We don’t think it will happen to us - but it’s got to happen to someone - that’s just the way it is - statistics don’t lie.

A study led by Dr. Steven B. Cohen, assistant team physician for the Philadelphia Phillies and reported on the website Science Daily, revealed the following:

• 45% of baseball players who have shoulder or elbow surgery were able to return to their previous level or higher
• players who had elbow surgery were more likely to reach their previous level of play or higher than players who had shoulder surgery
• for AA, AAA or major league players, only 18% were able to make the comeback

Prevention is the Key to Long-Term Success

The study was also reported on in the Tucson Citizen, where Cohen and co-author of the study, Dr. Gerard Varlotta said, “stretching and strengthening exercises are key for preventing injuries in professional - and recreational - players.”

Take the time to warm-up and cool-down, stretch and strengthen your shoulder.  It could make all the difference for you and your shoulder.

A separated shoulder is usually the result of:

• a fall onto an outstretched hand (my separated shoulder occurred as the result of a fall while skiing)
• a direct impact to the shoulder (often seen in football, rugby, lacrosse, or any other contact sport / activity)

(photo used courtesy of Neil Rickards)

Dr. William Pennington has been one of the developers of a new arthroscopic technique which results in less pain and less scarring. This procedure is specially designed to treat shoulder separations that are at least three months old.

Shoulder Separations are Distinguished by Severity of the Injury

The following data is used courtesy of Wikipedia – Shoulder Separation

Type I

A Type I AC separation involves trauma to the ligaments that form the joint, but no severe tearing or fracture. It is commonly referred to as a sprain. Most doctors treat this type of dislocation with anti-inflammatory drugs, pain medication and the placement of the arm in a sling or an immobilizer.

Type II

A Type II AC separation involves complete tearing of the acromioclavicular ligament, as well as a sprain or partial tear of the coracoclavicular ligaments. This often causes a noticeable bump on the shoulder. By pressing on the sternal aspect of the clavicle you force the acromial end down, and by releasing, watch it pop back up (eliciting a piano key sign due to the tearing of the AC ligament)[3]. Severe pain and loss of movement are common. Treatment is typically an arm sling, bedrest, ice and heat therapy, and anti-inflammatory drugs. Most people recover full motion of the shoulder and arm within 6 to 8 weeks, often with the assistance of physical therapy.

Type III

In a Type III AC separation both acromioclavicular and coracoclavicular ligaments are torn. A significant bump is formed by the lateral end of the clavicle. This bump is permanent. The clavicle can be moved in and out of place on the shoulder. It may take 12 weeks to heal, and physical therapy can be beneficial. It may take even longer for the shoulder strength to approach feeling normal. The injured shoulder may not be able to take the abuse that it could previously, but for most purposes it will be quite usable and sufficient. However, there still is controversy as to whether or not surgery may be necessary for optimal shoulder use in sport.

Type IV

This is a type III injury with avulsion of the coracoclavicular ligament from the clavicle, with the distal clavicle displaced posteriorly into or through the trapezius. This injury is generally acknowledged to require surgery.

Type V

This is type III but with exaggeration of the vertical displacement of the clavicle from the scapula. This injury generally requires surgery.

Type VI

This is type III with inferior dislocation of the lateral end of the clavicle below the coracoid. It is extremely rare and generally only involved with motor vehicle collisions. This requires surgery.

A Short Video Explaining Shoulder Separation and Treatments

No one realizes how much they depend on their shoulder – that is until they’ve injured their shoulder, have surgery and can’t use it. Frequently people want to know how long their particular shoulder injury will take to heal.

Answers that don’t help.

Imagine that you’ve sprained your shoulder and you want to know how to treat this injury. You could look at these suggestions for your shoulder information. However, these comments are the thoughts and advice of laymen who may or may not know what they are talking about.

Here is a thread from the Injury Update Forum that seeks to answer the question – How long will it take to recover from shoulder reconstruction?

