The Shoulder Center

Rotator Cuff Tear Treatment and Surgery in Wayne, Paramus, and Parsippany NJ

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Shoulder Arthritis, Arthroscopy & Replacement in Wayne, Paramus, and Parsippany NJ

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Frozen Shoulder Treatment and Surgery in Wayne, Paramus, and Parsippany NJ

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Clavicle Fracture Treatment and Surgery in Wayne, Paramus, and Parsippany NJ

The clavicle, also known as the collar bone, is an S-shaped bone that connects to the sternum.

Clavicle Fracture (Collar Bone Fracture)
The clavicle is an S-shaped bone that connects to the sternum medially and to the scapula laterally. A clavicle fracture can occur from direct trauma or falling onto the shoulder or arm. It is not uncommon to see clavicle fractures in cyclists, snowboarders, or football players who have fallen onto the shoulder. The fracture can occur anywhere along the length of the bone although it most commonly occurs in the middle portion of the bone.

Most athletes that have suffered a clavicle fracture will present with pain over the clavicle and a history of trauma. There may be tenting or pushing up of the skin over the fracture site. The clavicle bone site close to the skin surface and a displaced fracture or sharp fracture edge may threaten the skin. Our doctors will carefully examine your shoulder and clavicle area and order x-rays. Plain x-rays are used to evaluate the clavicle fracture and assess the fracture pattern, displacement, angulation, comminution, and shortening. After the fracture is assessed, appropriate management is decided upon by your orthopedic doctor. Generally, further imaging is not necessary unless your doctor suspects any tendon or ligament damage related to the injury.

Traditionally, clavicle fractures were managed conservatively in the pediatric, adolescent, and adult population, but more recent studies have shown that operative intervention may allow patients to return to activities more quickly, have quicker radiographic union, less chance of nonunion or malunion, and less pain during recovery. Clavicle malunion is usually a result of clavicle shortening and displacement. A malunion can potentially alter the kinematics of the scapula, leading to scapular dyskinesis and malrotation. Studies have shown that clavicular malunion in skeletally mature patients causes decrease in strength and velocity with certain movements of the upper arm, and it is thought that this may be true in adolescent patients as well.

Typically, pediatric clavicle fractures with little displacement and minimal shortening can be treated without surgery. Treatment generally consists of immobilizing the arm in a sling for 4 weeks. After that point the patient can begin range of motion and will generally be ready to return to activities 8-12 weeks after the fracture.

Surgical management of midshaft clavicle fractures is usually warranted when there is >15mm of significant shortening, 100% displacement, or significant comminution especially in pediatric patients involved in high demand activities. It has been shown that in pediatric patients 10 years and older with these fracture patterns use of an elastic stable intramedullary nail leads to less pain during recovery, increased patient satisfaction, and less time immobilized.

There are two options to consider when surgical management is decided. The first is fixing the bone with a plate and screws that lie on top of the bone. This will provide a secure and adequate reduction, although it does require stripping of muscle off the bone where the plate will rest.

The plate and screws also require an extensive incision over a good portion of the clavicle so it can be positioned properly. The patient may be able to feel the plate after surgery and it can potentially be bothersome when wearing a backpack, purse, or anything that puts pressure on the collarbone. A clavicle plate may oftentimes need to be removed with a second surgery due to the irritation it causes. Despite the drawbacks of using a clavicle plate and screws it may be the best option if the fracture is significantly comminuted or in multiple pieces.

Clavicle Fracture (Collar Bone Fracture)
The second option is fixing the bone with a clavicle nail. Although, this is a good option it is not appropriate for every fracture. A clavicle nail sits inside the bone in the intramedullary canal.

This eliminates the need to strip down muscle overlying the clavicle. The surgery is done through three small incisions. The hardware is placed inside the bone and cannot be felt by the patient after surgery. The clavicle nail also eliminates the irritation that patients sometimes experience from straps and backpacks. Rarely is this hardware removed after surgery. Our doctors will closely monitor your progress and healing with x-rays after surgery. Physical therapy may be part of your rehabilitation to help regain your motion and strength. Your doctor will let you know when it is safe to return to play and at what point you are released to use the hand without restrictions.

A clavicle fracture can cause serious setbacks for any athlete. Our goal at Modern Orthopaedics is for you to return to your sport better than before. This may take time and patience, but we want you to experience a full recovery. We understand that each athlete and sport is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office to have an initial evaluation for a shoulder or clavicle injury and receive superior care from our doctors and staff.

Labral Tear Treatment and Surgery in Wayne, Paramus, and Parsippany NJ

Labral tears of the shoulder involve the cartilaginous lining of the glenoid (socket).

