Torrance Orthopaedic & Sports Medicine Group
Physical, Hand & Aquatic Therapy
23456 Hawthorne Blvd.,
Torrance, CA 90505-4716
OPENING FALL 2017!
May 31, 2017
Shoulder Injury + Recovery = A LONG TIME
The shoulder is notorious for taking a long time to heal after an injury, even if the injury isn't considered severe. It's a complex joint with several muscles, tendons, and bones, and it has a generous range of motion. All of these factors make it extremely vulnerable to injury.
People of all ages are susceptible to shoulder pain, and it's the most injured joint. Pain can develop over time or from a sudden event. Athletes fall into both categories because overuse (weights, baseball, football, volleyball, etc.) can lead to pain just as easily as a sudden injury (collisions, falls, overextension). No matter how the pain got there, get medical attention. With the shoulder, sooner is best because even a small tear won't heal by itself. It will only get worse if ignored, never better.
Seeing a doctor early can help avoid a full-tear repair surgery that could be followed by as long as 18 MONTHS of recovery. Partial-tear repair surgery is slightly less than that. Recovery from nonsurgical procedures is usually closer to 4-6 months—still a long time, but better than the year-plus or year-and-a-half alternatives.
Recovery begins with many weeks of immobilization, many more weeks of "passive" (therapist moves your arm for you) then "active" (you move your own arm) therapist-guided exercises, and finally, several weeks or months of self-guided exercises. Assuming you chose the right doctor, stick to the recovery program, and don't re-injure your shoulder, you'll likely get great results after all this.
A board certified orthopedic surgeon specializing in shoulder repair is the best choice for properly diagnosing and treating shoulder pain. Because of the complexity of the shoulder area, choosing the right surgeon, whether you need surgery or not (about 90% don't), is crucial to minimizing recovery time and maximizing results. An "expert" needs to have this key combination: excellent medical training AND experience treating patients with a wide variety of shoulder issues. Our practice has doctors who are true experts in the shoulder area.
October 26, 2016
"Ouch—I feel an electric shock down my arm!"
Nerves that are trapped or damaged send painful or tingling distress signals to the brain. Many different conditions in the shoulder or arm can cause these symptoms. However, a distinct electric shock feeling running through the shoulder down to the hand is called a burner or stinger. It can only be caused by a few things.
1. Most commonly, athletes in contact sports suffer from burners and stingers. Football players who get tackled to the ground onto their head and shoulder, or wrestlers who get "taken down" onto their head/shoulder/neck area are often affected.
2. Any kind of other accident or trauma that forcefully pushes the head and neck to the ground or a hard surface can also be the culprit: a bicycle or auto accident, for example.
These first two scenarios do the same thing to the nerves in the neck. By forcefully squishing the head down and sideways against something hard, the head stretches away from the arm and shoulder. The nerves connecting them get stretched too far and start sending pain signals. These signals can last for a few seconds, minutes, hours, or even days. If they last for days or become more frequent or worse, it's time to see an orthopedic doctor.
3. Anyone who hasn't had trauma but is still experiencing burners and stingers should also head to the doctor because spinal problems can also cause this type of pain. Neck pain, prolonged weakness, or stinging and burning in both arms may also be cause for concern.
A board certified orthopedic doctor specializing in sports medicine or the shoulder and arm area is the best medical option for properly diagnosing and treating pain from burners and stingers. He or she will start by asking questions and may order x-ray or MRI imaging to rule out other possibilities, depending on the situation. Physical therapy may be prescribed to help with strength and motion.
March 14, 2016
Did "Popeye" need an orthopedic doctor?
The 1960's cartoon sailor was famous for "popping" his biceps up after consuming a can of spinach. To an orthopedic doctor, however, he looked like the next patient about to walk in the door. Anyone whose biceps tendon has just torn, or popped and curled up is probably in a lot of pain. That damsel in distress will have to wait...sorry, Olive Oil!
The biceps are the strong upper arm muscles on the inside of the arm. They can tear or detach at the elbow or shoulder after a trauma such as falling on an outstretched arm, throwing something with great force, or lifting something too heavy. Overuse can also cause a tear or rupture of the biceps, especially if the patient uses the arm and shoulder for a lot of overhead motions. This means that the older a person is, the higher the risk for this type of injury.
