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Monday, April 29

Fall and bump on shoulder = it's a shoulder separation!

My friend called me last night and said "I think I dislocated my shoulder!"  When he told me that he had a large bump on his shoulder, I knew that it was probably not a dislocation but a shoulder separation, where the joint between the shoulder blade and collarbone is disrupted.  This causes a large bump where the collarbone sticks up.  Here's a picture of his shoulder.
Picture of a bad shoulder separation
Shoulder separations usually occur from falling directly onto the shoulder.  Shoulder separations are also called AC separations.  "AC" stands for acromioclavicular, which is the joint between the collarbone and shoulder blade.  Some shoulder separations are minor, and do not require surgery.  Others are more significant, and need surgery to reconstruct the ligaments holding the collarbone.  Here's a picture of the x-ray.  Can you see the end of the collarbone sticking up?
Shoulder separation
If there is only a small bump and the collarbone is not too far from its normal position, the ligaments in a shoulder separation will heal just fine on their own without surgery.  It is important to understand that the bump will be permanent, but there will be no loss of strength.  In the case where there is a large bump and the collarbone is way out place (as with my friend here), then surgery is necessary to repair the torn ligaments.  Here is a video showing repair of a shoulder separation or AC separation.
 

 

If you think you might have a shoulder separation, getting an x-ray will confirm the position of the bones.  A shoulder surgeon should be able to help you understand your options and whether or not you need surgery.

Wednesday, April 3

I tore my biceps tendon! Now what?

The biceps muscle
Everyone knows the biceps muscle, the large muscle on the front of the arm.  The biceps has a tendon at the top of the arm that attaches in the shoulder and and another tendon that attaches at the elbow.  The biceps can be torn in either location.  Either type of tear can cause a "popeye" deformity in the arm, and means a loss of strength. 

Most people who tear their biceps tendon are male, in their 50's or 60's, and are lifting something or lowering something down.  Most say something like "it felt like I got hit in the arm" or "it felt like somebody shot me in the arm."  They will have pain and notice an extra bulge in the arm.  The bulge occurs because one end of the tendon has broken free and pulled back, like a rubber band, and the muscle balls up, creating a bulge.
Here's a picture of a torn biceps tendon.  Can you see the bump in the arm?
A torn biceps tendon causes a bump in the arm, or "popeye" deformity
Here's a video of a biceps tear as it happens:


Some people don't want surgery to repair their torn biceps.  For active people in their 50's and 60's, however, many patients choose to have surgery to repair the torn tendon.  Repair will restore the normal look of the muscle, increase strength, and prevent cramping that comes from having a torn, balled-up muscle.  Surgery is an outpatient procedure that is done through a 1-2 inch incision in the arm.  Recovery from surgery takes three months until return to full function.  

If you think you've torn your biceps, you should see a specialist to discuss your options.