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About Shoulder Injuries

The shoulder is the most mobile joint in the body. It consists of three bones: the humerus, scapula, and clavicle. It also consists of many muscles and tendons that hold the shoulder bones in place and stabilize the arm through its full range of motion. Each shoulder is held in place by a group of four muscles and tendons, called a rotator cuff, which covers and protects the humerus and lets you raise and move your arm.
Normally, the shoulder has a wide range of motion, making it the most mobile joint in the body. But because of this flexibility, it is not very stable and is easily injured.

Common Injuries of the Shoulder:

1. Shoulder Instability:
Shoulder instability happens most often in young people and athletes. When muscles and ligaments that hold it together are stretched beyond their normal limits, the shoulder becomes unstable. Treatment includes rest, physical therapy, or surgery.

2. Sprain :
A shoulder separation, or sprain, happens when the ligaments that hold the clavicle to the acromion tear; the clavicle is pushed out of place and may form a bump at the top of the shoulder. Sprain causes severe pain, a misshapen shoulder, and decreased shoulder movement. Treatment depends on the severity of the sprain and may include ice compress to help ease pain and swelling, keeping the arm in a sling to limit the movement of the shoulder, physical therapy exercises and sometimes surgery.

3. Dislocation :
Falling onto an outstretched hand, arm or the shoulder itself, or a violent twisting, can cause the shoulder bones to tear, causing inability of the bone to hold the joint together. The main symptom of dislocation is pain that becomes worse with movement. Competent Orthopedists like Dr Arunava Lala takes urgent care and treat dislocations by using gentle traction to pull the shoulder back into place.

4. Rotator cuff tear:
As people age and are less active, tendons start to degenerate and lose strength which can lead to a rotator cuff tear. Middle-aged or older adults who already have shoulder problems may develop this due to falling or lifting/catching a very heavy object with an extended arm. Symptoms include tenderness and soreness when using the shoulder, inability to raise the arm and not being able to sleep lying on that side.
Treatment depends on the severity of the injury. If the tear is not complete, your orthopedist may suggest RICE (rest, ice, compression, and elevation). Resting the shoulder is probably the most important part of treatment. But after the pain has eased, you will need to start physical therapy to regain shoulder movement. The orthopedist may prescribe a non-steroidal anti-inflammatory drug (NSAID) for pain.

5. Separation:
This injury affects the joint where your collarbone and shoulder blade come together. It’s called the acromioclavicular (AC) joint. A fall or hard blow tears the ligaments holding it together. If your collarbone gets pushed out of place, you’ll have a bump on top of your shoulder.

6. Fracture:
A bone can break or crack if one falls or get badly hit against a hard surface.. The most common breaks are to the clavicle (collarbone) and the humerus and can be very painful

7. Cartilage tear:
The cartilage that goes around the rim of your shoulder joint may be torn due to repetitive motion, a fall or anytime your shoulder absorbs a lot of force. With this type of injury, you might feel pain and weakness when you reach over your head, It might also feel like it’s catching, locking, or grinding.

8. Frozen shoulder:
Abnormal bands of tissue (adhesion) build up in the joint and keep your shoulder from moving freely mainly due to pain or surgery have made you use it less.

9. Impingement:
This happens when the tendons of the rotator cuff get pinched in the bones of the shoulder due to repeated lifting of arms over the head. It can cause swelling and pain

10. Bursitis:
The bursa (a fluid-filled sac that cushions in your joint) can get swollen and irritated due to repeated motion, a fall or another injury.

Other Causes of Shoulder Pain

• Osteoarthritis: Also called degenerative joint disease, this is the most common form of arthritis. It can affect any joint, including your shoulders. The cartilage between bones breaks down, and they rub together. This can cause pain and stiffness.

• Rheumatoid arthritis: This is a disease that causes your body’s immune system to attack the protective lining in your joints. It can also cause pain and stiffness in your shoulders.

• Tendinitis This is when the tendons that make up your rotator cuff get inflamed. It can happen slowly over time or as the result of a fall or a direct hit to your shoulder.

• Bone spurs. Also known as “osteophytes,” these small, smooth pieces of bone rub up against and wear on your rotator cuff and keep your shoulder from moving the way it should. They can lead to tendinitis or a rotator cuff tear.

Diagnosis :
The orthopedist will start with a physical examination, check the strength and flexibility of the shoulder, get X-ray/ MRI / CT Scan / EMG done as needed and advise treatment.

Treatment :
For dislocations, separations and fractures, you need a doctor’s help to get your shoulder back in the right position and then a sling to hold it in place while it heals.
For many other issues, your doctor may suggest rest, heat or ice and a medicine like ibuprofen or aspirin to reduce the pain and swelling.
If your shoulder doesn’t improve after these first steps, your doctor may try injecting a corticosteroid (an anti-inflammatory medicine) straight into the joint to relieve swelling and pain.
Sometimes cartilage tears, rotator cuff tears and frozen shoulder don’t improve with rest and medicine. Your doctor may recommend surgery.
With any problem in your shoulder, your treatment plan will probably include exercises to help you stretch and strengthen the joint, and to improve your range of motion.

Here are some cases of Dr. Arunava Lala

86 yr old man with a mid shaft fracture humerus and a radial nerve palsy…. followed up after 6 months…. with united fracture and near to full range of pain free motion and no residual Neuro vascular deficit!!

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