Shoulder pain is extremely common and is the third leading cause of orthopedic disability in the United States both in adults and children.
There are actually many causes for shoulder pain. There are various traumatic causes like shoulder dislocation and shoulder fractions and tears to the rotator cuff. There are many degenerative conditions such as shoulder arthritis and the shoulder tendons can wear out as well.
The first step in diagnosing shoulder pain is sitting down with your physician for a history and physical exam. After that we will do a diagnostic ultrasound in the office or order an x-ray or MRI so we can confirm what’s going on in your shoulder and direct treatment.
There are many treatments for shoulder pain. Conservative treatments consist of physical therapy sometimes pain medication we also give injections. If surgery is indicated we do minimally invasive surgery done with a camera to repair things such as a torn rotator cuff or torn ligament. We also do joint replacement surgery for arthritis.
You don’t have to suffer with shoulder pain. We have many options available. Call (402) 717-0820 to schedule an appointment to have your shoulder injury evaluated.
Fellowship-trained CHI Health Orthopedic Surgeons Treat All Shoulder Conditions
Whether the cause is related to arthritis, inflammation, or rotator cuff injuries, CHI Health would like to help. The CHI Health Shoulder Center is a specialty clinic devoted to the diagnosis and treatment of shoulder conditions. The Shoulder Center team is comprised of orthopedic surgeons with fellowship training in shoulder disorders and radiologists specifically trained in orthopedic and shoulder imaging to assist in the diagnosis of your condition. Physical therapists also serve a vital role in helping to restore function.
Your First Visit
The Shoulder Center is designed to provide a quick diagnosis. Same or next day appointments are available. During your initial visit, you will meet with a surgeon and a physical therapist. Together they will devise a plan and begin treatment immediately. You will have email access, so a shoulder surgeon can answer your questions at any time during your treatment. The Shoulder Center is available at three locations for your convenience:
- CHI Health Creighton University Medical Center - Bergan Mercy
- CHI Health Immanuel
- CHI Health Lakeside
Patients of the Shoulder Center have the comfort of knowing they are being treated by the top specialists in this area of care. Our comprehensive shoulder services provide the following:
- Individualized treatment plan tailored to your specific needs
- Multi-disciplinary medical team consisting of physicians, a case manager, physical therapists and nurses
- Education about your condition
- Overseeing the successful completion of your rehabilitation
If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Shoulder replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.
If you decide with your doctor that shoulder replacement surgery is the best option, our goal is to return you to a more normal, healthy lifestyle as soon as possible after your surgery. Our Joint Replacement Center, a recognized center of excellence, is dedicated to your care as a shoulder replacement patient.
Our comprehensive care, which serves as a model for facilities around the world, includes:
- Pre- and post-surgery education
- Dedicated patient care unit
- Focused care from specially trained staff
- Joint Care Manager who will coordinate your care
- Group physical therapy
- Patient education materials
- Assistance in choosing the best rehabilitation option for you after discharge
- Shorter length of stay – typically three days
What You Can Expect from Shoulder Replacement Surgery
Before you have shoulder surgery, the Joint Replacement Center will make sure you’re thoroughly prepared to achieve the best possible outcome. First, you will take part in a class in which you will tour the facility and learn what to expect of the surgery, as well as the recovery and rehabilitation process.
In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid).
The procedure usually takes about two hours. Your medical team will give you several doses of antibiotics to prevent infection. Most patients are able to eat solid food and get out of bed the day after surgery. You will most likely be able to go home by the third day after surgery.
Preparing for Surgery
Making simple changes in your home before surgery can make your recovery easier.
For the first several weeks after your surgery, it will be hard to reach high shelves and cupboards. Before your surgery, be sure to go through your home and place any items you may need afterwards on low shelves.
When you come home from the hospital, you will need help for a few weeks with some daily tasks like dressing, bathing, cooking and laundry. If you will not have any support at home immediately after shoulder surgery, you may need a short stay in a rehabilitation facility until you become more independent.
