.

Dr. Anz is an orthopedic shoulder surgeon and sports medicine specialist in the Gulf Breeze/Pensacola, Florida area. If you have sustained a shoulder dislocation, have recurrent shoulder instability, or are seeking additional resources to treat your shoulder pain, please contact our office to schedule a consultation.

Biceps Tendonitis

Biceps tendonitis of the shoulder is an inflammatory condition of the long head biceps tendon that affects the area where the bicep muscle meets the front of the shoulder. This condition is very common among athletes where extra strain is placed on the biceps tendon. There are multiple reasons why biceps tendonitis may exist. Repetitive motion of the shoulder joint and overuse are usually the main culprits. Multi-directional instability and direct trauma of the joint are other causes.

In some instances, biceps tendonitis can be prevented. Consult with Dr. Anz to review your exercise regimen and discuss strategies to care for your shoulder and prevent overuse injuries.

Symptoms

There are several significant warning signs associated with long head biceps tendonitis. This disease process is most often accompanied by pain in the front of the shoulder associated with movement. This pain will be felt when you extend your arm out in front of you or raise your arm above your shoulder. As biceps tendonitis develops, the pain may become more severe, spread over a larger area and be felt throughout the day. Additionally, patients may feel pain when the actual area is touched and complain of pain radiating down toward the elbow. The area may be red or swollen and you could feel a burning sensation. Some patients feel or hear a snapping sound in the shoulder during movement.

Diagnostic Testing

Dr. Anz will examine your bicep muscle and shoulder for signs of tenderness and inflammation and may then order some tests such as X-rays, or MRI to identify any other problems in the area and confirm the diagnosis.

Treatment

Non-Surgical

Biceps tendonitis is best treated by resting the affected area and slowly working back into light movement. Applying ice to the affected area and taking anti-inflammatory medications may help to alleviate the pain and inflammation. In more severe cases, a corticosteroid injection will help to reduce more acute pain for a longer duration.

Surgical

Surgery for biceps tendonitis is usually performed arthroscopically and is only needed in severe cases where a tendon is damaged. In some cases, the damaged section of the biceps is removed, and the remaining tendon is reattached to the upper arm bone in a procedure called a biceps tenodesis. Removing the painful part of the biceps from the shoulder usually alleviates symptoms and restores normal function.

In severe cases, the long head of the biceps tendon may be so damaged that it is not possible to repair it. Dr. Anz may elect to release the damaged biceps tendon from its attachment with a procedure called a biceps tenotomy.

Post-Op

Depending on the nature of the injury and the exact surgical repair used by Dr. Anz, patients will be prescribed a strict set of rehabilitation guidelines to use with a physical therapist. Physical therapy is mandatory in order to return the patient to optimum function. Most patients have good results and typically regain full range of motion and mobility after completing the program.

For additional information on biceps tendonitis, or to learn more about arthroscopic shoulder surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Biceps Tendon Injuries

The biceps is located on the front of the upper arm and is made up of two muscle units that originate from the shoulder and insert on a bone in the forearm. The two units of the biceps are known as the short head of the biceps (which attaches to the shoulder blade at the coracoid), and the long head of the biceps (which attaches to the shoulder blade at the top of the shoulder socket). Biceps tendon injury can occur at one of its attachments on the shoulder blade or its attachment in the forearm. The majority of biceps tendon problems occur in the long head of the biceps tendon near its insertion at the top of the shoulder socket, often referred to as proximal biceps tendon injuries.

Injuries to the proximal biceps can range from an inflamed tendon (tendonitis), to a complete rupture. Injuries of this nature are common among individuals who participate in repetitive shoulder activities that involve the use of the arm above the head. In some instances of repetitive stress and irritation, the tendon can become weak and tear partially, causing fraying. In other instances, the tendon can completely tear from its attachment site. A complete tear may occur suddenly during an activity such as heavy lifting. Proximal biceps tendon injuries are also commonly seen in association with tears of the rotator cuff muscles around the shoulder, which may allow the biceps tendon to subluxate (move out of position) from its normal groove.

Injuries to the biceps tendon at the forearm, also known as distal biceps injuries, occur less frequently. Partial or complete detachment of the biceps tendon can occur from the radius, bone of the forearm where the muscle inserts. Often patients report a pop while using their arm for lifting or while their arm was jerked into a straight position. This is often accompanied by swelling, bruising, and a deformity at the arm.

Symptoms

The most obvious symptom associated with a proximal biceps tendon injury, is pain in the front of the shoulder joint with overhead activity. With documented tendon tears, patients often report a sudden, sharp pain and a “pop” feeling or sensation that occurs when the tendon tears. Most patients will report weakness in the shoulder or elbow depending on the location of injury. Bruising, and a change in the appearance of the front of the arm may occur as well. This bulge results as a result of the altered resting position/tension of the biceps muscle and is often called a pop-eye deformity.

Diagnosis

To determine the proper course of treatment, Dr. Anz will perform a physical examination of the shoulder and arm, and will determine the patients level of pain, function, strength, and mobility. Specific physical exam tests for proximal biceps tendon injuries include the Speed’s test, Yergason’s test, and tenderness over the biceps groove. Specific tests for biceps tendon injury at the forearm include the hook test, passive forearm pronation test, and biceps crease interval test. In addition to specific clinical tests, an MRI to confirm a diagnosis may be necessary.

Treatment

With biceps injury at the shoulder, if the diagnosis is consistent with biceps tendonitis or a strained tendon, Dr. Anz will usually recommend non-surgical treatment measures including rest, ice, anti-inflammatory medication, a change in daily activities that irritate the tendon, and physical therapy. In some instances, an injection into the tendon sheath can help decrease the inflamation/irritation at the tendon. In cases of a complete tear of the tendon at the shoulder, many patients still retain good function without surgery. However, some patients may exhibit symptoms of a deformity and cramping pain. In these scenarios, a biceps tenodesis may be appropriate. This involves surgery to reattach the torn tendon at a different location to alleviate cramping pain and restore a normal arm contour.

With biceps injury at the forearm, partial injuries typically do well without surgery. A period of rest and recovery is necessary. Complete tears of the biceps at the forearm are accompanied by a 30% decrease in forearm flexion strength and a 40% decrease in supination strength of the elbow. For some patients, this decrease in strength is acceptable and function/pain will not be a long term problem. For some patients, surgical repair is important due to their occupations and/or recreations.

Post-Operative

In surgical scenarios, Dr. Anz will limit activities during the first portion of the recovery phase. He will also prescribe a thorough physical therapy rehabilitation program that will detail appropriate progress regarding motion and strengthening exercises. It is necessary to allow time for the tendon to heal to bone. It typically takes 2-3 months before patients can return to their normal functional activities.

To learn more about biceps tendon injuries, or for additional resources on arthroscopic shoulder surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.