The symptoms of a biceps tear or rupture are usually obvious to a good orthopedic doctor:
• loss of strength in the biceps
• pain/difficulty turning the palm up and down
• a "pop" sound at the time of injury
• sharp pain at the time of injury
• pain, bruising, and swelling after
• cramping of the biceps when strained
Treatment depends on a patient's lifestyle needs. Sometimes less active, older patients don't need to regain full strength in the arm. If this is the case, the biceps may be left alone. In time, the muscles will atrophy (shrink) from lack of use, and the arm will still work but remain weaker than it was before. After the initial injury, the pain is managed until it goes away, and no further intervention is likely needed. Patients who need to regain strength should see an orthopedic doctor right away, as the muscles can be difficult to treat or reattach if left damaged too long.
September 10, 2015
"Do I really need elbow surgery?"
If an injury or painful condition in your elbow doesn't get better with treatments such as rest, activity modification, injections, and physical therapy, you may be a candidate for elbow surgery. Although TOSMG orthopedic doctors are able to treat most elbow problems without surgery, it still sometimes turns out to be the smartest option.
The good news is that many procedures can be done with an arthroscope, which is a small camera inserted into the elbow through a small incision. Other small incisions are made in the area to insert surgical instruments. Because there is less cutting due to the smaller instruments, recovery is faster, there is less bruising, bleeding, and swelling, and the procedure itself is often faster than traditional open surgeries. Some of the most common elbow arthroscopy procedures treat:
• rheumatoid arthritis
• tennis elbow
• range of motion problems
• pain caused by bone fragments or loose cartilage
When elbow arthroscopy cannot be performed, an open procedure may be recommended. Some conditions that usually require open surgery are:
• multiple or complex fractures
• golfer's elbow
• elbow joint replacement
• damage to collateral ligaments (on the sides of the elbow joint)
Multi-faceted elbow problems may be treated with both arthroscopy and open surgery for the different issues.
A board certified, experienced orthopedic doctor who specializes in the elbow is the best resource for successful elbow treatment. Seeing a doctor who wants to help you meet your sports and lifestyle goals is key to any orthopedic treatment plan. Only you and your doctor can decide what's best for you.
August 18, 2015
Grating, Clicking, Pain, and Weakness in the Shoulder
These symptoms are common in many types of shoulder injuries, but the shoulder can be damaged in several ways. It takes an attentive orthopedic doctor specializing in shoulder problems to make the right diagnosis. Shoulder tears in the glenoid labrum are one common cause of shoulder pain. The glenoid labrum is soft tissue attached to the socket part of the shoulder. It provides extra stability for the ball part of the joint, keeping it from popping out of the socket too easily and allowing the shoulder to move in many different directions.
Specific symptoms of a glenoid labrum tear may include:
• Pain when raising the arms overhead
• Noises such as clicking and popping
• A sensation of the shoulder locking up or getting caught
• A feeling of instability in the joint
• Pain during rest or everyday activities
• Weakness in the shoulder
• Inability to fully move the shoulder in all directions
The glenoid labrum can tear in more than one direction. Symptoms are different depending on the direction. Pain from a tear can happen gradually from repetitive motion, or it can be the result of a sudden injury.
These and other factors make it important to see an experienced orthopedic doctor to get a proper diagnosis. He or she may take different types of images to see what's going on. X-rays won't show soft tissue tears, but they can rule out other causes of pain. MRI or CT scans can but don't always show a small glenoid labrum tear, but arthroscopic surgery, where the doctor inserts instruments and a camera into the shoulder through small incisions, is the surest way to a definitive diagnosis.
Although a tear will not fix itself, strengthening the muscles around it can improve symptoms enough to relieve the pain. Anti-inflammatory medications and activity changes can also help. If those treatments don't work, arthroscopic surgery may be necessary. The doctor will trim the tear away and in some cases add stability with hardware or sutures.
July 9, 2015
A "Pop" Sound and Severe Pain at the Elbow
Men over age 30 have the highest risk of rupturing the biceps tendon at the elbow. This can happen when trying to lift up a box that's too heavy and straining the biceps to a state of extreme overload when the arms are straight, causing the tendon to suddenly disconnect from the forearm bone. It can also happen when forcefully throwing a heavy object. As soon as the arm outstretches to let the object fly, the overloaded/hyperextended biceps can pop off the bone. Most biceps ruptures tear completely away from the bone, although a small number only tear partially.
