|
 shoulder
injuries and prolotherapy
ALVIN
STEIN, M.D.
Shoulder pain is a
common type of pain treatable by Prolotherapy. Much of the
shoulder joint pain
is associated with
bursitis. This is an
Inflammation of the tissue lying above
the rotator cuff tendon. The bursa or potential fluid filled sac becomes
inflamed from irritation associated with overuse or with rubbing of the tendon
on the bone that is above the shoulder, the
acromion process.
The shoulder is a
joint that has a great deal of mobility, it allows us to move our arms freely
and in many different directions. This occurs because there is a relatively
small bone to bone surface area as compared to the hip joint, but a large
amount of ligament restraint to keep the bones in place. The bones I talk
about are the humerus and the scapula with its glenoid (socket) and the
acromion process.
The scapula or wing
bone provide the socket. It is a relatively small and shallow dish like
structure that allows the humeral head to articulate with it. The humeral head
is held in place by the capsule of the shoulder joint, which has several
specialized areas in its structure. These specialized areas are reinforced by
ligaments, which stop the head of the humerus from sliding out of place. These
ligaments are called the anterior and posterior glenohumeral ligaments.
In the anterior
capsule there are three such ligaments, the superior, middle and inferior
glenohumeral ligaments. The inferior is the most important and thickest one of
the three. Its job is to prevent the humeral head from sliding forward and
upward. If the head of the humerus slides forward and upward it interferes
with the normal arc of movement. This allows the humeral head to come closer
to the acromion process that is above the shoulder. The acromion acts as an
attachment for the muscles that move the shoulder, especially the deltoid
muscle and all of its specialized parts.
As the humeral head
comes closer to the glenoid, the space allowed for the rotator cuff tendon is
reduced and the tendon gets caught between the two bones and starts to get
inflamed. This causes the bursitis in the shoulder. As the bursitis gets
worse, the inflammation weakens the rotator cuff by rubbing away some of its
fibers, if the process continues unchanged, the result is a rupture or tear of
the rotator cuff and the need for reparative surgery to reestablish the
continuity of the tendon. This condition is called IMPINGEMENT SYNDROME.
Conventional
recommendations for the treatment of bursitis are the use of
anti-inflammatory medication and
cortisone injections into the shoulder. This will get rid of
the pain and the patient will go on until the next episode. Here they are
often referred to
physical
therapy for exercises to strengthen the rotator
cuff in an effort to bring the head of the humerus into the proper place. This
makes the assumption that the muscle is weak, and needs strengthening and that
the inflammation is primary, or else secondary to muscle weakness. The
conventional treatment does not consider ligaments being loose allowing the
humeral head to move out of place causing the inflammation and or the
weakness.
When the bursitis
becomes chronic and the
tendonitis becomes chronic, the patient often stops
using the shoulder and the loss of function is called a
frozen shoulder (which
usually requires a lot of treatment leads to a prolonged morbidity associated
with this condition). SURGERY is often recommended and at times, it is the
only thing to do. This involves removal of the undersurface of the acromion
and repair of the rotator cuff, if it can be accomplished. The postoperative
treatment includes a lot of physical therapy and home exercise and often still
leave the patient with weakness and pain BECAUSE THE UNDERLYING PROBLEM IS NOT
SOLVED BY THESE SURGICAL PROCEDURES! The surgery treats the effect and not the
cause. It treats the immediate cause of the pain, but not the cause of the
condition. The surgery takes away a piece of bone as if that suddenly grew
large and became the culprit. Although removing that piece of bone usually
does no harm, (note I said usually) that is not always the case.
Postoperatively, enough patients have more problems than they bargained for
because the primary cause of their problem was not dealt with at all. The
repaired rotator cuff can wear out again and rupture anew perhaps making it
unrepairable.
IS THERE AN
ALTERNATIVE TREATMENT? YES, YES, YES!!!
This is where
prolotherapy comes in and can help, preferably before all the damage has
occurred, but even afterward. Using prolotherapy, we inject the glenohumeral
ligaments in the anterior and posterior capsule of the shoulder. This causes
the ligaments to tighten and pull the head of the humerus back into the normal
position in relationship to the glenoid. It pulls the humeral head down away
from the acromion. That allows the rotator cuff to have the room it needs to
work without being impinged and without getting inflamed and without the
bursitis and the pains that are present with and without activity.
The plan is for an
examination and an
x-rays of the shoulder. If there is any instability and/or
tenderness in the area of the ligaments in the capsule, injections are given
to the entire anterior capsule. The ligaments are injected with the
proliferant
solutions to force these tissues to return to their normal
(healthy) size and length thereby restoring the proper anatomy and relieving
the problem. Sometimes only one injection session is all that is needed. On
other patients two or three sessions may be needed. The healing then begins.
Results are usually seen in two to six weeks. The improvement is usually
permanent. The injection can be repeated if needed without and adverse
effects. This treatment does not do any damage to the shoulder.
PROLOTHERAPY IS ALSO
USEFUL IN RECURRENT DISLOCATION OF THE SHOULDER WHEN USED IN THE SAME FASHION
DESCRIBED ABOVE!
© Alvin Stein, M.D.
The opinions expressed
here does not necessarily reflect the views of the other member physicians of
getprolo.com.
|
