Shoulder Pain in Overhead Athletes Now With New Arthroscopic Technique

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Shoulder Pain in Overhead Athletes Now With New Arthroscopic Technique
Study lead Dr. Kevin Plancher confirms new technique can relieve pain and restore function

NY, NY and Greenwich, CT, July 2007  Serious athletes and active adults who participate in overhead sports  from throwing baseballs and swinging tennis rackets to playing volleyball and swimming frequently experience weakness and pain in the shoulder region. The most common cause is inflammation or tearing of one or more of the muscles and tendons that make up the rotator cuff. But recent research by the Orthopedic Foundation for Active Lifestyles led by OFALS founder and leading sports medicine orthopaedic surgeon Dr. Kevin Plancher confirms the existence of a little-known ligament called the spinoglenoid. This ligament is to blame in some cases of shoulder dysfunction, causing misdiagnosed patients to undergo ineffective physical therapy and other treatments.

Until recently, little was known about the spinoglenoid ligament, explains Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and an official orthopaedic surgeon for the U.S. Ski & Snowboard teams. In Dr. Plancher’s OFALS study1, he and his team were able to confirm the existence of this ligament in 100% of cadavers studied. The spinoglenoid ligament stretches from the spine into the shoulder, traveling through a bony structure called the spinoglenoid notch.

Tight squeeze of ligament and nerve cause trouble
Dr. Plancher continues, The ligament runs through the back of the shoulder, often constricting the suprascapular nerve one of the major nerves in the shoulder region that delivers sensation and messaging to the two main tendons of the rotator cuff, the supraspinatus and the infraspinatus. In fact, the suprascapular nerve is responsible for the major function of the shoulder joint. Dr. Plancher adds, The spinoglenoid ligament can compress the nerve, similar to carpal tunnel in the hand, leading to marked weakness and pain that mimics the symptoms of rotator cuff injury.

An MRI to investigate the condition of the rotator cuff, coupled with an electrodiagnostic study of the suprascapular nerve, can pinpoint whether the injury is muscle/tendon related or nerve-related, Dr. Plancher advises. Physical therapy to rehabilitate this condition is not effective for the long-term, but may alleviate discomfort temporarily. Injections can often confirm the diagnosis.

New arthroscopic procedure hastens return to play
In the past, the most frequently prescribed treatment for nerve compression in the shoulder was to cease the activity that caused the compression, followed by six months to a year of intensive physical therapy specifically designed to alleviate the tendons compression of the nerve. More often than not, athletes with this type of compression never returned to their sports of choice. However, Dr. Plancher recommends a relatively new arthroscopic technique that provides more immediate relief from pain and possible restoration of shoulder function.

Within the region of the spine to the shoulder, there is a massive web of ligaments, tendons and muscles that power the movements of the back, shoulders and arms, Dr. Plancher points out. The spinoglenoid ligament can thicken for overhead athletes, and when it causes more harm than good by compromising nerve function, patients can benefit from a procedure called spinoglenoid ligament release, he adds.

This new arthroscopic approach, which Dr. Plancher presented at the 2007 San Diego Shoulder Meeting in June, involves arthroscopically detaching the ligament at the shoulder site and removing it from its position overlying the suprascapular nerve. With this procedure, patients experience much faster relief of pain and weakness in the shoulder, and can often return to overhead sports with little more than a brief course of physical therapy to strengthen surrounding muscles, tendons and ligaments, Dr. Plancher says.

Dr. Plancher founded The Orthopaedic Foundation for Active Lifestyles in 2001 to promote, support, develop and encourage research and education concerning orthopaedic care and advancements in musculoskeletal diseases. Clinical research at OFALS concluded recently includes a comparative study of a new anti-inflammatory versus a popular prescription anti-inflammatory on patients with osteoarthritis of the hip, and a head to head comparison of two prescription medications for decreasing low back pain. A third study is now being completed to evaluate the effectiveness of an injectible cosimane type drug for osteoarthritis of the knee. Soon this medicine will be tested in the shoulder as well.

In just a few short years, OFALS has had the opportunity to make great contributions to the field of orthopaedics, both in our understanding of how the human anatomy works and in how to improve the quality of life for patients with orthopaedic injuries and diseases, Dr. Plancher concludes. We take great pride in our progress to date, and we’ll continue to research and report on new developments and improvements in the field.

  1. J Bone Joint Surg Am. 2005 Feb;87(2):361-5
  2. Arthroscopy 2007 in press

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