Before Your Operation
Wear loose-fitting clothes and a button-front shirt when you go to the hospital for your surgery. After surgery, you will be wearing a sling and will have limited use of your arm.
Pain Management
After surgery, you will feel some pain, but your surgeon and nurses will provide medication to make you feel as comfortable as possible. Physical therapy will begin soon after surgery, and when you feel less pain, you can start moving sooner and get your strength back more quickly. Talk with your surgeon if postoperative pain becomes a problem.
Your Recovery and Rehabilitation Process
Most shoulder replacement surgery patients are able to return home immediately after their stay at the Joint Replacement Center. You may also be referred to CHI Health Home Care or a transitional care unit.
Whatever the case, we will make sure you have access to all of the resources you need, including nursing, home health aides and physical and occupational therapy. If you need additional assistance, a social service/case manager will help arrange for home healthcare, outpatient therapy or placement in a skilled nursing facility or acute rehabilitation center.
After you leave the Joint Replacement Center, you will be given detailed information and instructions for exercises to do at home to aid in your rehabilitation. We will also give family members detailed instructions on how they can assist in your recovery at home. Depending on your unique needs, you may also be referred to CHI Health Rehabilitation Care.
Reverse Total Shoulder Replacement
Reverse total shoulder replacement is an excellent option for patients with shoulder arthritis and a torn rotator cuff. No formal rehabilitation is required after this surgery.
Reverse Shoulder Replacement and Post-op Exercises
Are You a Candidate for Reverse Total Shoulder Replacement Surgery?
Find an expert orthopedic surgeon at CHI Health to see if the procedure may be right for you.
What is Shoulder Instability?
According to Dr. Matthew Dilisio, Orthopedic Surgeon for CHI Health Clinic, shoulder instability is when the ball of the shoulder comes out of the socket. There are two main types. The first kind is called atraumatic shoulder instability - that’s where the ligaments are loose and the shoulder may shift. That responds well to physical therapy.
The second type is called traumatic instability - that’s more related to sports. That’s where a severe injury dislocates the ball from the socket and often there’s a ligament tear. Sometimes we need to repair the ligament back down to the bone to restore stability to the shoulder and get the patient back to sports.
What are the symptoms of shoulder instability?
The symptoms of shoulder instability can be pain. Usually it’s a subtle shifting of the shoulder. Often it occurs with heavy activity like sports. Sometimes the symptoms are severe enough where the patient can have the shoulder shift during sleep. When it’s that severe, we recommend an evaluation by an orthopedic surgeon.
How is should instability treated?
Atraumatic shoulder instability responds well to conservative treatment in which we strengthen the muscles around the shoulder. Traumatic shoulder instability that results from a ligament tear, often requires operative intervention. We will fix the ligament with minimally invasive surgery done with a camera.
Biceps Tendon Surgery (Biceps Tenodesis)
Biceps tendon injuries cause rotational deficits to the shoulder, which means there is pain and limited motion when reaching behind your back, throwing a ball, dressing yourself, and other similar activities. These are all rotational type motions. Most people hear "biceps tendon injury" and immediately think of the biceps curl, but biceps tendon injuries do not affect your ability to perform a biceps curl, that is the biceps muscle.
Biceps tendon tears and injuries cause pain with rotation to the shoulder. This can be seen in athletes, tennis players, volleyball players, throwers, baseball players as well as weight lifters and weekend warriors. Sometimes when conservative treatments such as rest, anti-inflammatory medications, therapy and cortisone injections fail, surgery may be needed.
Biceps Tendon surgery is ambulatory, meaning the patient goes home after surgery and the procedure takes about 15 minutes to perform. Recovery is fast, and patients may use their arm the day following surgery to perform activities of daily living. Patients regain near full motion by 3-6 weeks following surgery.
The shoulder is made up of three bones: the upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). The shoulder is a ball-and-socket joint: the ball, or head, of the upper arm bone fits into a shallow socket (glenoid) in the shoulder blade.