At the time of injury, there is severe pain. Swelling and bruising become visible shortly after. The biceps roll up the arm into a coil at the top near the shoulder, where a lump can be seen. It's important to seek medical attention when these symptoms occur. An evaluation can confirm the diagnosis, and an orthopedic doctor can review the different treatment options available:
ELECTING TO NOT HAVE SURGERY
Patients who are older or sedentary, in consultation with their orthopedic doctor, may elect not to have surgery. Patients whose health cannot endure having a small-to-medium surgery may also need to forego it. The arm can still function without the biceps attached. Turning the palm from down to up with any kind of force won't be possible, and the arm will lose a third or more of its strength. The arm can heal without surgery, but the biceps tendon will not restore itself. It will stay rolled up near the shoulder, shorten, and become less visible. By not having surgery, the patient needs to understand that the damage and reduced strength to the arm is permanent.
WAITING TO HAVE SURGERY
This is not recommended. The biceps tendon shortens and scars within 2-3 weeks after the injury. Surgical outcomes after this point are not as good and surgeries have more complications.
ELECTING SURGERY IMMEDIATELY
Active patients will likely want the biceps repaired. An orthopedic doctor specializing in the elbow and arm (upper extremity) is the best choice for a surgeon. He or she will likely be the most experienced with biceps tendon ruptures, since it's not a common injury. The surgeon will reattach the biceps tendon using metal hardware or stitches threaded through drilled holes in the forearm bone. Rehabilitation after surgery is gradual. The patient is often in a sling or cast at first, but moving the arm begins soon after surgery. Physical therapy is usually necessary. Healing from the surgery takes about 90 days, and it can be six months or more before the biceps tendon regains full strength.
June 19, 2015
"My shoulder hurts when I lift my arm above it!"
There can be many reasons for this type of shoulder pain. One common cause is calcific tendinitis. This condition happens when a lump of calcium forms on one of the tendons in the shoulder area. Besides pain from lifting the arm above the shoulder, it can also be painful to lie on that shoulder. The pain can disrupt sleep and activities.
If you see your orthopedic doctor with these symptoms, he or she will perform a thorough physical examination of the shoulder and talk with you about previous injuries or strains to your shoulder and about your physical habits and athletic activities. It's also likely that your doctor will take x-ray and MRI images, both of which can show calcific deposits.
The body concentrates calcium in the wrong place for a few different reasons, and researchers haven't pinpointed any single reason for calcific tendinitis. Not surprisingly, without a definitive cause, there is also no single treatment that will work for everyone. Some people respond to a temporary reduced-calcium diet. Others find relief with sound-wave therapy. Still others may do well with medications and physical therapy. This treatment program can lessen inflammation and improve the biomechanics of shoulder movement. The calcium lump stays but the pain may be reduced or eliminated.
The most successful treatment for most people with calcific tendinitis who do not respond to the conservative therapies above is slightly more invasive. An orthopedic doctor anesthetizes the area and inserts an ultrasound-guided needle to poke holes in the deposit. As the calcium breaks up, the doctor aspirates it from the deposit area. Some studies have shown that 75% of patients are significantly helped with this procedure.
May 7, 2015
"It hurts to lean on my elbow!"
The tip of the elbow is naturally padded so that when you lean on a tabletop or crawl on your elbows, it doesn't hurt. But after prolonged leaning or crawling, pain can set in. This can take many months or even longer. People who lean on their desks all day and plumbers and heating/air technicians are especially at risk for developing pain in the elbow.
The pointy bone at the tip of the elbow is called the Olecranon. A bursa, which is a slippery sac with a small amount of lubricating fluid in it, supplies padding between the bone and the skin. When too much pressure is applied to the area, the bursa fills with extra fluid and becomes larger, inflamed, and sometimes infected. This is what causes the pain. The condition is called Olecranon bursitis.
