Diagnosis and Treatment of Shoulder Disorders

Diagnosis and treatment of shoulder pain and disorders is a specialty of Dr Michael Boothby and the team at the The Orthopedic & Sports Medicine Institute in Fort Worth. Shoulder disorders are associated with ongoing pain and place limitations on a person’s active lifestyle. The OSMI team provide highly-specialized care in a state-of-the-art facility.

Diagnosing Shoulder Separation

Shoulder separation is a common injury that occurs when the collarbone separates from the upper part of the shoulder blade (acromion). The acromioclavicular joint (AC joint) is where the clavicle meets the highest point of the acromion.

Diagnosing an AC separation will involve a physical examination in which your doctor will most likely:

• Compare the position of the injured arm and shoulder to the uninjured side.
• Feel the bones and soft tissue around the AC joint and between the acromion and clavicle.
• Evaluate range of motion.
• Examine the shoulder to identify a bump or deformity.
• Isolate specific areas of pain and weakness.
• X-ray the area to determine separation or fracture (may include an x-ray of the uninjured shoulder for comparison).

Treatment for Shoulder Separation

Treatment of AC separation depends on the severity of the injury. Shoulder injuries Grades I and II usually do not require surgery, while a Grade III injury can require surgical repair if the injury does not heal properly with other treatments. Shoulder separation treatment typically involves:

• Managing pain
• Supporting the shoulder
• Reestablishing strength and range of motion (physical therapy)
• Pain management usually includes:
• Ice or cold packs: Helps with swelling, reducing pain.
• Sling: Immobilizing the arm for a few days keeps the pain level down.
• Use of non-steroidal anti-inflammatory drugs (NSAIDs): Medications such as aspirin and ibuprofen.

Surgery for Shoulder Separation

An AC separation may require surgery if it is considered to be a Grade III injury which has not responded well to non-surgical treatments, with pain persisting for 2-3 months. Other patients who may be considered for early surgery are:

• Highly active individuals
• Manual laborers whose jobs require heavy overhead work
• Athletes with frequent, stressful overhead movement

Shoulder Arthroscopy

Shoulder arthroscopy is a minimally invasive surgical procedure in which a tiny camera (arthroscope) is used to identify and repair damaged tissue inside and around the shoulder joint. Arthroscopy is a highly advanced technique resulting in:

• Smaller incisions
• Shorter recovery times
• Less pain and stiffness
• Fewer complications

Recovering from Shoulder Separation

Recovering from shoulder separation depends on the severity of the injury and the type of treatment administered. Most patients with an AC separation experience a full recovery, although may have a residual bump left on the shoulder. Typical recovery times are:

Grade I: Approximately 2 weeks

Grade II: Approximately 6 weeks

Grade III: Up to 12 weeks for non-surgical patients

Surgical patients may have longer recovery times with restrictions on lifting and overhead motions for up to 12 weeks. Athletes may be restricted from throwing for 4-6 months. Physical therapy for 6-8 weeks is typical to regain full range of motion.

Diagnosing and Treament of a Frozen Shoulder

Diagnosing a Frozen Shoulder

Frozen shoulder, or adhesive capsulitis, is a condition which causes pain and stiffness in the shoulder joint that gradually worsens over time, making it very difficult to move the shoulder.

Diagnosing frozen shoulder will involve a physical examination in which your doctor evaluates your passive range of motion (someone else moves your arm) and your active range of motion (you move your own arm). A numbing medicine may be used to help determine range of motion.

While frozen shoulder can typically be diagnosed from this exam, your doctor may recommend imaging tests, such as an x-ray or MRI, to rule out the possibility of other causes for the pain and stiffness.

Treatment for Frozen Shoulder

Treatment for frozen shoulder involves pain management and restoration of range of motion. Non-surgical treatments include:

• Medication: NSAIDs or prescription pain relievers and anti-inflammatories.
• Physical therapy: Range-of-motion exercises and stretching to restore mobility. Heat may be used in conjunction with therapy to loosen up the shoulder.
• Steroid injections: Corticosteroid, a powerful, anti-inflammatory agent is injected directly into the joint.
• Surgical treatments may be necessary in some frozen shoulder cases, when non-surgical techniques fail to relieve symptoms. Common procedures include:
• Shoulder manipulation: Performed under general anesthesia, your doctor manipulates the shoulder in different directions, which allows the scar tissue to stretch and tear. This loosening of the tissue can increase range of motion.
• Shoulder arthroscopy: Minimally invasive procedure in which a fiber optic camera and lighted tubular instruments are used to cut through tight portions of the joint capsule restoring range of motion.

Diagnosing and Treament Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs when the tendons of the rotator cuff and the subacromial bursa (sac filled with lubricating fluid) are squeezed between the humerus and the acromion.

Diagnosing Shoulder Impingement

Diagnosing shoulder impingement involves a physical examination by your doctor which may include:

• Muscle tests to determine if rotator cuff is torn
• Manipulation of the arm to identify pain triggers
• X-ray and MRI may be recommended

Treatment for Shoulder Impingement

Shoulder impingement can be successfully treated with:

• NSAIDs: 6-8 week regiment.
• Physical therapy
• Avoidance of repetitive overhead activity
• Corticosteroid injection: If other treatments are unsuccessful.
• Subacromial decompression: In rare cases, a surgical procedure is performed which expands the space between the acromion and the rotator cuff tendons.
• Most shoulder impingement patients recover fully within a few weeks, depending on symptom severity and treatments.

Our goal at OSMI is to provide our patients quality, cutting-edge orthopedic treatments, both surgical and non-surgical.  If you have questions about and would like to schedule an appointment, please submit an online appointment request or contact our office at 817-529-1900.