Jaicharan Iyengar, MD
stocktonshoulder.com

Conditions Treated & Procedures Performed
Shoulder Disorders

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 with motion but also stability of the shoulder. When 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 other joints leading to further injuries. There are many types of rotator cuff tears. Small tears especially those that are not full thickness in nature (with most of the tendon still attached) may be treated with a course of physical therapy and/or injections. If the patient’s condition worsens, surgery may be indicated. Commonly, minimally invasive, arthroscopic techniques are used to repair the rotator cuff tears.

Shoulder instability
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 (especially individuals that are not very active in sports) with instability can be managed without surgery by means of rehabilitation. However, if the patient continues to experience symptoms, surgery may be indicated. This procedure is usually be performed using arthroscopic minimally invasive techniques to repair the torn tissues. In severe or recurrent cases, open techniques are needed to correct the anatomy.

Shoulder arthritis
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 and other injection(s) with stretching exercises can be useful. Surgery is an option when these non-operative treatments do not or stop working. While there are numerous options individualized for each patient (depending on severity of the disease), surgery typically involves either a total (anatomic) shoulder replacement or a reverse shoulder replacement. In general, patients with loss of cartilage but otherwise intact joints are candidates for the total shoulder replacement while those with significant damage to other structures (especially 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. However, it does occur in males also. 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 85% of people with frozen shoulder can be sucessfully treated non-operatively. This typically consists of monitored and routine shoulder stretches. This will be done with the assistance of trained therapists and also on a daily basis at home. In addition of this, cortisone injections are frequently given to alleviate the inflammatory pain and help with the physical therapy exercises. If no improvement is noted within 12 weeks of non-operative treatment, surgery is then indicated. Surgery involves releasing the tights shoulder capsule. This is always done through a minimally invasive arthroscopic technique involving two to three 1 cm incisions. Following this, the patient resumes range of motion therapy the day of or after surgery.

Other common shoulder disorders:

Shoulder bursitis
Impingement syndrome
Calcific Tendinitis
Biceps Tendinitis
Clavicle fractures
Proximal Humerus Fracture
Labral ("SLAP") Tears
AC Joint Dislocation ("Shoulder Separation")
AC Joint Arthritis ("Weightlifter's Shoulder")
Thrower's Shoulder ("Tendinitis")

Procedures Performed:

Shoulder Arthroscopy
Rotator Cuff Repair (Arthroscopic)
Total/Reverse Shoulder Replacement
Biceps Tenodesis (Arthroscopic)
Labrum/Instability Repair (Arthroscopic)
Capsular Release (Arthroscopic)
Subacromial Decompression/Acromioplasty (Arthroscopic)
Distal Clavicle Resection (Arthroscopic)
Clavicle Repair
Proximal Humerus Repair
AC Joint Repair
Ultrasound-Guided Injections
Platelet-Rich Plasma Injection ("PRP")
Stem Cell Therapy (Coming soon - May 2017!)