• Swelling at the tip of the elbow
• Pain when leaning on the elbow
• Pain when bending the elbow
• Swelling that limits elbow motion
• Elbow skin becomes red and warm (infection)
• Pus coming out of an elbow wound (infection)
• Prolonged leaning on elbows
• Elbow injury such as a traumatic blow
• Rheumatoid arthritis
• Bone spur or loose bone or cartilage fragment at the tip of the elbow
• Insect bite, scrape, or puncture wound that allows bacteria to enter and infect the bursa
The right treatment for Olecranon bursitis depends on what's causing the bursa to swell. An infection may require the doctor to extract fluid from the bursa to determine what type of antibiotics to prescribe. If the doctor suspects a bone spur or loose fragment is causing the condition, he or she may order an x-Ray. When prolonged pressure on the elbow has caused the bursa to swell, treatments such as elbow pads, activity modification, and medications can be helpful. Cortisone injections may be an option for pain that persists after other anti-inflammatory medications have failed.
Sometimes conservative treatments don't work. In those cases, your doctor may recommend surgical removal of the bursa. A new bursa will grow in its place after a few months. Loose bodies and bone spurs can also be removed surgically, allowing the bursa to return to normal function.
An orthopedic doctor specializing in elbow and arm problems is well equipped to give the right diagnosis and treatment for Olecranon bursitis. Together you can create a treatment program that works with your needs and the needs of anyone who may be caring for you while your activities are restricted or you're recovering from a procedure.
March 13, 2015
Elbow Problems Need Expert Follow-up
Did your elbow land you in the emergency room or urgent care? If it did, the doctors there probably identified the major problems with it before sending you home. The more subtle problems that can cause trouble down the line may not have been on their list or presenting at all, though.
Soft tissue damage, nerve damage, and other seemingly small issues can develop into bigger ones, leading to elbow instability and other painful conditions later on. An orthopedic doctor who specializes in detecting these subtleties before they become serious can put you on the right track to healing properly. Early detection makes a big difference.
February 13, 2015
"My shoulder makes popping and clicking sounds!"
Not every pop or click is cause for concern. A shoulder that's cold and tight may just be making some cracking sounds as it warms up, releasing gas from the joint (like knuckle cracking). In this case, as the shoulder becomes warmer and looser, the sounds usually go away.
As people age, the chances that osteoarthritis is causing those sounds becomes more common. The first signs of the condition may be just clicking, snapping, or popping sounds and no pain at all. Osteoarthritis can and often does become a painful condition, though, and seeing an orthopedic doctor/surgeon for advice on how to slow its progress or relieve the pain is a good idea. In the early stages of osteoarthritis, the doctor can prescribe non-invasive remedies such as exercises, activity modification, and icing to strengthen the shoulder and keep inflammation and pain at bay for longer.
Shoulder noises can also be a result of a minor cartilage tear or a problem with the muscles in the shoulder. If pain radiates in either direction, the arm can't be lifted above the shoulder, or normal motions and exercises cause pain, see the doctor. These symptoms often indicate an injury that will get worse, not better, without treatment.
December 29, 2014
Tennis Elbow Develops Gradually
This is a painful condition almost always caused by overuse, commonly in sports such as tennis but also among anyone stressing a particular forearm muscle—the extensor carpi radialis brevis (ECRB)—repetitively. Plumbers, painters, cooks, carpenters, auto workers, and cooks are all at a higher risk of developing tennis elbow than the rest of the population. Those between the ages of 30 and 50 are diagnosed most often, but anyone can get it.
Because the ECRB tendon gets inflamed and/or damaged, symptoms include burning or pain along the outside of the elbow and a weak grip, especially when doing the activities that caused the condition. A weak handshake is also common.
An orthopedic doctor specializing in the hand and elbow areas is best qualified to diagnose tennis elbow. He or she will perform a physical exam, use imaging, and sometimes electromyography (nerve testing) to arrive at the correct diagnosis.
Most people get relief from tennis elbow without surgery. A combination of treatments such as rest, physical therapy, anti-inflammatory medications, activity modification (correcting an improper tennis stroke, for example), equipment modification, bracing, and steroid injections may help. An orthopedic doctor may recommend surgery if these treatments do not return a patient to health within a reasonable amount of time. Surgery can almost always be done on an outpatient basis.
