Orthopedic Treatment For Shoulder Instability

by Administrator 24. April 2017 10:56

Shoulder is a ball and socket joint made up by articulation of the three bones, clavicle (collarbone), the scapula (shoulder blade), and the humerus.  This joint is responsible for the gliding movement of the arm. Shoulder Instability refers to a condition in when these bones are unable to maintain the normal structure of the joint i.e. ball of the humerus begins to slip within the shoulder.


  • Sudden blow to the joint or overuse
  • Previous injury that may have torn the ligaments or cartilages of the joint
  • People born with congenital ligament laxity
  • Athletes involved in sports that require overstretching of the shoulder capsule like swimmers, baseball pitchers, volleyball players, etc.


  • Pain
  • Repetitive dislocations
  • Feeling like shoulder is giving out
  • Inflammation
  • Tendonitis or bursitis may develop
  • Shoulder looks deformed
  • Numbness and tingling in the arm


The doctor may begin by conducting a physical examination to check for the excessive laxity of the shoulder joint. This check will also uncover the secondary conditions that may be leading to instability in the shoulder joint.  To have a clear view of the deformity in humerus or arm bone that may occur due to unstable shoulder, the doctor may recommend an X-ray. A MRI scan may also be suggested to have a clear view of the outstretched joint capsule.

Treatment –

Non- Surgical Treatment

  • Medication – The doctor may recommend anti-inflammatory medicine to reduce inflammation in the joint.
  • Immobilization -   To keep the arm from moving the doctor may ask the patient to wear sling for few days. This will help the arm to stay stable and heal quickly.
  • Exercises - After the joint becomes a bit stable, the doctor may ask the patient to do some stretching and strengthening exercise. This will help to restore the lost strength of muscles and ligaments.

Surgical Treatment – 

  • Depending upon the severity of the conditions the orthopedic surgeon may choose to perform one of several surgical options available.
  • The surgeon may conduct an open surgery to restore the attachment of the labrum and the ligaments of the ball and socket joint.
  • If the anterior lip of the joint’s socket has a damaged bone, grafting can be used to restore its configuration.
  • In case the socket has become too flat the orthopedic surgeon may reshape the bones. This procedure is known as Posterior glenoid osteplasty.

If you are looking for an orthopedic surgeon to treat Shoulder Instability, contact Dr. Mitchell F. Fagelman. He is well-known for treating conditions like fractures, shoulder pain, elbow pain, etc. He also has expertise in treating various sports related injuries. To request an appointment, call at (972) 492 – 1334 or visit 4780 North Josey Lane, Carrollton, Texas 75010.

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Shoulder Separation: Causes, Symptoms And Treatment

by Administrator 24. March 2017 02:56

Shoulder Separation refers to partial or complete parting of acromioclavicular joint that attaches collarbone to the scapula (shoulder blade). The condition occurs due to tearing of the ligaments (coracoclavicular (CC) and acromioclavicular (AC)) that stabilize the shoulder joint. Based on the severity of ligament damage, Shoulder Separation can be divided into three stages –

  • Type I injury - Partial tearing of AC ligament, but CC ligament is unaffected
  • Type II injury - Complete tearing of AC ligament
  • Type III injury – Ripping up off both AC and CC ligaments


  • A direct blow to the shoulder while playing contact sports or an accident
  • Trying to balance the body with hands, during a fall
  • Activities like football, hockey, rock climbing, rugby, skiing, volleyball etc.


  • Severe pain and tenderness
  • Restricted movement of the shoulder
  • Bruising and swelling
  • Bump on the top of the shoulder due to displaced collarbone


The doctor may look for a bony bump on the affected shoulder and check range of motion of the joint. He may also analyze patient’s pulse rate to assess the rate of blood flow. If it appears to be a major damage, imaging tests may be recommended.


For type I and type II injuries, the doctor may recommend conservative treatment.

