shoulder injury

Shoulder Dislocation: Risk of Recurrence

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X-Ray of Shoulder Dislocation

Recurrent shoulder dislocation, also known as shoulder instability, occurs when the shoulder joint repeatedly slips out of its normal position. Several factors can contribute to an increased risk of recurrent shoulder dislocation. These risk factors include:

  1. Previous Shoulder Dislocation: Once an individual has experienced a shoulder dislocation, the risk of recurrence is higher compared to someone who has not had a previous dislocation. The risk increases further if the initial dislocation occurred at a younger age.
  2. Ligamentous Laxity: Some individuals naturally have looser or more lax ligaments, which can contribute to increased shoulder joint mobility and instability. Ligamentous laxity can be genetic or acquired through repetitive overhead activities or trauma.
  3. Trauma or Injury: High-impact injuries or trauma to the shoulder joint, such as a fall, sports-related injury, or motor vehicle accident, can damage the stabilizing structures of the shoulder, making it more prone to recurrent dislocations.
  4. Structural Abnormalities: Certain anatomical variations or structural abnormalities can predispose individuals to shoulder instability. The “Bankart” lesion or anterior labral tear is the structural damage that results from a dislocation. When the labrum/ligament remains displaced there is a loss of restraint that keeps the shoulder in place. Bone loss from an initial and more commonly repeated dislocations or subluxations increase the risk of recurrent dislocations and may need to be corrected at the time of surgery in addition to repairing torn ligaments. Other abnormalities, such as a loose joint capsule or abnormal bone shapes, can also contribute to instability.
  5. Muscle Weakness or Imbalance: Weakness or imbalances in the muscles surrounding the shoulder joint, particularly the rotator cuff and scapular stabilizers, can disrupt the dynamic stability of the shoulder and increase the risk of dislocation.
  6. Participation in Contact Sports or Overhead Activities: Engaging in sports or activities that involve repetitive overhead motions, forceful throwing, or contact can put stress on the shoulder joint and increase the risk of dislocation. Sports such as rugby, football, basketball, volleyball, and swimming are commonly associated with recurrent shoulder dislocation.
  7. Poor Rehabilitation or Noncompliance with Treatment: Inadequate rehabilitation following an initial shoulder dislocation or noncompliance with treatment protocols can lead to persistent muscle weakness, decreased joint stability, and an increased likelihood of subsequent dislocations.
Bone loss associated with recurrent shoulder dislocation. Glenoid (socket) bone loss leads to smaller surface area for humeral head (ball) to make contact with socket (glenoid).

It’s important to note that while these factors increase the risk of recurrent shoulder dislocation, not everyone with these risk factors will experience dislocations. Treatment options for recurrent shoulder dislocation may include physical therapy, strengthening exercises, bracing, and in some cases, surgical intervention to repair or stabilize the shoulder joint and reduce the risk of future dislocations. Consulting with a healthcare professional, such as an orthopedic specialist or sports medicine physician, can help assess individual risk factors and develop an appropriate treatment plan.

Surgical options I utilize include minimally invasive arthroscopic repairs and open repairs that address that pathology. Treatments are individualized based on the patients activity level, type of sports, age, hand dominance and lesions present.

Example of arthroscopic Bankart or ligament repair for recurrent shoulder instability

ACL Surgery: In The News

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In a recent segment on NBC news I was interviewed about the ACL repair technique I have been performing utilizing the BEAR implant.

Dr Rizio interviewed on WNBC TV (link to interview)

This procedure repairs the injured ACL (Anterior Cruciate Ligament) and avoids the taking a graft from another pert of the knee or use of donor tissue. The procedure is best for acute tears (recent). I am available for consultation to determine which procedure is best for each patients injury.

Press: Article from City Lifestyle Magazine

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See my recently featured article on ACL repair and a new FDA approved implant. I have been performing this procedure and was the first in Northern New Jersey to perform the operation. I hope you enjoy the article.

ACL Repair with BEAR implant

Dr. Rizio performs First ACL Repair with BEAR Implant at Short Hills Surgery Center

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ACL repair has long been considered an operation that will fail. In recent years there has been a renewed interest in repairing the ACL. Based upon new information, a revisiting of old research articles and newer devices has identified tears that may be amenable for repair. Success with repair in the proper patient can be achieved reliably and the native ACL can be saved.

The BEAR technique utilizes a recently FDA approved device to “bridge” the gap in the repair and enhance healing by promoting healing through the use of the patients own blood and growth factors, providing a scaffold for repair and blocking the synovial (joint) fluid from disrupting the repair process. This now allows for an even wider array of tear patterns to be amenable to repair.

