Common Shoulder Injuries

Treatments:
  • Arthroscopic Rotator Cuff Repair;
  • Arthroscopic Repair of Glenoid Labrum;
  • Arthroscopic Treatment of Instability;
  • Arthroscopic Subacromial Decompression;
  • Arthroscopic AC Joint Resection;
  • Arthroscopic Biceps Tenotomy
    and Open Subpectoral Tenodesis;
  • Arthroscopic Superior Capsular Reconstruction;
  • Stemless Total Shoulder Replacement or Hemiarthroplasty;

Top Shoulder Orthopedic Surgeon Chicago

For Over 20 years, Chicago Orthopaedic Surgeon, Dr. Gregory G. Markarian, has been restoring patients mobility and lives with his innovations in arthroscopic shoulder surgery. Through exclusive license, of the Single Portal Arthroscopy he uses minimally invasive arthroscopic techniques, instruments and implants to provide better surgical alternatives and outcomes on athletes and weekend warriors.

Shoulder injuries are the most popular reasons why professional athletes (and non-professional athletes) come to our top rated orthopedic practice.

Whatever your shoulder issue is, your first step is to reach out to our medical staff for an initial consultation. Dr. Markarian will be happy to meet with you personally and determine the best course of action to alleviate your shoulder pain.

Diagnostic tests, treatments consultations can often be carried out on the same day. Our top goal is to give you the best treatment and quickly get you on the road to recovery.

Treatment includes rest, medication, physical therapy, corticosteroid injections, and possibly surgery. Dr. Markarian will identify which option is best for you.

Treated Shoulder Injuries:
Shoulder Instability - Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse.Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.

Symptoms
  • Pain caused by shoulder injury;
  • Repeated shoulder dislocations;
  • Repeated instances of the shoulder giving out;
  • A persistent sensation of the shoulder feeling loose, slipping in and out of the joint, or just "hanging".

Bicep Tendon Tear at the Shoulder - Tendons attaches muscles to bones. Your biceps tendons attach the biceps muscle to bones in the shoulder and in the elbow. If you tear the biceps tendon at the shoulder, you may lose some strength in your arm and have pain when you forcefully turn your arm from palm down to palm up. Many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms. If symptoms cannot be relieved by nonsurgical treatments, or if a patient requires complete recovery of strength, surgery to repair the torn tendon may be required.

Symptoms
  • Sudden, sharp pain in the upper arm;
  • Sometimes an audible pop or snap;
  • Cramping of the biceps muscle with strenuous use of the arm;
  • Bruising from the middle of the upper arm down toward the elbow;
  • Pain or tenderness at the shoulder and the elbow;
  • Weakness in the shoulder and the elbow;
  • Difficulty turning the arm palm up or palm down;
  • Because a torn tendon can no longer keep the biceps muscle tight, a bulge in the upper arm above the elbow ("Popeye Muscle") may appear, with a dent closer to the shoulder.

Arthritis of the Shoulder: Simply defined, arthritis is inflammation of one or more of your joints. In a diseased shoulder, inflammation causes pain and stiffness. Although there is no cure for arthritis of the shoulder, there are many treatment options available. Using these, most people with arthritis are able to manage pain and stay active.

Symptoms

Pain. The most common symptom of arthritis of the shoulder is pain, which is aggravated by activity and progressively worsens.

  • If the glenohumeral shoulder joint is affected, the pain is centered in the back of the shoulder and may intensify with changes in the weather. Patients complain of an ache deep in the joint.
  • The pain of arthritis in the acromioclavicular (AC) joint is focused on the top of the shoulder. This pain can sometimes radiate or travel to the side of the neck.
  • Someone with rheumatoid arthritis may have pain throughout the shoulder if both the glenohumeral and AC joints are affected.

Limited range of motion. Limited motion is another common symptom. It may become more difficult to lift your arm to comb your hair or reach up to a shelf. You may hear a grinding, clicking, or snapping sound (crepitus) as you move your shoulder.

Night pain is common and sleeping may be difficult.

AC Joint Arthritis - Acromioclavicular osteoarthritis (AC joint arthritis) is a progressively degenerative disease that cannot be reversed; however, a few steps may be taken to slow the degenerative process and control pain.

Symptoms
  • Pain and/or stiffness in affected joints;
  • Limited mobility in the affected joints.

Shoulder Impingement: One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints combined with tendons and muscles that allow a great range of motion in your arm. Because so many different structures make up the shoulder, it is vulnerable to many different problems. The rotator cuff is a frequent source of pain in the shoulder.

The rotator cuff is a common source of pain in the shoulder. Pain can be the result of:

  • Tendinitis. The rotator cuff tendons can be irritated or damaged.
  • Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
  • Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against ( or "impinge" on) the tendon and the bursa, causing irritation and pain.
Symptoms

Rotator cuff pain commonly causes local swelling and tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.