  • Supporting the shoulder with a sling may help to immobilize the shoulder and ease discomfort.
  • Performing muscle strengthening exercises may increases shoulder’s range of motion.
  • Icing the affected area as recommended by the physician may help to reduce inflammation
  • Anti-inflammatory medications may also be prescribed

Surgical treatment may be recommended to the patients suffering from type III shoulder injury. In this procedure, the orthopedic surgeon may trim the ends of a collarbone, so that it does not rub against the acromion (a bony projection over the scapula).

The surgeon may also perform a reconstruction surgery by excising the distal ends of the clavicle. In order to stabilize the joint, he may use a screw or suture.

Prevention Tips

  • Wear protective gear while playing contact sports
  • Warm up before a strenuous exercise
  • Exercise daily

If you are looking for an effective treatment of Shoulder Separation, visit Dr. Fagelman in Carrollton, TX. He has an extensive experience in treating a wide range of sports related injuries. To schedule an appointment with the orthopedic surgeon, you can call at (972) 492 – 1334.

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Tips To Prevent Shoulder Pain

by Administrator 19. June 2015 05:09

The shoulder is the most mobile joint in the human body with the widest range of motion. It is made up of three bones, Clavicle, Scapula and Humerus, and various associated muscles, tendons and ligaments. Most of the movements carried out throughout the day involve the shoulder which makes it vulnerable to injuries, strains, sprains etc. Any problem with the shoulder can cause severe pain and inability in the movement of the joint. Here are some tips to prevent shoulder pain:

  • Exercises: Shoulder pain can be caused by overuse and fatigue in the shoulder and Rotator Cuff. Exercising the muscles and tendons regularly, can help in building strength which increases the ability of the muscles to work for longer durations. It is advised to do low intensity and low impact exercises to prevent strains.
  • Stretch: Pain which is caused by stiffness can be prevented by stretching. It helps in flexing the muscles and improving their range of motion. Conditions like Frozen Shoulder can also be prevented with the help of stretching.
  • Avoid injuries: Injuries to any part of the shoulder can cause severe pain in the joint. Prevention of injuries to the Rotator Cuff or the ligaments of the joint can help in avoiding pain. Also injuries like fractures which can be caused by falls on the shoulder, accidents or sudden landing on the joint must be avoided by walking carefully on uneven grounds, wearing proper shoes to avoid falling and wearing seat belts while driving.
  • Massage: Sometimes, due to overuse and strain, knots can be formed in the muscles. Massaging the muscles of the shoulder can be helpful in relieving the built up stress in them and avoiding the possibility of shoulder pain.
  • Proper posture: Improper posture for prolonged duration of time can also cause injuries or sprains to the joint. Sleeping while keeping the arm in an awkward position may cause pain in the muscles. Also, inappropriate posture while lifting heavy objects can cause severe injuries to the Rotator Cuff. Maintaining proper posture while sitting, standing, sleeping etc. is suggested in order to avoid shoulder pain and any injuries. Also, taking precautions while picking heavy objects can be helpful in preventing injuries.
  • Comfortable workstation: The work setup at your office should be comfortable and soothing. There should be proper support for arms in order to avoid overuse or strains in muscles of arms and shoulder.
  • Sports activities: People who get involved in rough sport activities like football, rugby, basketball etc. are more susceptible to shoulder pain and injuries. These can be avoided by wearing proper protective gears during such activities. Also, people who take part in sports which require repetitive overhead movements of the arm like swimming can suffer from shoulder pain. It is suggested to take precautions in order to prevent shoulder pain.

These tips can be helpful in the prevention of shoulder pain. 

Consult Dr. Fagelman in Carrollton, TX for diagnosis and treatment of shoulder pain. To schedule an appointment with the orthopedic surgeon, call at (972) 492 – 1334

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Orthopedic Treatment For Frozen Shoulder

by Administrator 21. May 2015 11:08

Frozen Shoulder is a painful condition in which the shoulder capsule becomes inflamed and stiff, restricting the movement of the joint. Also known as Adhesive Capsulitis, the condition is characterized by formation of scar tissue in the shoulder capsule, making it impenetrable and leaving less room for movement. It occurs when the sleeve surrounding the joint swells and thickens. The symptoms of Frozen Shoulder may appear and resolve gradually over a time period of 1 to 3 years.