The shoulder is a ball and socket joint that is composed of the humerus bone in the upper arm, the scapula, and the clavicle. The head or “ball” of the humerus sits in the socket portion of the scapula called the glenoid. The cartilaginous lining around the outside of the glenoid is called the labrum. The labrum helps to stabilize the shoulder and deepen the socket, or the glenoid. The labrum essentially functions as a bumper that helps stabilize the shoulder. Athletes that sustain a shoulder subluxation or dislocation may concurrently injure their labrum. In these cases, the labrum is torn off the bone when the humeral head comes out of the socket. This tear may also make the shoulder less stable and increase the shoulder’s propensity to sublux or dislocate again. Many times an athlete may not even realize that their shoulder is sliding in and out of the socket, but they have shoulder pain and sometimes catching or clicking.

Other labral injuries involve the biceps tendon which attaches to the top or superior portion of the labrum. These are often referred to as SLAP tears, superior labral tear from anterior to posterior, and are a common type of labral tear. This injury is common in athletes when exerting maximum effort throwing, but is also seen in patients who may experience pain with overhead activities. There are different types of SLAP tears and they are classified according to the severity of the tear and the involvement of the biceps tendon. These athletes usually present with pain and sometimes catching or clicking in the shoulder with certain motions. Athletes affected by labral tears are likely unable to achieve peak performance due to pain. Sports that require extensive arm and overhead motion may be near impossible to play in some cases.

SLAP tears are a common overuse injury in baseball and softball players. It is important for athletes, coaches, and parents to understand the importance of limiting pitch count, especially in young athletes. Proper technique is also extremely important and can help to avoid unnecessary injury to the shoulder. Lastly, stretching and strength training is crucial for any athlete. If you or your coaches are unsure as to what stretches, exercises, or muscle groups to focus on don’t hesitate to reach out to a local physical therapist who can help.

Labral tears are sometimes difficult to diagnose with physical examination alone. An MRI and an MR arthrogram is a good diagnostic test used to evaluate for labral tears. Although not always necessary, a MR arthrogram may be done where dye is injected into the shoulder joint. This dye allows your doctor to more clearly visualize labral tears in particular. If for some reason a labral tear cannot be visualized on an MRI, but is still highly suspected then a shoulder arthroscopy is the best way to definitively diagnose the problem. A shoulder arthroscopy is invasive, but will allow your doctor to directly see the labrum and surrounding structures.

Initial treatment for small labral tears or fraying may be conservative and involve anti-inflammatory medications and rehabilitation focused on strengthening of the rotator cuff muscles and periscapular stabilization. Physical therapy can often strengthen the surrounding muscles and alleviate or eliminate the pain. Usually if physical therapy is prescribed, our doctors will recommend that you stick with it for at least 6 weeks to see if it actually makes an improvement. Oftentimes, patients are surprised by the improvement they have with physical therapy and they can return to their sport stronger than before. Other patients do not have success with conservative management and they may be a candidate for an arthroscopic labral repair.

Labral repairs are done arthroscopically. Shoulder arthroscopy involves introducing a small camera and instruments into the shoulder joint through a series of small incisions to examine different parts of the shoulder. This may oftentimes be both diagnostic and therapeutic. Arthroscopy allows your surgeon to visualize the labrum, biceps tendon, capsular ligaments, undersurface and superior surface of the rotator cuff, the glenoid, humeral head, and subacromial space. Debridement and repair of the labrum can be done through the small portals made in the shoulder.

Labral Tear
The repair involves putting the labral tissue back in its native location around the glenoid. Anchors are placed in the bone, and sutures are used to secure the labrum. Your surgeon will also clean up any frayed tissues and address any other issues in the shoulder. The biceps tendon may be repaired, but often the biceps tendon is cut and attached in a different location or just left alone. Your surgeon will discuss these treatment options with you prior to your surgery.

Rehabilitation following a labral repair is very important. Early gentle motion is encouraged after surgery to avoid stiffness. Your therapist will guide you through specific motions and exercises that are prescribed by your doctor. At about two months after surgery, the patient can begin to progress their physical therapy to stretching and strengthening exercises. A full recovery can be expected within three to six months after surgery.

Labral tears can cause serious setbacks for any athlete. Our goal at Modern Orthopaedics is for you to return to your sport better than before. This may take time and patience, but we want you to experience a full recovery. We understand that each athlete and sport is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office to have an initial evaluation for shoulder pain and receive superior care from our doctors and staff.