Beginning symptoms may be mild. Patients frequently do not seek treatment at an early stage. These symptoms may include:

  • Minor pain that is present both with activity and at rest
  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain with lifting and reaching movements
  • Athletes in overhead sports may have pain when throwing or serving a tennis ball

As the problem progresses, the symptoms increase:

  • Pain at night
  • Loss of strength and motion
  • Difficulty doing activities that place the arm behind the back, such as buttoning or zippering

If the pain comes on suddenly, the shoulder may be severely tender. All movement may be limited and painful.

Rotator Cuff Tears - The actual rotator cuff is the group of tendons in the shoulder joint providing support and enabling proper range of motion. Major injury to the rotator cuff tendons may result in tears of these tendons and the condition is called a "rotator cuff tear". It is one of the most common causes of shoulder pain in middle-aged adults and older individuals. It may occur with repeated use of arm for overhead activities, while playing sports or during motor accidents. Rotator cuff tear causes severe pain, weakness of the arm, and crackling sensation on moving shoulder in certain positions. There may be stiffness, swelling, loss of movements, and tenderness in the front of the shoulder. Symptoms

Symptoms
  • Pain at rest and at night, particularly if lying on the affected shoulder;
  • Pain when lifting and lowering your arm or with specific movements;
  • Weakness when lifting or rotating your arm;
  • Crepitus or crackling sensation when moving your shoulder in certain positions.

MENISCUS TEARS

Meniscus tears are some of the most commonly treated disorders in orthopedics, and it is a commonly treated item here at our practice. The most commonly involved comparted is the medial compartment, although the lateral compartment can also have meniscus tears as well. There are tears that resemble a hangnail tear where it is a very simple procedure, and you go in and you basically trim the hangnail. Then there are tears that may require an actual repair. Those are bigger repairs and more often times involved in association of an anterior cruciate ligament tear or a multiligament tear as well, but can exist in absence of a ligament tear. Treatment for meniscus tears is usually operative. It is very important to make sure that there is no concomitant arthritis in the knee joint, so appropriate x-rays are very necessary to obtain as a compliment to the MRI. Typically what the patient experiences is locking, catching or swelling. There are many causes to meniscus tears, any type of twisting of the knee in conjunction with an axial load. So this can occur with getting up from a seated position, such as a chair or in a car, which is a common mechanism. Other mechanisms are in sports, pivoting sports like basketball, soccer or football, can cause that was well. Or everyday activities can cause meniscus tears. Physical examination typically involves inspecting the joints. They may be present with swelling in the knee. Swelling is a secondary finding that usually indicates that there is some sort of pathology or derangement going on within the knee and can be associated with meniscus tears. The exam also will look at the range of motion of the knee and determine whether there is tenderness specifically with palpation along the joint lines. There are two joint lines. There is the inside or medial joint line, and the outside lateral joint line. With palpation of those structures if there is pain, then that is considered a positive finding for a meniscus tear. There are other maneuvers that are performed by the physician or clinician: The Steinman maneuver, and that is typically the knee in 90 degrees and twisting with concomitant palpation. The McMurray sign which basically takes the knee from range of motion and then eliciting either tenderness, clicking or a pop or pain. That can be performed on either joint line. Then pain with hyperextension of the knee is usually indicative of a medial meniscus tear. It is a physical finding that we see with a medial meniscus tear. Treatment, if conservative management has failed within a time period of six weeks, then what is recommended is an arthroscopy. We are the only ones that offer the single portal arthroscopy with the Stryker system. Most meniscus pathologies can be addressed with that system, and there are some advantages to that. Or there is a conventional dual portal system. The procedure for a partial medial meniscectomy takes about 10 to 15 minutes, and then the patient can go home that same day. Then after 4 to 6 weeks of physical therapy they are basically recovered from that injury as long as there are no injuries. For a meniscus repair where a suture would be used to repair the structure, the timeframe is longer. It is about three months of therapy. Those patients again would go home as an outpatient. They would then be in therapy as an outpatient for about three months and would be able to go home after therapy. That is it for meniscus tears.

CHONDRAL DAMAGE

Chondral damage or articular cartilage damage can be seen at the time of arthroscopy and can cause swelling. It is basically that glistening that you see at the end of a chicken bone, and that is damaged. Unfortunately, once it is damaged it is like a crack in a windowpane. The cartilage cells are basically unable to heal themselves, and so as a result the damage can get bigger with time. When it becomes the full thickness of the actual articular surface, or cartilage surface, then that is the definition of arthritis because exposed bone would then be present. In those situations patients have pain with weightbearing. They may have swelling. Their physical findings are nonspecific, but an MRI can show bone marrow edema and damage to the cartilage depending on the quality of the MRI. X-rays may or may not show anything but are very important to rule out advanced disease and should always be obtained in the evaluation. The treatment for chondral damage would be arthroscopy, and it can vary with stem cell techniques. The one that I use is a nanofracture device which is 1 mm in diameter and 9 mm deep, which allows full penetration into the marrow-rich elements to attract stem cells and allow stem cells to basically migrate in that area. I would do that in conjunction with an arthroscopic chondroplasty using radiofrequency energy. If that procedure is recommended as necessary and to be performed, it usually is done in lesions that are 10 x 10 mm and no greater than that. Again, that would be done as an outpatient. They would go home the same day. It would be about a 20 minute procedure. They would have about three months of physical therapy. They would be nonweightbearing for six months and have a postop MRI at three months. The results are usually fairly good with this type of repair of cartilage using marrow stem cells. The other option in lesions that are larger, in patients under the age of 40, would be an osteoarticular allograft transplant, or cartilage transplant. That would basically be a procedure that would be arthroscopic and then arthroscopic assisted with a small open incision where we can actually put in a *dowel of osteoarticular cartilage that matches the donor site where the damage is. We would prepare the area and then implant the cartilage to match the surface anatomically of that area that is involved. That can be done anywhere. That can be done on the medial femoral condyle. It can be done along the lateral femoral condyle. It can be done in the patellofemoral joint. Those procedures are outpatient. Patients are nonweightbearing for six weeks. MRIs are performed at six weeks and at three months, and then they need about three months of therapy and have good results.