  • Diabetes: People suffering from Diabetes are more likely to develop Frozen Shoulder.
  • Other Medical Conditions: Other medical conditions such as a heart problems or Parkinson’s disease can also make you susceptible to Frozen Shoulder.
  • Previous Injury: The medical condition may also develop if the arm is left immobilized for a long period of time after a fracture, surgery or injury.


Stiffness and pain are the two main symptoms of Frozen Shoulder. People who suffer from this condition tend to experience difficulty in moving the arm and severe pain while carrying out normal shoulder movements. Symptoms of Frozen Shoulder normally develop appear in stages.

  • Freezing: This is the stage when the symptoms start emerging. The pain grows from mild to severe and the patient begins to face difficulty in carrying out daily tasks that involve shoulder movements. This stage can last for 2 to 9 months.
  • Frozen: In this, the stiffness in the shoulder may severely increase. However, the pain generally decreases. This stage lasts for 4 to 12 months.
  • Thawing: The stiffness significantly decreases and the patient may regain some movement in the arm while the pain begins to fade. Although, the pain may occasionally come back as the stiffness decreases. This stage can last for 12 to 24 months.


  • Heat Or Ice Packs: Applying heat pads, ice packs or using both alternately can help to ease stiffness and pain.
  • Anti-Inflammatory Medicines: The shoulder surgeon may prescribe non-steroidal anti-inflammatory drugs to provide relief from pain.
  • Physical Therapy: Once the pain has subsides, physical therapy may be recommended to restore the normal range of motion of the shoulder joint.
  • Surgery: This is usually recommended if the symptoms do not subside with non-surgical treatment.

For comprehensive treatment of Frozen Shoulder, consult Dr. Fagelman in Carrollton, TX. To schedule an appointment with the shoulder specialist, you can call at (972) 492 – 1334

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Common Causes Of Shoulder Pain

by Administrator 20. March 2015 09:01

Shoulder pain is a common condition, especially with the athletes and sportspersons. However for proper treatment it is essential for the doctor to determine the exact cause of the pain. Here are some of the common causes of shoulder pain.


Any activity that involves the repeated use of tendons often leads to Tendinitis. Rotator cuff tendons, which offer stability and motion to the shoulder, are the most commonly affected tendons in the shoulder. Acute tendinitis results due to excessive overhead activities or sports that involve ball throwing. Chronic tendinitis occurs because of arthritis or repeated wear and tear of tendons with age.


Bursae are fluid filled sacs in the joints, which act as cushions between the bone and the overlying soft tissues. They help in reducing friction between the bone and the gliding muscles. Due to excessive use of the shoulder, the patient experiences inflammation and swelling of the bursa between the shoulder blade and the rotator cuff. The condition is called as subacromial bursitis. The condition causes pain in the shoulder and it becomes difficult to carry out simple routine tasks.

Tendon Tears

Sometimes an injury or degenerative changes in the tendons lead to tearing and splitting of tendons. The tear may range from partial tear to complete damage. The tendon is often pulled away from the attachment to the bone.

Shoulder Instability

Often due to sudden injury or overuse, the head of the upper arm bone is forced out of the shoulder socket and this leads to shoulder instability or dislocation. The condition causes pain and unsteadiness while the dislocation can be partial or complete. If the ball of the upper arm comes partially out of the socket, the condition is called subluxation. If one experiences shoulder instability, he or she becomes susceptible to frequent dislocations, which increases the risk of arthritis in the joint.

Shoulder Impingement

The impingement occurs when the acromion, the top of the shoulder blade, pressurizes the underlying soft tissues, bursa and rotator cuff tendons. Shoulder impingement leads to tendinitis and bursitis, which cause pain and limit movement.


Arthritis is one of the major causes of shoulder pain. With age, people often develop osteoarthritis, which occurs due to chronic wear and tear of the joint, sports and work related injuries, inflammation and infection. The soft tissue parts of the joint become tight and stiff resulting in restricted shoulder movement.


Due to trauma or high impact injury, the shoulder bones, clavicle, scapula and humerus may break and this results in fracture, which is quite painful.