Video representation of BEAR procedure (Hold link to open video)

This is particularly exciting for younger, pediatric patients that are still growing. This technique avoids the need to use the patient own tissue and allows for safe repair without as much risk to the growth plate. Dr. Rizio is accepting new patients interested in this technique and also many other sports related injuries. Dr. Rizio sees sports injuries in adult and pediatric patients.

To learn more about the actual device, clink the link below for the company website:

https://miachortho.com

Ambulatory Care Center

200 South Livingston Avenue

Suite 230, West Wing

Livingston, NJ 07039

P: 973-322-7005

City Life Style Magazine – New article

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Check out my latest article. Hope you enjoy and learn some more about my practice!

Orthopedic Sports Medicine Surgeon helping pediatric and adult athletes get back to competing for 20 years

https://citylifestyle.com/morristown-nj/articles/health-and-wellness/dr-rizio

Don’t Shoulder The Pain – Health & Life Magazine

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CHECK OUT A RECENT ARTICLE IN MORRIS/ESSEX MAGAZINE WHERE I AM A FEATURED CONTRIBUTOR ON ROTATOR CUFF DISORDERS

Don’t Shoulder the pain – Health and Life Magazine

Read on – https://www.healthandlifemags.com/dont-shoulder-the-pain/

Don’t Shoulder The Pain – Health & Life Magazine
— Read on www.healthandlifemags.com/dont-shoulder-the-pain/

Clavicle (collarbone) Fractures

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Breaking the clavicle or “collarbone” occurs from a fall or direct blow to the area. Contact sports like football, rugby and ice hockey are common high risk sports. Falls while cycling, skiing and motor vehicle accidents are other common ways to fracture the clavicle. Immediately following the injury patients experience pain, swelling and limited use of the arm. X-rays are usually sufficient to make the diagnosis and initial treatment involves immobilization in a sling and use of ice and over the counter pain medications.

X-ray showing a clavicle fracture that is displaced and in multiple pieces

Treatment can be surgical or non- surgical. Non-surgical management simply lets the fracture heal in the position it is in and includes a period of immobilization. The immobilization period is typically 3-4 weeks until sufficient healing occurs so therapy can begin and pain is decreased. Non-surgical management has been the norm for a long time, however, surgical fixation or repair is gaining popularity for certain injuries.

X-ray showing clavicle plate

Surgical repair can be accomplished with a variety of devices, but usually a plate and screws has some advantages. Repair can align very displaced fractures. When the fracture is very displaced and when fragments shorten or ride over each other patients who are active tend to complain of shoulder pain and sometimes weakness or dysfunction. This can be alleviated with surgical repair. In addition, fracture healing time is shortened with surgical repair and risk of fracture not healing is lessened by surgical fixation. Use of the upper extremity is allowed much sooner following surgical repair.

In summary, clavicle fractures can be managed with or without surgery. Treatment decision is made based on fracture type, displacement and shortening. Patients activity level, age and other risk factors are taken into consideration as well. Below is a short presentation on a clavicle fracture I treated utilizing sutures and a plate to restore the anatomy and fix the fracture anatomically.

Presentation of clavicle fracture treated surgically

Shoulder Pain – Calcific Tendonitis

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Shoulder pain is one of the most common complaints that patients come to my office for on a daily basis. There are many causes of shoulder pain including: bursitis, rotator cuff tendonitis, rotator cuff tears, labral tears, fractures of the shoulder, adhesive capsulitis ( frozen shoulder ) and many others. In this post I am going to focus on calcific tendinitis of the shoulder.

Calcific tendinitis is a common painful condition of the shoulder that results from calcium deposits within the rotator cuff. The calcific material is actually calcium hydroxyapatite. The calcium hydroxyapatite can be present in as many as 10% of people that her asymptomatic, although approximately half of these people will become symptomatic or painful from the calcium deposit. This is a more common condition in women. It commonly occurs in patients between 30 and 60 years of age and can be in both shoulders. There is no known definite cause calcific tendinitis, but the res include degeneration of the rotator cuff, repetitive trauma and injury. Patients with diabetes and hypothyroidism may be at higher risk for the development of calcium deposits in the rotator cuff.

