Robert Filice, M.D.
Because it is the most mobile joint in the human body, the shoulder takes on a disproportionate chance of injury. The boney components of the joint include the clavicle, the scapula, and the upper portion of the humerus. There are also interconnections that will be found as far away as the sternum and the rib cage in the back. Here are the most common injuries we see in no particular order:
These usually occur when a person attempts to break a fall by extending an outstretched arm or by a direct fall on the lateral shoulder itself. Most clavicular fractures (80%) occur in the middle third of the clavicle, and are called group I. These are not casted, but simply treated with an arm brace, even if there is displacement of the two ends of the bone. Group II fractures occur in the outer third of the clavicle and can sometimes produce arthritis in the AC joint (the junction of the clavicle with the acromion process of the scapula)while group III occur at the sternal side of the bone. Group III is often associated with other more serious injuries to organs or vessels of the chest. Any of the three groups of fractures are treated conservatively with a sling without casting when there is no displacement. Whenever bones are fractured, ligaments and tendons which attach to the area of the fracture can be torn or damaged and result in chronic pain which persists beyond the normal healing time of the fracture itself. Such soft tissue damage and pain is best treated with a course of Prolotherapy.
Proximal humerus fractures
These occur at the top portion of the upper arm bone which comprises part of the shoulder joint (Prolotherapy to the shoulder video), and usually affect elderly people who attempt to break a fall by extending an outstretched arm. In younger adults they usually occur from blunt trauma directly to the area. After careful orthopedic evaluation, here again tendon or nerve tissue can also be collaterally damaged, account for prolongation of pain or disability, and usually responds to prolo or Neural Therapy (see also Prolotherapy and Neural Therapy).
In most cases the head of the humerus dislocates in an anterior (towards the front of the body) direction out of the glenoid cavity in which it is supposed to lie. Falls are the most common cause. Occasionally there is a genetic weakness in connective tissue which predisposes the patient to repeated dislocations. These patients normally are unwilling to move their arm, and will usually cradle the affected arm in the opposite arm. Simple inspection often cinches the diagnosis, because of the noticeable anterior bulge of the head of the humerus with emptiness at its usual location. Reduction (replacement) of the humerus back to its usual position can be performed immediately after the injury in the field, but it must be remembered that muscle spasm sets in quickly after a dislocation, and can make the reduction process difficult as well as painful, and necessitate hospitalization with general anesthesia. After traditional treatment, here again Prolotherapy can be very valuable in strengthening the ligaments and tendons which hold the humerus in place. Traumatic dislocations are usually accompanied by tendon and ligament injuries, so Prolotherapy is often needed as an adjunct to simple reduction of the dislocated bone. Prolotherapy will reduce the pronounced tendency (67-97%) for recurrent dislocations.
Acromioclavicular strain or separation
The ligaments which hold the end of clavical to the acromion process at the tip of the scapula are frequently torn as the result of football related trauma. If all ligaments are disrupted, the outer third of the clavicle’s position will rise from the front more towards the top of the shoulder.
Rotator Cuff tendon tears
The four muscles of the rotator cuff hold the head of the humerus in its position in the glenoid cavity of the scapula. Traumatic injuries can occur at any age, but overuse tendonitis is increasingly common in the elderly, and in those who occupationally or athletically put undo strain on the shoulder joint. The symptoms usually involve pain on rotating or lifting the arm toward the overhead position. This is an injury which we treat commonly and extremely successfully at Caring Medical. I would go so far as to say that Prolotherapy is the first line therapy that should be tried, and constitutes the definitive treatment for rotator cuff tendonitis, assuming no structures have suffered a complete tear. Review articles of multiple studies of therapeutic modalities previously employed by orthodox practitioners (surgery, non-surgical, conservative, and pharmaceutical) failed to show the superiority of any one approach over the others. Prolotherapy is a non surgical conservative therapy that was NOT included in that review, yet it is by far the most effective treatment for rotator cuff tendinopathy. Abnormal MRI’s that do NOT show complete tears are NOT in and of themselves an indication for a surgical approach.
Readers should be aware that the standard treatment recommended for all of these injuries is RICE treatment: rest, ice, compression, and elevation. Although there may be a limited role for temporary anti-inflammatory drugs in fractures, in general, Prolotherapy doctors recommend MEAT instead: movement, exercise, analgesics, and treatment (Prolotherapy). MEAT produces better result through faster recovery time and less residual disability. Our case files are full of patients who have recovered full functionality of the shoulder through Prolotherapy. My recommendation is to NEVER accept a surgical approach without first seeing a Prolotherapy doctor.