Besides these causes, various other infections or nerve disorders can also lead to shoulder pain.

For complete treatment of shoulder pain, visit Dr. Fagelman in Carrollton, TX. To schedule an appointment with the shoulder surgeon, call at (972) 492 - 1334 or visit 4780 North Josey Lane, Carrollton, Texas 75010.

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Orthopedic Treatment For Shoulder Dislocation

by Administrator 22. September 2014 11:05

Shoulder Dislocation is a condition caused due to an injury leading to darting out of the bone of the upper arm from the cup shaped opening in the shoulder blade. The shoulder, being the most flexible of all joints, is most susceptible to getting dislocated.

Shoulder can be either partially or completely dislocated. In a partial dislocation, the top of the humerus (upper arm bone) gets moderately out of the glenoid (opening in the shoulder). In a complete dislocation, it gets completely detached from the socket and both the conditions can cause unsteadiness and pain in the shoulder joint.


  • Trauma: Shoulder dislocation may occur when the joint is in an exposed position and gets popped out suddenly. A hard knockback to the shoulder in a road accident is one of the common causes of dislocation.
  • Excessive strain on shoulder ligament: Sports such as swimming, volleyball, baseball, tennis etc. that need recurrent overhead movements can overstrain the ligaments in the shoulder.
  • Falls: Shoulder may also get dislocated as a result of falling from a height or tripping on something.


  • Extreme pain
  • Visible disfigurement in the shoulder
  • Recurrent instances of dissemination of shoulder
  • Feeling of weakness, numbness, pins and needles in the arm
  • Shoulder might feel loose, hanging and sliding in our out of the joint
  • Uneasiness while making certain movements of the shoulder
  • Swelling and bruising


The treatment options for shoulder dislocation may include:

  • Closed reduction: The orthopedic doctor may use manual exercises to get the shoulder bones back into place. You might be administered a muscle relaxant or sedative if the pain is intense.
  • Immobilization: The patient might need to use a sling or splint for some time to restrict the movement of shoulder. The time for which the splint should be worn varies from patient to patient.
  • Surgery: If a person has frail shoulder ligaments or joints, surgery might be needed to treat the dislocated shoulder.
  • Rehabilitation: After the splint is removed, a gradual rehabilitation therapy is required to restore, stability, strength and range of motion of the shoulder.

If your shoulder has suffered a minor dislocation and there has not been much damage to the tissues or nerves, the joint is likely to recover within a few weeks. However, you must not resume activity soon after the treatment as it may make you susceptible to injuring your shoulder and getting it dislocated again.

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Orthopedic Treatment For Shoulder Impingement

by Administrator 21. August 2014 10:35

Also known as Rotator Cuff Tendinitis, Shoulder Impingement is caused when the tendons are recurrently stuck and flattened while moving the shoulder. While raising the arm over the shoulder, the acromion can rub against the tendons and bursa, resulting in irritation and pain. This syndrome is quite common in athletes and middle aged people. Repetitive overhead movements while performing activities like painting, construction, swimming, tennis, basketball, volleyball, badminton, weight lifting etc. is a risk factor for impinging of the shoulder. It can also cause other bone and joint abnormalities. Due to this, the tissues within and around shoulder joint get stressed and cause inflammation and swelling.


  • Repetitive overhead movements while playing volleyball, tennis, badminton, golf, baseball, softball etc. and similar activities like stocking shelves, paper hanging, and construction can cause this syndrome.
  • Shoulder instability in young athletes is a likely cause of Shoulder Impingement. 
  • It can also be a result of some kind of fall injury.
  • Arthritis can cause narrowing of the subacromial space, due to which the rotator cuff and bursa have less room to travel. During motion, these structures get pinched, causing Shoulder Impingement.
  • Structural or anatomic abnormalities can also result in a narrow subacromial space, resulting in this syndrome. 


  • Difficulty reaching behind the back.
  • Pain in shoulders with overuse of arm.
  • Weakness in shoulder muscles.
  • Swelling and tenderness in front of the shoulder.
  • Pain and stiffness while lifting up the arm.
  • Pain radiates to front of the shoulder to the side of arm.
  • Loss of strength and motion in the shoulder.
  • Limited and painful movement of the shoulder.