The symptoms can include pain which is often severe and constant, limited motion and difficulty with lifting and reaching away from the body or behind the back. Almost all patients have no history of injury to the shoulder. The symptoms often come on abruptly and the pain seems out of proportion to the lack of trauma. The pain is often on the outside part of the shoulder and can radiate down to the mid arm or lower. However, pain can be more diffuse and poorly localized. An x-ray is usually diagnostic and rarely is an MRI, CT scan or other imaging modality necessary to make the diagnosis. An MRI may be indicated when symptoms are not resolving with proper treatment to look for additional pathology such as a rotator cuff tear.

The symptoms can include pain which is often severe and constant, limited motion and difficulty with lifting and reaching away from the body or behind the back. Almost all patients have no history of injury to the shoulder. The symptoms often come on abruptly and the pain seems out of proportion to the lack of trauma. The pain is often on the outside part of the shoulder and can radiate down to the mid arm or lower. However, pain can be more diffuse and poorly localized. An x-ray is usually diagnostic and rarely is an MRI, CT scan or other imaging modality necessary to make the diagnosis. An MRI may be indicated when symptoms are not resolving with proper treatment to look for additional pathology such as a rotator cuff tear.

  • X-RAY of the shoulder showing a calcium deposit in the rotator cuff
X-RAY of Calcium deposit in the rotator cuff on the left and an MRI image on the right

Treatment of calcific tendinitis includes rest from painful activities, anti-inflammatory medications such as Aleve or Advil or could be a prescribed anti-inflammatory. In addition, ice or and physical therapy/home exercises are often helpful. A cortisone or steroid injection into the shoulder can also be performed to ease pain and improve function. On occasion, more than one injection may be necessary over a several week period to alleviate symptoms. When these methods fail to resolve symptoms there are other methods to try and break up or dissolve the calcium deposit. The methods vary in invasiveness and include ultrasound-guided needle decompression/debridement, shockwave therapy, ultrasound-guided percutaneous micro debridement with a TENEX device and arthroscopic debridement of the calcium deposit. Most patients recover with the need for surgery, below is a video of a calcium deposit removal I performed arthroscopically.

Rotator Cuff

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Shoulder pain is one of the most common complaints seen in the orthopedic surgeon’s office. There are many causes for shoulder pain, but one common cause is disorders of the rotator cuff. The rotator cuff is a group of 4 muscles called the “SITS” muscles, this stands for Supraspinatus, Infraspinatus, Teres Minor and Subscapularis muscles. These 4 muscles work in coordination with each other to provide fine tuning for shoulder stability, motion and strength. Disorders of the rotator cuff could range from bursitis to complete tears. Symptoms can develop due to aging, overuse or acute trauma. The most common cause of rotator cuff damage is due to age-related degenerative changes of the rotator cuff tendons. The incidence of age-related degenerative tearing of the rotator cuff increases every decade of life beginning in the 30s to 40s.

Symptoms of rotator cuff injury can include pain, weakness and loss of motion. Frequently patients complain of pain with lifting the arm above shoulder level, reaching behind her back, reaching to their side and lifting objects away from their body. Pain at night is a frequent symptom and often keeps people awake. After a traumatic event, patients can often have a loss of active motion and strength.

Diagnosing rotator cuff tears begins with a thorough history, physical exam and diagnostic x-rays. While x-rays may not show soft tissue damage, the x-rays will show if there is underlying arthritis, calcific deposits or other bone lesions that could be responsible for the symptoms. The history and physical exam often gives the orthopedic surgeon an idea of the severity of symptoms, duration of symptoms and amount of physical dysfunction from motion loss or weakness. When appropriate, an MRI may be necessary to confirm the presence or absence of a tear.

Treatment of rotator cuff tears ranges from non operative to surgical management depending upon the duration a symptoms, level of dysfunction and pain. Initial treatment with physical therapy or home exercises, possible injection and activity modification is usually the first line treatment for atraumatic rotator cuff symptoms. With these modalities fail to resolve symptoms and a rotator cuff tear is identified, surgical management with an arthroscopic rotator cuff repair and possibly open repair is an option. While many patients with known rotator cuff tears have minimal or no symptoms and normal function, it is generally accepted that approximately half of patients will develop rotator cuff tear enlargement or progression over time. It is important to follow these tears on a regular basis for tear progression even in the absence of symptoms, which could indicate the need for operative repair. It has also been shown that earlier repair of rotator cuff tears has higher healing rates from surgery. The treatment of each patient’s rotator cuff problem should be individualized based upon the patient’s overall activity level, level of symptoms, level of weakness or loss of motion and underlying health of the shoulder joint. Below is a short video of a rotator cuff repair I performed. The video shows an arthroscopic double row rotator cuff repair. I welcome comments and questions and will do my best to answer them for you here!

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