Proximal Humerus Fracture​ Treatment and Surgery in Wayne, Paramus, and Parsippany NJ

Proximal humerus fractures can occur in many different fracture patterns involving the greater tuberosity, lesser tuberosity, surgical neck or may be associated with a dislocation. Many of these fractures may be treated with nonoperative management, but others need to be treated surgically taking into consideration the age and health of the patient. If treated nonoperatively, the patient will rest the arm in a sling for four to six weeks. They generally begin to do pendulum exercises about three weeks after the fracture and begin range of motion with the shoulder at about four weeks. This will be determined at follow up appointments after careful examination and x-rays to check the alignment and healing of the fracture.

Generally, we try to get the shoulder moving again as soon as possible to avoid frozen shoulder. The patient will likely return to their normal activities after the fracture heals, although in some cases they may have decreased range of motion when compared with the uninjured side.

Shoulder Instability Treatment and Surgery in Wayne, Paramus, and Parsippany NJ

The shoulder joint has exceptional mobility and is the most commonly dislocated large joint.

The shoulder joint has exceptional mobility and is the most commonly dislocated large joint. Males aged 10 to 20 years old are the most common first time dislocators, followed by those in the 50 to 60 year age group. Often times shoulder subluxation or dislocation may be recurrent, as once the shoulder has initially dislocated, it is more prone to do so again in the future. The shoulder may be unstable anteriorly, posteriorly, inferiorly or multidirectionally. Initial traumatic dislocations are most likely the result of a fall, trauma or forceful throwing motion. Shoulder dislocations are also much less commonly atraumatic are caused by ligamentous laxity, connective tissue disease or bony abnormalities.

The shoulder is usually put back in place (reduced) in the emergency room. Unfortunately, many times there may be associated injuries that the patient is unaware of. Studies have shown that one in every three patients will sustain a greater tuberosity fracture or a rotator cuff tear after a primary shoulder dislocation. In patients over the age of 40, the likelihood of having an associated rotator cuff tear increases dramatically. Associated labral tears and axillary nerve traction injuries are also not uncommon. Children who have not reached skeletal maturity are more likely to sustain injuries to their growth plates. The elasticity of the shoulder capsule in young children may help prevent damage to the capsulolabral complex and decrease the likelihood of redislocation. It is important that patients of all ages follow up in an orthopedic office after shoulder dislocations for further evaluation. Associated injuries are oftentimes overlooked if not evaluated by a specialist.

After an acute dislocation is reduced the patient will likely be immobilized in a sling for three to four weeks. Often times an MRI will be obtained if there is suspicion of an associated rotator cuff tear or labral pathology. CT scans may be ordered if there is suspected bone loss or fracture. Redislocation is most common in males under the age of 20 but may occur in older patients as well. Instability may be the result of soft tissue or a bony deficiency. In the case of recurrent dislocation, surgery may be necessary. A Bankart lesion is a tear of the labrum and detachment of the inferior glenohumeral ligament that results from an anterior-inferior dislocation of the humerus. Hill-Sachs lesions, impression fractures in the humeral head, often result from glenohumeral dislocations. The glenoid itself, the socket part of the joint, may also be fractured as a result of dislocation making it difficult to ensure stability by only addressing the soft tissues. In this case, a Latarjet procedure may be necessary, which involves transferring autograft from the distal coracoid into the glenoid defect.

Throwing Shoulder Treatment and Surgery in Wayne, Paramus, and Parsippany NJ

Shoulder injuries are very common in the throwing athlete.

Shoulder injuries are very common in the throwing athlete. The use of high-speed video technology has shown that pitching a baseball requires the arm to accelerate at a speed of 7,000 degrees per second. Larger muscles surrounding the shoulder are most active during the acceleration of the throw, whereas the smaller, more delicate rotator cuff muscles are most active during the deceleration phase.

Our specialists will evaluate the throwing athlete by obtaining a thorough history and physical exam. A series of tests will be performed on both shoulders to compare range of motion, strength and evaluate maneuvers that elicit pain. Radiographic imaging and MRIs will be obtained when necessary for diagnosing the problem. Microtrauma injuries to the rotator cuff muscles are common and can cause pain while throwing, whereas more significant tears may cause profuse night pain. Instability may cause pain or give the sensation of subluxation especially during the follow through phase of throwing. Athletes that are experiencing decreased range of motion, particularly internal rotation, may have contracture of the posterior capsule.
Treatment for shoulder injuries in the throwing athlete will be focused on the patient’s specific issue. There are many different possible pathologies in the shoulder that can cause pain and dysfunction. Our shoulder specialists focus on conservative management initially which usually requires physical therapy directed toward strengthening the shoulder girdle, stretching and decreasing pain. If there are no improvements seen over a three to six month time period, surgical treatment may be considered.