October 16, 2014
A "Slipping" Elbow
When an elbow joint has become unstable, it may feel like it's sliding out of place, or it may pop or feel like it catches when moving it in certain ways. Previous elbow surgery, an elbow deformity, or in most cases, a fall on an outstretched hand are the most common causes of elbow instability.
An orthopedic doctor is well-equipped to properly diagnose elbow instability. During an exam, he or she will typically:
• Take a medical history
• Ask about any falls or physical trauma
• Move the elbow in many directions, looking and listening for various symptoms
• Test arm strength
• Rule out nerve damage
• Rule out conditions other than elbow instability
It's common for the orthopedic doctor to take an x-ray because they are so effective at showing subtle misalignments, fractures, and dislocations. An MRI is not always necessary to properly diagnose elbow instability, but if the doctor determines he or she needs a closer look at the elbow's surrounding soft tissues, the MRI will enable that.
Most cases of elbow instability can be treated with a nonsurgical prescription of physical therapy, medications, activity modification, and/or bracing. If there is a fracture or severe soft tissue injury, surgery is usually required. Athletes with less severe instability but who need to perform at high levels may require surgery to get them back to full function.
December 1, 2014
"My shoulder pain is getting worse!"
When Shoulder Replacement Becomes an Option
When shoulder pain keeps you from doing a favorite sport or activity, sometimes taking a break or trying something new is best. An orthopedic doctor may also recommend physical therapy, injections, ice, or medications that reduce inflammation. But shoulder pain that's still getting worse and starts to keep you from everyday activities such as reaching into overhead cabinets, caring for yourself, or sleeping well should send you back to the doctor.
Patients with this severe type of pain may be candidates for shoulder replacement surgery. There are many reasons shoulder replacement is an option. Arthritis caused by aging, injury, or inflammatory conditions can lead directly to the destruction of the shoulder joint. Trauma that shatters the bones in the shoulder joint or issues that disrupt the blood supply to the bones may also compromise the joint beyond the scope of conservative treatments.
The decision to have shoulder replacement surgery is made by the patient and patient's family. It's based on the orthopedic doctor's thoughtful recommendation after careful study of the patient's current health problems, health history, imaging and other test results, and when appropriate, consultation with the patient's other doctors. The goal is to get the patient as free from pain as possible and back to doing what they love to do.
Because the shoulder is a very complex joint, many patients opt for a board certified, fellowship trained surgeon who specializes in shoulder problems. The shoulder doctors at Torrance Orthopaedic & Sports Medicine Group are trained in the most current minimally invasive shoulder replacement techniques. This is key to helping speed recovery and reducing any risks during and after surgery.
September 18, 2014
"My shoulder feels 'loose'!"
Shoulder Dislocation and Instability
Athletes or anyone who performs overhead repetitive motions with their arms can be vulnerable to shoulder problems like dislocation (ball pops out of the socket) or instability (shoulder joint moves slightly in and out of the socket), feeling "loose." Volleyball players, swimmers, racquet sport players, baseball players, and double-jointed people are especially prone to these conditions. Trauma victims can also get these types of shoulder injuries. Once instability or dislocation happens, it's more likely to happen again because the tendons and ligaments around the joint have been stretched beyond the normal range or damaged. Nerve damage can also occur.
Instability symptoms may include:
• Joint feeling like it is moving around too much
• Swelling, numbness, weakness, and bruising
Dislocation symptoms may include the above, plus:
• Severe pain while the joint is dislocated
• Observing that the ball of the joint is not in its socket
A shoulder can become dislocated in a forward, backward, or downward direction. If you pop the shoulder back into joint yourself, tell your doctor which direction your dislocation happened in, and whether you have dislocated it before.
Your orthopedic doctor will do a thorough physical examination and take images of your shoulder to find out how damaged your shoulder is. Once that's clear, he or she will design a treatment program to get you back to health. In most cases this will involve one or more of the following: temporary or permanent activity modification, anti-inflammatory and/or pain medicine, injections, and physical therapy. More severely damaged shoulders may require surgery to repair tendons and structures that cannot be rehabilitated by conservative treatments.
August 7, 2014
"My elbow is locking up..."
Cartilage injuries in the elbow typically happen gradually with repetitive stress. Sometimes, though, injury to the cartilage occurs after an impact. It's common to feel a locking sensation when bending the elbow back and forth, described by most patients as if there's "something in there not letting the joint move." Tenderness and swelling in the joint are common, too.