PATELLOFEMORAL JOINT

The patellofemoral joint is very common joint that is involved in pain and most often requires conservative management or treatment. There are some indications for operative treatment in the event of patellofemoral instability or chronic patellofemoral dislocations. An arthroscopy can be performed, a lateral retinacular release and then an MPFL reconstruction using allograft, and a small incision can be performed. Again, those are outpatient procedures. The MPFL, or medial patellofemoral ligament, is a check rein to prevent recurrent dislocations. Usually the therapy for that is six weeks in a brace and then postop PT from six to three months. Then after three months they are discharged.

ACL OR ANTERIOR CRUCIATE LIGAMENT

The anterior cruciate ligament is the most common ligament torn in the human body. Oftentimes it is seen in patients that play pivoting sports like basketball, soccer or football. They oftentimes experience a pop and can experience the acute onset of swelling and then have instability as well. On physical examination typically there is swelling, but there may not be swelling, but most often in acute ACLs there is. The patients have difficulty moving the knee in some instances, and if the knee is locked that can be because of the torn stump of the ACL or a bucket handle tear of the meniscus, which can be associated with an ACL tear as well. So it is very important to look for secondary structure damage. Physical exam also would show that there would be a positive Lachman test which is noted, or a positive anterior drawer test, or a positive pivot shift test on exam. The typical treatment is once full range of motion is restored with physical therapy, then the ACL is reconstructed anatomically. For this reason I freehand my femur to make sure that I am at an anatomic point reconstructing the ACL, and I use allograft tendon because that is a fast recovery and does not sacrifice other anatomic structures that in my opinion is very necessary, like the hamstrings or the patellar tendon. Those are necessary structures that should not be sacrificed. From a technical standpoint, it is an outpatient procedure. It takes about 40 minutes to do an ACL reconstruction. The patients go home the same day. They are in therapy for about three months as an outpatient, and then they go to a home exercise program. They are discharged at six months. The PCL is less commonly involved. A lot of times isolated PCL injuries are rare, but can be seen. Their typical presentation is a hyperextension injury with a little bit of swelling and pain. Physical exam would be positive for a posterior drawer test. Again, it is important to get x-rays and MRI. Physical therapy is the initial hallmark treatment, but if patients fail physical therapy and continue to have issues mainly of patellofemoral pain, then a posterior cruciate ligament reconstruction would be performed. It is done as an outpatient with allograft, and they would be in therapy for about three to four months.

ARTGRITIS

Early arthritis of the knee in patients over the age of 40 is a very difficult area to treat. It is very important to know whether there is no joint space collapse, but exposed bone. A lot of times the workup that is needed in these situations would be x-rays, MRI and most likely a failed arthroscopy with associated lesions greater than 10 mm in circumference. Those lesions can be treated in the office with injections such as Supartz or any type of viscosupplementation. Cortisone is only a temporary treatment. There are stem cell treatments, both autologous stem cell treatments that can be done in the office or allograft stem stems, and the Regenokine program is also a very good treatment for early arthritis that is nonoperative. They all have their benefits in terms of their mechanism of action. Early arthritis can be treated surgically with an inlay resurfacing technique. Over the age of 40, biologic treatment of early arthritis does not work very well. The Arthrosurface inlay implant is a very good option in these situations, and I have published reports of this. Not only a second look report that was published in the Journal of Surgical Orthopedic Advances, looking at how the body reacts to the implants over time showing an overgrowth of cartilage on those implants and preservation of that actual joint space, but we also show a high level of return to function. That was presented at the ISAKOS Conference in Leon, France, where we looked at 33 consecutive knees for Worker’s Compensation claims that had failed knee arthroscopies because of the early arthritis that was present in the knee. All those patients had inlay resurfacing implants performed, and 91% returned to work, 65% returned without restrictions. So it is a very good alternative for early arthritis. If patients that have unicompartmental arthritis, then partial knee replacements would be the way to go. In both these instances they are outpatient procedures. In the case of the inlay procedure, they are nonweightbearing versus the partial knee replacement where they are weightbearing. The partial knee replacement gives you a more kinematic knee than a total knee replacement. Less is taken out. There is less bone loss. The literature is now showing that the return to function is good and complications are low.
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