The ball and socket joint is protected by articular cartilage, the smooth, white tissue that covers the ends of bones (humeral head) where they come together to form joints. The cartilage allows the bones to glide over each other with very little friction. The articular capsule is made up of fibrous tissue (ligaments) that completely encircles the joint and helps provide strength and support.
The Rotator Cuff
The rotator cuff is made up of four tendons: the Subscapularis, Supraspinatus, Infraspinatus and Teres minor. Working together, they hold the humerus bone in place while allowing it to move freely in a circular motion within the glenoid (socket).
Rotator Cuff Tears
A rotator cuff tear is an injury in which a tendon no longer fully attaches to the head of the humerus.
Any one of the four rotator cuff tendons can tear, however the most common tendon involved in rotator cuff tear is the supraspinatus tendon. This tendon is positioned between the humeral head and the top of the shoulder blade (acromion) which provides a roof above the ball and socket joint.
If a tear enlarges, it may extend either to the back (Infraspinatus) tendon or the front (Subscapularis) tendon. The biceps tendon also passes over the humeral head and also may be injured by the same factors that caused the rotator cuff tear.
Tears can either be partial thickness or full thickness, depending on whether the tear extends all the way through the tendon. Full thickness tears result from a partial thickness tear that was not repaired and has worn through.
Rotator cuff tears can be very painful and can affect movement. If a tear is not treated and corrected within six months of the injury, the muscle attached to one of the tendons loses strength and atrophies because it’s not working. The quality of the tissue declines and becomes much harder to repair.
With an aging population, the need for rotator cuff surgery has increased dramatically. But up to now, the only option for patients who were operable has been the reverse shoulder replacement. However, since 10 to 15% of patients require additional surgery within 10 years, this is not suggested for younger patients.
Superior Capsular Reconstruction
At CHI Health, we offer an innovative procedure, called Superior Capsular Reconstruction, for complete rotator cuff tears that many physicians say are irreparable.
Superior Capsular Reconstruction is new option for younger patients and those looking for a minimally-invasive procedure and older patients who don’t yet have shoulder arthritis resulting from irreparable rotator cuff tears.
Dr. Samuel Dubrow is the first orthopedic surgeon in Nebraska and Iowa to perform Superior Capsular Reconstruction and the only surgeon in the metro Omaha area performing a new minimally-invasive procedure for rotator cuff tears. He has also lectured and instructed other Orthopedic surgeons from across the country on this procedure, and has assisted other surgeons in learning the technique.
In the reconstruction, a piece of tissue is sewn into the top of the socket and into a portion of the rotator cuff. This keeps the natural mechanics of the shoulder and restores function while reducing pain. In one study, eight patients who were manual workers were able to return to their manual jobs after surgery.
Superior Capsule Reconstruction is performed arthroscopically so there are fewer complications and recovery is faster.
The CHI Health Shoulder Center
The CHI Health Shoulder Center is unique in that we provide a “one stop” center for your care. We are the only integrated physician practice in the region, a dedicated, multidisciplinary team that devotes a significant portion of our time to shoulder pain and injuries.
We are also the only team focused on shoulder care. You don’t have to travel all over town to see your orthopedic shoulder surgeon, orthopedic nurse or care coordinator, physical therapist, physical medicine and rehabilitation physician and musculoskeletal radiologist. Your care is coordinated in one place – and includes everything from assessment to outpatient, inpatient and rehabilitative care.
Our team assembles around you. We put all our knowledge and skills to work so you get the best care. We meet frequently, formally and informally, on a regular basis to review patient cases and data on how we’re performing as a team.
Some of the advantages we offer are: one phone number, same-day visits, a physician physiatrist and physical therapist who see you as a team and physical therapy that can begin on day one.
Everyone at the Shoulder Center works together as a team toward a common goal – your best possible outcome. This coordinated care means patient outcomes are even better, patients are more satisfied and lose less time from work, and costs are held down because there is no duplication, or waste of time and resources.
Call (402) 717-0820 to schedule an appointment to have your shoulder injury evaluated.