This syndrome can be diagnosed by an orthopedic doctor by performing physical examinations and evaluating medical history. These diagnostic tests help to detect if there are any changes in the bone or if there is some injury to the muscles.



Shoulder Impingement syndrome can be treated by avoiding overhead and repetitive movements so that the pain and irritation subsides. Anti-inflammatory medicines and ice can help to reduce the swelling. To restore normal range of motion in athletes, exercises can help to reduce the pain. These non-surgical methods can take up to several weeks and even months, but help in gradual improvement to return to function normally. Physical therapy also reduces pain and strengthens the shoulder. Steroid injections may be needed if these methods do not provide relief from the pain.


Surgery is required when the pain does not subside. The shoulder surgeon performs surgery on the shoulder to create more space for movement of rotator cuff. By way of this, the inflamed portion of the bursa is removed.  The doctor may either use open surgery and arthroscopic surgery to perform the procedure. Post-surgery, a rehabilitation program helps to regain the strength and movement of the shoulder, which might take 2 to 4 months or a year.

This syndrome can occur to anyone but it is, nevertheless, avoidable. Athletes can modify their playing techniques and avoid movements that risk hurting the shoulder. Avoiding repetitive movements can prevent this syndrome. Taking necessary treatment in time can prevent the condition from getting worse and protect the rotator cuff and bursa from getting pinched.

For expert treatment of Shoulder Impingement or any other shoulder condition, contact Dr. Fagelman at (972) 492-1334.  You can also visit him at 4780 North Josey Lane, Carrollton, Texas 75010.

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Rotator Cuff Syndrome: Causes, Symptoms & Treatment

by Administrator 21. April 2014 09:58

Rotator cuff syndrome is a debilitating and extremely painful condition of the shoulder. It can come about in a variety of ways and can have many causes or problem areas. The rotator cuff gives the shoulder its mobility and range of motion, and consists of muscles and tendons.  Any damage to these tendons causes rotator cuff syndrome. This condition happens due to a number of different causes and can be treated based on the nature and severity of the condition. It can be the cause of severe pain and loss of motion and needs to be treated immediately to avoid any further complication.


Rotator cuff syndrome can happen due to a variety of different external causes which can damage the tendons in the area. A few of these are -

  • Keeping the hand and shoulder in one particular position for long periods of time. This happens to people whose work involves daily and heavy use of computers.
  • Sports activity like tennis which involves heavy use of the rotator cuff.
  • Activity that needs long periods when the hand remain overhead.
  • Bad sleeping posture.
  • Lack of coordination of movement in shoulder blades.
  • These are a few of the things that can be responsible for rotator cuff syndrome.


Rotator cuff syndrome brings acute pain especially felt when there is any attempt to move the hand or shoulder. The pain might be mild at first but usually increases in intensity. There is also severe loss of mobility and range of motion accompanied by lack of strength and stability.


The first step of treatment is to undergo a physical exam by an orthopedic surgeon and conduct important diagnostic tests like an x-ray. Depending on the acuteness of the pain, doctors in Carrollton might also recommend procedures like ultrasound tests or MRIs to gauge the extent of the shoulder pain. Once the damage has been ascertained treatment for normal cases usually consists of rest, regular application to hot or cold compress and generally avoiding activity except for the kind that is absolutely necessary. Over the counter painkillers and anti-inflammatory medication can also be used. This is ideally supplemented with a range of exercises and physical therapy to give strength to the area and to restore range of motion. In severe cases orthopedic doctors can also use the application of steroids to stimulate the healing process. In case of a complete rotator cuff tear, the only helpful mode of treatment might be surgical repair.

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Shoulder Pain: Causes, Symptoms & Treatment

by Administrator 17. December 2013 13:52

Shoulder pain can be caused by an injury to the shoulder, or arise from a disease affecting the shoulder joint. Pain in the shoulder arises when the tendons, ligaments, cartilages, menisci, or bursae comprising the shoulder joint are affected. Shoulder pain is highly common, because of the high mobility of the shoulder joint, which makes it prone to injuries. In certain cases, pain in the shoulder could be indicative of a disease affecting the joint itself, or the soft tissues and bones surrounding it. Shoulder pain could also be caused by an abnormality in the nerves supplying sensation to the shoulder.