Treatment for this type of orthopedic condition is arthroscopic removal of the loose cartilage fragments or cartilage repair. The arthroscope and surgical instruments are small, so the incisions for the surgery are minimal. This allows shorter recovery time and faster return to activities compared to traditional surgical techniques. Surgery outcomes are good to excellent. Physical therapy may be necessary to get range of motion back and to help with post-surgical pain and swelling.
July 16, 2014
SHOULDER PAIN: Does a tear need surgery?
The upper part of the shoulder socket has a ligament called the SLAP ligament (Superior Labrum Anterior to Posterior). It stabilizes the long head of the bicep tendon and keeps the ball joint in place in its socket. Damage to the SLAP ligament most often results in shoulder pain and weakness. Activities like throwing a ball or reaching overhead become especially difficult.
• Sports related activities that involve repetitive ball throwing
• Lifting a heavy object
• Falling on an outstretched arm
An arthrogram, MRI and arthroscopy along with physical special manual tests are the most reliable means of diagnosing a SLAP tear. Treatments depend on the severity of the tear and the patient's health and lifestyle. Physical therapy is recommended for all types. Small, stable tears may be left to heal on their own while unstable ones may require surgical reattachment or removal.
June 5, 2014
Elbow Expectations: Stressed Elbows Are More Likely to Develop Osteoarthritis
Osteoarthritis is common as we age, especially in weight bearing joints like the hips and knees. Even though elbows are the least likely joint to succumb to this often painful condition where the cartilage deteriorates, they're not immune. Prior elbow injuries are the usual culprit that cause elbow arthritis. The ligaments surrounding overworked elbows tend to destabilize over time, resulting in more wear and tear on the elbow cartilage. Professional baseball pitchers and tennis players, and people doing hard physical jobs often complain of elbow problems related to osteoarthritis.
• Loss of range of motion
• Numbness in outside two fingers
Conservative treatments include physical therapy, activity modification, pain medications, corticosteroid injections, and joint fluid improvement injections. There are many surgical options for those who do not improve after trying conservative treatments: arthroscopy, elbow replacement, contracture release, and surface renewal are among the most successful.
May 6, 2014
Scapula Fractures: You may remember the ride in the ambulance...
Because the scapula (shoulder blade) is surrounded by several muscles, it typically does not get injured. Scapula fractures account for just 1% of bone fractures. A high impact force such as a motor vehicle accident or a fall from high up usually causes a scapula fracture. Many additional injuries often accompany the fracture because of the extreme force to the body. A full medical exam and imaging of all the tissues and bones surrounding the scapula may be performed as a result.
• Pain with arm movement
Treatment for scapula fractures includes placing the arm in a sling and gradually initiating physical therapy to avoid developing a frozen shoulder and elbow contracture. It's not normal for treatment to involve surgery, but depending on the severity and location, it may be warranted.
March 20, 2014
Piercing Finger, Hand, or Elbow Pain?
Radial tunnel syndrome occurs when the radial nerve is entrapped in the supinator muscles, which are the muscles helping to rotate the forearm. This condition is common with people who play racket sports like tennis and with spin bowlers.
• Pain around the elbow when resistance is placed on the middle finger during extension (straightening)
• Cutting, stabbing, and piercing pain at the back of the hand or top of forearm
An orthopedic doctor can correctly diagnose radial tunnel syndrome by conducting a thorough physical exam. Images are usually taken to rule out other possible problems.
Stretching, technique modification, physical therapy, and neoprene bracing are common treatment methods. More severe symptoms may require surgery to reduce pressure on the affected nerve.
February 26, 2014
Shoulder pain? Visible bump on top of the shoulder? See an orthopedic doctor...
Acromioclavicular Dislocation (AC) is diagnosed when the collar bone and shoulder blade become separated from each other. It can be caused by a blow or fall that tears or damages the ligaments that hold the two bones closed. Contact sports, falling on the ice, falling on an outstretched arm, or having an impact on the point of the shoulder blade, such as when being launched over the handlebars of a bicycle, are common situations reported to cause AC.
There are six grades of AC dislocation, one being the least severe and six being the most.
