Amit Sahasrabudhe 2013-07-31 12:29:36
Shoulder Anatomy & Common Injuries Dr. Amit Sahasrabudhe is a board certified orthopedic surgeon specializing in sports medicine surgery and fracture care at the Arizona Sports Medicine Center (www. asmcmd.com). Dr. Amit is one of the team physicians for the Arizona Cardinals, Phoenix Coyotes, Colorado rockies, and Chicago Cubs. He also takes care of several local area high schools. In addition to taking care of athletes and their families, his practice focuses on independent medical examinations for worker’s compensation cases as well as personal injury. He currently holds active medical licenses in Arizona and new Mexico. For more information or to get in touch with Dr. Sahasrabudhe, please feel free to call ExamWorks at (866) 800-4637. ANATOMY The shoulder is a ball and socket joint, made up of two bones—the humerus and the scapula. A portion of the scapula is the glenoid, which is the socket. Lining the ball and socket is normally a smooth, shiny, white layer called articular cartilage. The cartilage can be thought of as a brake pad in your car—even without an accident, it wears and thins out over time. Surrounding the socket is the labrum, a ring of cartilage, like the rubber ring on a blender - it acts as a bumper to help prevent the shoulder from dislocating. If you imagine this cartilage ring as a clock, the biceps tendon attaches at 12 o’clock. The rotator cuff is made up of four tendons and their muscles, attaching on the edge of the ball, allowing you to move your arm around in multiple directions. COMMON INJURIES Fractures - while bones are typically strong, fractures of the humerus and scapula do occur. Even a low-energy injury, such as a ground-level fall, can be enough to cause a fracture. Fortunately, the majority of fractures involving the shoulder can be successfully treated without surgery. Dislocations & labral tears - the most commonly dislocated joint in the body is the shoulder. This is because the socket is fairly shallow and the shoulder can move in multiple directions. Given the right amount of energy, anything from a ground-level fall onto an outstretched arm to an automobile accident can cause a shoulder dislocation. In dislocation, the ball “pops” out of the socket, often causing a tear of the labrum. Upon relocation, the back of the ball may hit the front of the socket, creating a Hill-Sachs lesion, or divot in the bone and cartilage. These divots can often be managed nonsurgically; on the other hand, the larger the labral tear, the more likely one is to dislocate in the future, even without a significant new injury or trauma. Since the labrum is made of cartilage, it does not heal once injured or torn. After an initial dislocation, studies indicate that recurrent dislocations are more frequent in younger people. Therefore many labral tears are treated with arthroscopic surgery, to reattach the labrum to the socket. A relative contraindication to labral repair is the presence of arthritis. It should be noted that trauma causing a labral tear does not immediately cause arthritis. In other words, after trauma, if immediate X-rays / MRI show a labral tear and arthritis, it is possible that the labral tear was caused by the trauma. The arthritis, however, was most likely already present, i.e. pre-existing. Rotator cuff tears - there are two types of rotator cuff tears: traumatic and degenerative. Traumatic tears tend to occur in younger individuals, while degenerative tears are often related to the natural wear and tear process. It should be noted that a relatively low-energy mechanism of injury superimposed on degenerative (weakened) rotator cuff tissue may be enough to cause a tear. It is also important to recognize that people with rotator cuff tears may continue to do certain activities of daily living because it may not involve overhead lifting of the arm (for example driving a car). In a physiologically young or active person, surgery may be warranted to fix the rotator cuff. SLAP tears - SLAP stands for superior labrum anterior posterior. It is basically a tear of the labrum from 11 o’clock to 1 o’clock, encompassing the biceps anchor. As a result these patients often have biceps pain. Often these injuries can be treated successfully without surgery. In an overhead athlete or young, active person, a SLAP repair may be appropriate. In older individuals or in those that conservative management fails, surgery consisting of either a biceps tenodesis (reattachment) or tenotomy (cutting) is reasonable. There are certainly other injuries of the shoulder and variations to the ones listed above. When in doubt, consult a physician.
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