Here is a discussion on the issue of How long to heal from a dislocated shoulder that resulted from being hit by a car.

Would you let your friend work on your $40,000.00 automobile?

It should be obvious by now that everyone has an opinion about everything – including your shoulder injury. But who are you going to trust with the care of your most versatile joint? Where can you find credible shoulder information? What you need is believable information about your shoulder and there are a number of sources that are quite extensive.

See a Doctor – an Orthopedic Surgeon who specializes in Shoulder Repair!

(photo courtesy of soldiersmediacenter)

Visit Shoulderdoc – this is a vast web site filled with:

• Medical Educational Material – What’s the difference between SLAP, SLIP and SLOP? Do you want to purchase a book about shoulders? This is the place to look.
• The Latest Shoulder News – Do you want to read about the latest research in shoulder surgery techniques or shoulder rehab?
• Rehab Protocols – this is an immense section of information about shoulder rehab procedures.
• Much, much more.

Shoulderdoc offers a wealth of information on all aspects of your shoulder. Use this web site to educate yourself.

- - -

“Thanks to the rotater I was able to get back to work and not lose the use of my shoulder in this demanding profession.”
- Officer D. Pesko

Smoltz believes rehab will start soon – by Mark Bowman

Smotz, who went on the disabled list on April 26^th due to inflammation of his rotator cuff and biceps tendon plans to throw from the mound for the first time this Saturday. read Mark Bowman’s article on MLB.com

Rangers’ Bradley out with a sore shoulder

Milton Bradley, the designated hitter for the Texas Rangers was pulled in the 7^th inning of Monday nights game with the Mariners due to a sore shoulder and probably will not return to the line up until Friday.

Prior takes step back in rehab – by Jon Greenburg

The latest on Mark Prior was that is that he was scheduled to undergo an MRI this past Monday to access the condition of his shoulder. Jon Greenburg reports that there is the possibility of a trip to Birmingham Alabama to see Dr. James Andrews, the prominent orthopedic surgeon who performed arthroscopic surgery on Mark in 2007. read Jon Greenburg’s article

Schilling throws from 60

Amalie Benjamin reported that Curt Schilling threw from 60 ft. this past Sunday (May 11th), though Andrew Johnson notes that Schilling “had a sizeable bag of ice” on his shoulder on Tuesday (May 13th).

Schilling’s last blog post entitled Getting the ‘go ahead’ which he posted on May 6^th seemed guarded. Schilling said that he feels healthy and confident, but the “doing it” still had to be done. Personally, I hope he “does it”.

Posada rehabbing in Tampa with Alex Rodriguez

Yankee catcher, Jorge Posada is in Tampa at the Yankee training facility where he played catch this past Monday while rehabbing his inflamed rotator cuff. Tyler Kepner reports that he will be out until at least early June.

It’s springtime.  The days are longer.  The sun is brighter.  And the world is becoming more alive all around us.  Makes me want to get physical and start teaching my girls how to throw a softball (or baseball), ride our mountain bikes and horses. 

(photo courtesy of foxypar4)

The problem is that although my mind is willing, my body may not be ready – (No! – that is not me in the photo). 

How to avoid stupid injuries

What else would you call them?  I mean, once you hit middle age it’s time to do a little prep work before you do something stupid.  Bruce Mandelbaum (a frequent guest on “The View” and “The Today Show”) wrote an outstanding “get ready for physical activity” article entitled Spring into Spring (but not too hard): A Guide to Avoiding Injuries. 

It’s all about using common sense.  You didn’t get out of shape in a couple of days and your shoulder won’t be ready to throw a fast ball (hard or soft) in a couple of days either.  Take it slow and warmup.  Your kids may make fun of you and be a little restless, but that’s a small price to pay for a pain free shoulder.

How long should you wait to train following a Shoulder Separation?