• Pain when moving the arm overhead or sleeping on the injured shoulder
• Popping sound when joint is moved
• Visible bump on the top of the shoulder
• Weight of the arm pulls shoulder down
The vast majority of AC injuries can be treated non-surgically. This includes the use of a sling, cold packs, anti-inflammatory medications, and completing a physical therapy program.
In the less common cases of severe injuries, surgery may be required to either shave the end of the collarbone or reconstruct the ligaments. The goal of surgical and non-surgical treatments is to restore and rebuild range of motion, strength, and flexibility.
December 16, 2013
Surgery Is Rare with Clavicle Fractures
Clavicle (collar bone) fractures are usually easy to diagnose as most patients remember hearing a 'crack' to describe the sound they heard when the fracture occurred. There is typically bruising, tenderness, and sometimes a deformity that can be seen or felt. Other symptoms include local swelling and pain over the clavicle.
These fractures are common among young athletes, with sports like ice hockey, cycling, riding, and rugby. Depending on the severity of the fracture, treatment can include the use of a sling for 6-8 weeks. In severe cases, surgery may be necessary (plate and screws). Physical therapy is often necessary to restore function.
October 18, 2013
Rotator Cuff Tears: painful, weak shoulders
The rotator cuff is a group of tendons that allow the muscles to lift and rotate the bone of the upper arm. The location of the tendons under the shoulder blade make them very vulnerable to damage.
CAUSES & SYMPTOMS: Damage to the rotator cuff can be caused by an injury such as a fall. It can also be damaged by overuse, poor circulation around the cuff, and/or a gradual weakening of the shoulder tendons.
As people age, it is normal for the rotator cuff tendon to wear and degrade, resulting in a painful, weak shoulder.
With a damaged rotator cuff, it may be difficult and/or extremely painful to lift or rotate the arm with the same range of motion as before the injury. Pain is also very common at night, often radiating down the arm.
TREATMENT: A physician may prescribe therapy to strengthen the muscles and provide pain relief. In some cases, the physician will recommend a rotator cuff repair. This involves stitching the torn tendon onto its attachment to the arm bone. After the repair, the physician will prescribe therapy to assist with shoulder mobility, pain relief and strengthening.
October 8, 2013
Many Ways to Treat Shoulder Pain from Bursitis
Within the shoulder, the fluid-filled bursa sac sits between the tissues and provides cushioning. Bursitis happens when the bursa and the rotator cuff tendons get compressed between the bones of the shoulder. Left untreated, this chronic impingement can lead to fraying and eventually tearing of the rotator cuff tendons.
• Repetitive impact
• Poor postural awareness
• Pain and weakness of shoulder muscles, especially when using the arm overhead
• Limited shoulder mobility, such as trouble reaching up and behind the back
Bursitis can also appear in the hip, knee, and elbow.
• Anti-inflammatory medication
• Cortisone injection
• Physical therapy: massage, ultrasound, interferential current, range of motion exercises
• Surgery in some cases
September 23, 2013
Do orthopedic surgeons always want to operate?
An orthopedic surgeon is first and foremost a medical doctor who helps patients get better. Most of the time that doesn't mean actually having surgery. The doctors at TOSMG estimate that for every patient who comes to them with orthopedic problems, less than 1 in 10* will actually have surgery. So what happens to the rest?
Physical therapy, rest, ice, anti-inflammatory medications, changing habits, injection therapy, and stretching are among the most common prescriptions for our patients. It's only when a combination of these more conservative treatments fail that surgery may be suggested. But the simple fact is that most people get better without it.
*Estimate only. Does not include patients who are referred for a surgical consultation, meaning that another doctor has already determined, and that the TOSMG doctor agrees, that the patient needs a highly trained, expert orthopedic surgeon in order to get the best outcome.
September 3, 2013
Thoracic Outlet Syndrome
Thoracic outlet syndrome is a general term used to describe brachial plexus disorders, or problems with the nerves and blood vessels that extend from the spine through the shoulder joint. The condition usually arises when these nerves and blood vessels sustain an injury, or when they become compressed as they pass over the first rib.