If you are experiencing chronic shoulder pain, you can seek treatment from an experienced orthopedic doctor in Carrollton, TX. There are various remedies that can be adopted to provide relief from shoulder pain and restore a normal range of motion. Below is a look at the common causes of shoulder pain, the symptoms of the condition, and its treatment options:


  • Inflammation of the bursae, which are tiny fluid-filled sacs that cushion and lubricate the joint, reducing friction between the bones. This is known as shoulder bursitis, and can result from injury, infection, or rheumatic disease.
  • Inflammation of the tendons, which connect the muscles to the bones. This is referred to as tendinitis.
  • Muscle strain
  • A frozen shoulder, which is usually caused by a shoulder injury, and associated with a limited range of motion.
  • Impingement syndrome- a condition in which the rotator cuff tendons get inflamed due to their rubbing against the shoulder blade.


  • Pain which can range from dull to sharp and severe
  • Muscle spasm
  • Inflammation
  • Restricted movement
  • Numbness or tingling sensation
  • Visible deformity
  • Arm weakness


  • The treatment of shoulder pain usually involves the use of anti-inflammatory medications or over-the-counter pain relievers.
  • Acute shoulder pain, such as that caused by a sports injury can be relieved by the local application of moist heat or ice.
  • If shoulder pain persists, you might need to get a local corticosteroid injection. It is especially useful for pain caused by arthritis of the shoulder.
  • Shoulder exercises can expedite recovery by helping to restore the normal range of motion.
  • Surgery might be required if the pain is caused by an underlying nerve condition.

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Burners and Stingers: Causes, Symptoms, Treatment& Prevention

by Administrator 20. November 2013 13:05

Burner and stringers are the painful injuries to the nerves which are responsible for the movement, sensation and coordination of upper arm. These nerves run from the back of the neck into the arm forming the network of nerve fibers in the upper shoulder called brachial plexus. Injuries to the brachial plexus, causing stinging or burning sensation from shoulder to hand are called burner and stringers.


  • Contact sports: According to orthopedic sports surgeons in Carrollton, a sudden fall onto the head can lead to burner and stringers. Normally, the athletes associated with contact sports like wrestling, soccer, football, etc. are more likely to cause these injuries.
  • Spinal stenosis: There is a growing evidence of an association between spinal stenosis and burner and stringer. Spinal stenosis is basically a condition caused due to narrowing of the open spaces in spine cord.
  • Quick movement of neck and shoulder: A jerk to the neck or shoulder can cause the neck to bend towards the opposite shoulder which further leads to burners and stringers.

It is important to seek immediate medical help if any of the following symptoms are noticed:

  • A burning or electric shock sensation from shoulder to hand
  • Numbness and weakness in the area
  • A warm feeling in the arm
  • Intense pain in the arm
  • Tingling sensation

Treatment of burners and stringers depend on the severity of the condition. The sports injury doctor may perform imaging tests like X-rays or MRI or electrodiagnostic tests such as an electromyogram in order to determine the extent of the injury. The treatment recommended most often include:

  • Taking break from the involved activity until the pain stops.
  • Applying ice to the affected area.
  • Anti-inflammatory medications may be prescribed by the doctor to reduce inflammation and pain.
  • The doctor may also recommend wearing neck roll for a few weeks.
  • A range of strengthening, stretching and motion exercises may also be recommended by the doctor. These exercises help rehabilitate your injury and improve the flexibility of injured tissue. Some of such exercises include axial extensors, cervical side bend, cervical rotators, neck circles, cervical flexors, etc.


  • Using protective gear while performing any physical activity
  • Keeping the neck and head in comfortable position
  • Performing neck and shoulder stretching and strengthening exercises prior to any physical activity
  • Wearing the proper running shoes for better traction on uneven and slippery surfaces.

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