For me, it was a long time before I went back to hitting the iron.  There are all sorts of issues to deal with.  Some physical and some mental.  You don’t want to start too soon and destroy your orthopedic surgeon’s hard work.  But for a physical person it’s hard to get out of the habit of being physical. 

Dave Draper, the bodybuilding legend was asked a similar question on his web site – davedraper.com.  His advice on this topic it great, but I really love his closing quotes:

“Overall training will bring you back to full power and speed in time. Injury and recovery have a weird way of complementing the musclebuilder….Confidence will grow with exercise-injury understanding and muscle strength and shoulder health.”

The Effect of Ergonomics on Shoulder Pain

It’s no longer a secret – you should be somewhat comfortable when you work.  Now the words “work” and “comfort” are seldom used in the same sentence, but for a person who spends a great deal of their time working from a desk, this concept is important. 

I have been sitting in what I thought was a comfortable chair – but I’m not comfortable.  My shoulders and neck ache and my arms hurt.  After watching the video below that I found in an article posted by Dr. Edward Gould entitled “Pain at Work”, I think there may be a better way. 

Watch this video – I’ll be looking for the Freedom Chair and accessories.

(photo by RubyVrooom and used under this creative commons license)

The construction of the shoulder joint allows it to be the most mobile joint in the body. You can do incredible things with your arms and hands because of the way our shoulders are designed.

• You can throw all kinds of things. If you can grasp it and lift it, then you can throw it.
• You can lift items in front, to the side and over your head.
• You can pull yourself up – if you are strong enough.

The downside is that in order to be the most mobile joint, some stability is sacrificed. The ball of the upper arm bone rests in a very shallow socket called the glenoid. When this ball (of the humerus) is caused to become dislodged from the socket, then the shoulder is said to be dislocated. It can be quite painful and your range of motion will be limited.

Controversial surgery proving effective for young athletes

According to a public release put out on March 8, 2008 by the American Orthopaedic Society for Sports Medicine, a recent study indicates that young athletes who go through a first-time shoulder dislocation and have arthroscopic surgery to repair it are experiencing greater long term benefits than those patients who take the more conservative, non-surgical approach.

The study was performed on young military cadets who are required to be very physically active. If your child is less active, then the conservative non-surgical approach may be a better option.

(photo by PamelaVWhite – creative commons)

Always consult a qualified physician.

Tags: shoulder+dislocation, shoulder+surgery

My rotator is torn

I experienced a torn rotator while pitching during a pony league baseball game when I was fourteen. I knew right away that something was wrong, but it wasn�t until the following day that I realized that I may have done permanent damage when I could not even mimic a throwing motion without excruciating pain.

At that time (the late �70�s), shoulder surgery for a young high school athlete was not even considered. Fortunately, my shoulder healed and it was not until my senior year (1979) that I succeeded in tearing my rotator again. Up until that point, I had dreams of a college scholarship and possibly a professional career.

Shoulder surgery is common today

Today, shoulder surgery is common. I know of countless people who have had some form of shoulder surgery or another. It remains the most viable option for shoulder repair � UNTIL NOW!

Stem cell procedure may be the answer to surgery

WATCH THIS VIDEO � Dr. Chris Centeno, using the Regenexx procedure, extracts stem cells from the bone marrow in a patients hip, multiplies those stem cells in the lab to increase the total number of stem cells and then injects the patients own stem cells back into the patients damaged tissues.

Results have been promising and patients are are spreading the news of their experience with this new procedure.

The shoulder is a complex joint made up of three bones:

• the HUMERUS � the upper arm bone
• the SCAPULA � the shoulder blade
• the CLAVICLE � the collar bone

The scapula has a shallow socket called the glenoid, which the ball of the humerus fits into. The union of these bones is referred to as the glenohumeral�joint or shoulder-joint. (To see a very good animation � click here)

Shoulder Dislocation

When the glenohumeral joint is disrupted, the humerus loses contact with the glenoid and results in the condition known as shoulder dislocation.

Shoulder Separation

The uppermost part of the scapula (shoulder blade) is known as the acromion. The union of the clavicle (collar bone) and the acromion is called the acromioclavicular joint or AC joint. When this joint is disrupted, a shoulder separation / AC separation results.

Shoulder separations classified by severity of injury

Shoulder separations are classified according to the severity of the injury. You may hear it described as different levels, grades, types or degrees of separation.

All joints are held in place by ligaments (extremely tough, tissue structures that connect bone to bone). In the AC joint, one set of ligaments forms the joint capsule around the AC joint (this is known as the acromioclavicular ligament). Two other ligaments connect the clavicle to a bony protrusion of the scapula, called the coracoid process. These are called the coracoclavicular ligaments.

• TYPE I � there is a partial tear of the acromioclavicular ligament (AC ligament), with no change of the position of the clavicle (collar bone).
• TYPE II � there is the rupture of the AC ligament and partial tearing of the coracoclavicular ligament with some change of the position of the clavicle (collar bone).
• TYPE III � there is the rupture of the AC ligament and coracoclavicular ligament, definite upwardly displaced clavicle.
• TYPE IV � there is posterior (rearward) displacement of the clavicle, behind the AC joint.
• TYPE V � there is an upward displacement of the clavicle, puncturing muscle tissue.
• TYPE VI � there is a downward displacement of the clavicle, which becomes lodged beneath the acromion or coracoid process.

TYPE I and TYPE II separations are the most common types of AC separations and rarely require surgery.

TYPES IV, V and VI are rare injuries and commonly result in surgical repair.

TYPE III separations are the most controversial. They are fairly common, but there is still some debate as to whether surgery is the �right� treatment, though surgery may be recommended for high level throwing athletes. Some feel that the joint will heal without surgery if the injury is managed properly.

Surgery for a TYPE III separation usually involves relocating the AC joint and repairing the torn ligaments. The clavicle will also be secured, either by screw or possibly goretex tape, until the ligaments have had sufficient time to heal. If a screw is used to secure the clavicle, then it is normally removed within eight weeks of surgery.

In the event that you are faced with a TYPE III AC separation, consult with your physician about the pros and cons of surgical and non-surgical treatment. Ask about:

• possible physical restrictions you may face
• mobility issues
• the strength of your shoulder
• possible future complications
• your rehabilitation time
• any possible risks

• the development of scar tissue within the joint
• lack of use
• both

In all likelihood, you don�t throw a baseball, softball or football as much as you did in the past. Or, maybe you don�t work around the house hanging wallpaper, painting, doing carpentry or any of the things you used to do that required you to use your shoulder throughout it�s full range of motion.

In my case, this condition was a byproduct of shoulder surgery. Following surgery, I was required to have my shoulder immobilized for an extended period of time. This lack of movement for a considerable amount of time, resulted in a diagnosis of �frozen shoulder�. My orthopedic surgeon recommended physical therapy.

At this point, my curiosity was stimulated. I wanted to know more about adhesive capsulitis, so I did some research. I found out that �frozen shoulder� is most prevalent in women who were middle-aged and older. This was very sobering to me since I thought that I was a fairly healthy man. My ego was crushed to find out that I had a condition that most commonly occurred in women.

All jokes aside, �frozen shoulder� affects nearly everyone (man or woman) who has shoulder surgery because the joint must be immobilized and stabilized to reduce the chances of damaging your newly repaired shoulder.

The logical course of action to regain your range of motion involves your participation in a program of physical rehabilitation. This process of physical rehab can be long, tedious and painful � the variables being:

• your willingness to work hard during your recovery/rehabilitation
• the amount of time you invest in performing your exercises
• your desire to regain the full use of your shoulder
• your pain tolerance

Physical therapists are some of the nicest people you will ever meet, but they have a job to do. Regardless of what you may think, they take no pleasure in causing you pain and you will experience pain during the rehab process. But it is necessary and it is the only way for you to regain your range of motion. This is a small price to pay for a fully functioning shoulder. Be sure to thank your therapist.

I suffered another blow to my ego when I started some basic flexion exercises. My physical therapist handed me a pink dumbbell. I thought to myself, �I am six feet tall and weigh two hundred and twenty pounds. I need a manly colored dumbbell.� My physical therapist explained to me that the pink dumbbell weighed only one pound and the �manly� colored dumbbells started at about seven or eight pounds.

So, I started with the pink one � I wasn�t even strong enough to lift it � especially laterally (out to the side). I had to work with the pink one for a long time. I couldn�t wait to advance to the purple one, which was right before the pastel green one.

I was always glad to finish my dumbbell exercises so that I could start on the pulleys. I was able to control this motion and provide a smooth, gentle stretch. This actually felt good.

After all the exercises were completed, I had to get on the physical therapist�s table and hope that they were in a good mood ( no family squabbles and no speeding tickets on the way to work � just happy). I wanted them as calm, relaxed and happy as possible. As I stated earlier, your PT�s job is to help you regain the mobility of your shoulder. This process involves them manipulating your joint in order to break up the scar tissue. There will be some discomfort involved.

Most of the time, you will be given a prescription that allows you to see your physical therapist three times per week. Since there is only so much that can be done in only three visits per week and there is only so much discomfort that you can stand during each visit, the rehab process can be lengthy.

If you are in this predicament and are looking for a way to speed up the process, have your therapist go to www.therotater.com and check out the shoulder rehab device video. Ask you physical therapist if you could benefit from using the Rotater during your off days.

Physical rehabilitation can be a long process, but the rewards are worth it. The ability to use your shoulder as it was intended and to do the things that you want to do without limitations is priceless.

For many years following high school, my shoulder would bother me by becoming painful again. Sometimes this was the result of overuse and other times it resulted simply from how I positioned it during sleep. There was discomfort, but not bad enough to see a doctor. It was always short-term, never lasting more than a day or two. After a couple of days, my shoulder would be back to normal.

Then, following a motorcycle wreck, I had a reason to see an orthopedist. Though surgery was an option, we tried to allow the shoulder to heal without resorting to it. But, this was not to be the case.

After several months, the bones had not healed as they should have and it became necessary for my doctor to perform a surgical procedure to re-break the bone and insert a bone graft. It was during my recovery from this that I began the long process of physical therapy.

By the time that I was finished with rehab, my shoulder was not back to 100% – it was about 110%! I had forgotten what it felt like to be completely pain-free. Now, my shoulder never bothers me – it doesn’t matter if I sleep on it or if I use it all day long. I couldn’t believe that I had tolerated the pain and discomfort for 25 years.

My repaired shoulder felt better that my undamaged shoulder!

Two years ago, while racing in Florida, I sustained another shoulder injury from another motorcycle wreck. I know it sounds funny now, but all I could think about while laying on the ground, holding my shoulder, was “I’m fixing to have two good shoulders”. I knew that this injury was going to require surgery and that following the rehab process, it would be better than new.

Having said all this, I’m not saying that you should or shouldn’t have surgery. That is a decision that only you can make. What I am saying is that if your orthopedist recommends surgery, then get a second opinion. If the diagnosis is confirmed, then do some more research to find the best possible surgeon available – like I did.

My surgeon was Dr. Godsil who practices at the Auburn Orthopedic Clinic in Auburn Alabama. Because of my hobby (motorcycle racing), I’ve kept Dr. Godsil busy with a lot of broken bones. Dr. Godsil has always done a wonderful job of putting me back together.

Research the surgery, ask questions, ask for references and find the absolutely best surgeon available. Surgery was the best option for me. I owe my newfound quality of life with two pain-free shoulders to my orthopedic surgeon – Dr. Godsil.