Symptoms often include:
• numbness and tingling in the fingers and arm
• muscle weakness
• poor posture
• diffuse arm pain at night
• pain that radiates from the neck towards the face
If you have any of these symptoms, see an orthopedic doctor to get an accurate diagnosis before beginning any type of treatment. Physical therapy is a conservative form of treatment during which postural training, stretching, strengthening, and work ergonomics can be addressed. Doctors may prescribe anti-inflammatory medication. If conservative management fails, surgery may be needed.
June 28, 2013
Adhesive capsulitis (frozen shoulder)
Adhesive capsulitis is a disorder in which the shoulder capsule and the connective tissue surrounding the joint becomes stiff and inflamed. Many patients are often frustrated because of the level of pain and the lengthiness of the recovery. This condition can last up to 24 months. Approximately 70% of frozen shoulder patients are women, although males with frozen shoulder seem to take longer to recover.
• Lung disease
• Connective tissue disorders
• Heart disease
• Shoulder pain, usually constant and may increase at night; painful activities include hair care and reaching for the seatbelt
• Restricted mobility in shoulder
TREATMENTS FOR THE THREE PHASES
1. Freezing - Painful Phase
Goal: Reduce pain and maintain mobility in the shoulder
• Ultrasound or iontophoresis to reduce inflammation
• Passive range of motion (therapist moves the patient) to assist with mobility; effective way to prevent adhesions (tissues stuck together) and maintain current range of motion
2. Frozen - Stiff Phase/Pain Decreases
Goal: Increase mobility in the shoulder
• Joint mobilization
• Active and passive motion
3. Thawing - Less Painful Phase
Goal: Continue to improve mobility in the shoulder
• Strengthening exercises
• Manipulation by a doctor under anesthesia if mobility still restricted; can help break up adhesions and scar tissue
Please contact Torrance Orthopaedic & Sports Medicine Group with any of your orthopedic needs, where caring for families in the South Bay is our privilege.
January 21, 2013
Did you know that tight muscles can cause headaches?
Chronic muscle tension can be due to bad posture, whether sitting, standing or walking in ways that put unnecessary stress on the body. Work habits such as cradling a telephone between the shoulder and ear, hunching over a computer keyboard or a forward head are common causes of muscle tension.
We are often unaware of how we contract these muscles because the actions become part of our habits. Continued muscle tension can lead to ongoing irritation of the nerves that lead to the head, and to chronic headache. Proper body mechanics offer new movement options to replace the poor postures. Physical therapy, aerobic exercise, and biofeedback can have strong headache-relieving effects. These are all good preventative measures that our knowledgeable TOSMG physical therapy team can show you. Talk to your physician about trying physical therapy as a conservative alternative.
December 7, 2012
Rotator Cuff Tears
The rotator cuff is a group of muscles that allow the arm to lift and rotate. A tear in one or more of the tendons can lead to a painful, weak shoulder. When the tendons or muscles of the rotator cuff are torn it may be difficult to lift and turn/rotate the arm with the same range of motion as before the injury. A tear can occur suddenly (trauma) or develop gradually over time. Other causes include a fall on an outstretched arm, poor blood supply to an area of the cuff, overuse, and gradual weakening of the tendons of the shoulder. Pain is also very common at night, often radiating down the arm.
Depending on the severity of the tear, surgery may be necessary. A complete rotator cuff tear will not heal on its own. Surgery is usually required if the patient's goal is to return to optimal function. Your doctor may prescribe physical therapy to help regain range of motion as well as strength. There is a possibility that your strength may not return to 100% after the tear.
July 13, 2012
iPad's have become a staple in many of our lives. Sometimes as modern technology advances, this can affect our general health. Many of recent iPad users have reported neck or shoulder pain, otherwise known as the "iPad shoulder." To prevent an "iPad shoulder," be aware of your posture and body mechanics when using the device. Just like a desktop computer, your iPad should be at eye level and a keyboard may be a great option to maintain proper body mechanics. Every few hours, stand up and stretch. One stretch that may be helpful is standing at a doorway and placing your shoulders and elbows at 90 degrees (similar to a goal post) and gently step one foot forward through the doorway. The name of the game – good posture and good mechanics with all electronic devices to prevent pain.
June 29, 2012
The shoulder joint is very susceptible to discomfort and injury because of it's large mobility and complexity. Poor posture and overuse are leading causes of shoulder pain.
A few tips: