The shoulder is a complex ball-and-socket joint made up of the humerus (head), glenoid (socket) and the clavicle (collar bone). Of all the joints in the body, it has the greatest range of motion. This allows for the many functions of the shoulder including household, work and recreational activities. The importance and frequent usage of the shoulder predisposes it to many painful conditions. While, we treat the whole spectrum of shoulder injuries, below are descriptions of some of the common disorders.
Rotator cuff tears
The shoulder is made up of four rotator cuff muscles. These muscles are responsible for not only shoulder strength and motion but also stability of the shoulder joint. When the rotator cuff is torn, patients may experience significant pain and/or weakness. Typically, overhead activities may become painful or impossible to perform. As a result of this, patients may compensate with adjacent muscle leading to further injuries. There are many types of rotator cuff tears. Small tears, especially those that are not full-thickness in nature (i.e. with most of the tendon still attached) may be treated with a course of physical therapy and/or injections. In cases of full-thickness tears, or if the patient’s condition does not improve, surgery may be indicated. Dr. Iyengar uses minimally-invasive arthroscopic techniques to repair rotator cuff tears to optimize healing and speed up rehabilitation.
The shoulder joint has the largest range of motion in the body. Subsequently, this extensive motion puts the shoulder at risk of instability. Instability may be a subtle and self-correcting occurrence (subluxation) or a more obvious, painful and non self-correcting experience (dislocation). The degree of instability usually depends on multiple factors such as inciting event or injury, patient anatomy, level of activity, age and gender. Most patients with instability (especially individuals that are not very active in overhead activities) can be managed without surgery with physical rehabilitation. However, if the patient continues to experience symptoms or recurrent instability, surgery is indicated. Dr. Iyengar usually performs this surgery using arthroscopic minimally-invasive techniques to repair the torn soft tissues. In severe or recurrent cases, open techniques may be necessary to correct the anatomy.
Arthritis is the loss of cartilage in the joint. This cartilage cushions the joint and provides an environment with minimal friction. Some loss of cartilage with aging is normal especially in very active individuals. However, in severe cases, the cartilage loss becomes extensive leading to increased friction and bony contact (“bone on bone” arthritis). This can be a very painful and debilitating process. Unfortunately, it usually is a progressive disease. Use of cortisone injections with stretching exercises can be useful in early stages. Surgery can be an excellent option when these non-operative treatments are no longer effective. Dr. Iyengar uses state-of-the-art arthroscopic techniques for restoration of cartilage in cases of early arthritis. Surgery for advanced shoulder arthritis typically involves either a total (anatomic) shoulder replacement or a reverse shoulder replacement. In general, patients with loss of cartilage are candidates for the total shoulder replacement while those with additional damage to the rotator cuff will require a reverse shoulder replacement.
Frozen Shoulder (Adhesive capsulitis)
The shoulder is enclosed a fibrous tissue known as a shoulder capsule. The shoulder capsule is typically pliable allowing for a wide range of motion. In certain instances this capsule become thickened, scarred and inflamed. This is known as a frozen shoulder (adhesive capsulitis). This condition most commonly occurs in females in their 40s, although it does occur in males with less frequency. The cause of this disease is not fully understood. However, we do know that it can be associated with trauma, diabetes and thyroid diseases. The diagnosis can typically be made based on the history and physical exam. When unclear, or if other disorders are suspected, further imaging such as an MRI maybe obtained. Over 80% of people with frozen shoulder can be sucessfully treated non-operatively. This typically consists of ultrasound-guided cortisone injections, and monitored shoulder stretches. This will be done with the assistance of trained therapists and also on a daily basis at home. Dr. Iyengar performs cortisone injections using precision ultrasound-guidance to ensure accurate placement in the shoulder capsule and to alleviate the inflammatory pain and help with the physical therapy exercises. If no improvement is noted within 3 months of non-operative treatment, surgery is then indicated. Surgery involves releasing the scarred shoulder capsule. This is always done through a minimally invasive arthroscopic technique involving three 1-cm portal incisions. Following this, the patient resumes range of motion therapy the day of or after surgery.
Other common shoulder disorders:
Proximal Humerus Fracture
Labral ("SLAP") Tears
AC Joint Dislocation ("Shoulder Separation")
AC Joint Arthritis ("Weightlifter's Shoulder")
Thrower's Shoulder ("Tendinitis")
Rotator Cuff Repair (Arthroscopic)
Total/Reverse Shoulder Replacement (Now Computer Navigated!)
Biceps Tenodesis (Arthroscopic)
Labrum/Instability Repair (Arthroscopic)
Capsular Release (Arthroscopic)
Subacromial Decompression/Acromioplasty (Arthroscopic)
Distal Clavicle Resection (Arthroscopic)
Proximal Humerus Repair
AC Joint Repair
Platelet-Rich Plasma Injection ("PRP")
Stem Cell Therapy (Coming soon - May 2017!)