Shoulder Surgery: Acromioclavicular (AC) Joint Repairs | Vegas OrthopedicA separated shoulder refers to a condition that causes the clavicle (collarbone) to detach from its normal attachment on the shoulder blade. This condition is frequently misunderstood as a shoulder dislocation. However, it is a different type of injury.

Shoulder separation usually occurs when a patient falls on the outside of their arm or shoulder. It leads to a bump and pain on the top of the shoulder. The bump develops due to the end of the clavicle pushing up against the skin.

Noninvasive treatments are a suitable option for most patients with a separated shoulder. A majority of orthopedic surgeons also agree that all type I and type II separations can be treated nonsurgically.

Thomas and Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding communities.

 

Surgical Treatment Options

The primary objective of all surgical shoulder separation procedures is to restore the normal alignment at the end of the clavicle with the shoulder blade’s outer edge (the acromion). The ultimate goal is to restore the alignment of these bones, stabilize their position, and provide pain relief at the acromioclavicular joint.

 

The main surgical options are:

Repairing the AC Joint

It makes sense to repair the acromioclavicular joint. The most visible facet of this injury is a joint disruption. Therefore, aligning and holding the joint in an appropriate position seems logical. The AC joint is usually held in position with metal pins or plates known as Kirschner wires (k-wires).

The disadvantage of this surgery is that it does not address the damage to the strong ligaments that hold down each end of the collarbone. In addition, the patient may experience pain due to the metal implants placed to position the joint. These may have to be taken out, and a more concerning complication is the likelihood of these implant moving from their position.

This involves the movement of these implants within the body. In some frightening instances, there have been reports of k-wires placed in the collarbone ending up within the chest cavity over a period.

 

Holding the Clavicle Down

There are many techniques to treat AC joint injuries that involve holding the clavicle down. Some of these approaches use metal while others employ heavy sutures. Typically, the clavicle is held to the coracoid process which is a hook of bone in front of the shoulder right underneath the collarbone.

The surgeon may either put a screw from the clavicle into the corocoid or wrap the two bones together firmly using sutures. The drawback of these methods is that the screws usually have to be taken out and sutures can cut through and break the bone.

 

Reconstructing Ligaments

In this category of options, the ligaments that hold the end of the collarbone in the appropriate position may be reconstructed. There are various options for this procedure using either donor tissue or the patient’s own tissue.

A commonly performed procedure in this category is known as a Weaver-Dunn surgery. This involves the shifting of the major ligaments that connect to the acromion over to the end of the collarbone.

This holds the collarbone in its proper place. Another option is the coracoclavicular ligament (that were torn at the time of the shoulder separation injury) reconstruction with either a donor tendon or one from the patient’s leg.

The surgeon wraps the tendon graft around the hooked coracoid and then into the collarbone. Dedicated board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and other towns and cities in this part of the country for orthopedic treatments.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Rotator Cuff Repairs | Vegas Orthopedic SurgeryRotator cuff treat treatment usually initiates with a significant effort at conservative therapy. The type of rotator cuff tear (acute versus longstanding), the size of the tear, and the patient’s activities will impact the effectiveness of nonsurgical treatment options.

Over 50 percent of patients with rotator cuff tears will find non-surgical procedures effective in relieving their symptoms.

Thomas and Bigler Knee and Shoulder Institute, led by astute board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and other suburbs and neighborhoods in The Sagebrush State.

 

Open Surgical Rotator Cuff Repair

All rotator cuff tear repair treatments involved the surgeon looking directly at the torn tendon through an incision around six to ten cm in length before the advent of arthroscopic surgery. The benefit of open rotator cuff repairs is that the surgeon can clearly view the rotator cuff tendons in this technique.

The process of repair itself is straightforward, and a majority of surgeons consider this surgical procedure to be more efficient and effective. A disadvantage is that the incision is significant making the recovery duration longer and more painful.

 

Mini-Open Rotator Cuff Repair

The mini-open rotator cuff repair method involves an arthroscopic part of the surgery as well as a small incision to access the torn rotator cuff. The surgeon can view the shoulder joint by using an arthroscope and remove any bone spurs or damaged tissue. They can make preparations for the rotator cuff repair arthroscopically.

After the arthroscopic part of the procedure is complete, a smaller incision is placed to repair the tendon back to the bone. This incision is around 3 cm in length, and the recovery may be more comfortable in comparison to an open cuff repair.

Similar to open rotator cuff repair, this procedure also involves some deltoid muscle trauma. However, there is no detachment, and the damage is less severe.

 

All-Arthroscopic Rotator Cuff Repair

An arthroscopic rotator cuff repair involves the placement of tiny incisions, and the repair is performed with the surgeon viewing the torn rotator cuff tendons and their repair through a small camera which projects on a television screen. In the area of rotator cuff tear treatment, this is a recent development. This procedure cannot address all types of tears.

In addition, arthroscopic rotator cuff repairs can be technically challenging. The surgeon must have expertise in this repair method. There is no consensus between surgeons that arthroscopic repair is as effective as repair carried out via an open incision. The deltoid muscle sustains only minor damage using the arthroscopic rotator cuff repair method.

 

Shoulder Replacement Surgery

More significant rotator cuff tears that have been left untreated for many years cause the shoulder joint cartilage to wear out eventually. These large rotator cuff tears are also known as massive rotator cuff tears. They involve a minimum of two of the four rotator cuff tendons.

A condition known as rotator cuff tear arthropathy is a dual problem which involves a large rotator cuff tear and shoulder arthritis. Since the rotator cuff is damaged, a standard replacement is typically not suitable in this case.

The patient will receive special implants to compensate for the abnormal functioning of the rotator cuff. One of these special implants is known as a reverse shoulder replacement.

Reliable board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas across the horizon for orthopedic treatments.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Arthroscopy For Frozen Shoulder | Vegas OrthopedicFrozen shoulder, or adhesive capsulitis, is a painful condition. Patients with a frozen shoulder find even the simplest movements of the joint to be difficult.

The common symptoms of a frozen shoulder include pain when moving the arm even while performing basic tasks such as wearing a seatbelt, washing hair, or fastening a bra. A frozen shoulder occurs due to the scarring of the shoulder capsule which is the dense lining of the shoulder joint.

Frozen shoulder can almost always be treated with simple, nonsurgical treatments. These treatments may be simple, but frozen shoulder recovery may take months, or at times, years.

Some patients do not fully improve even with time. For patients who have undergone these treatments to improve the mobility of their shoulder but still suffer from stiffness, frozen shoulder surgery may be a suitable option.

Thomas and Bigler Knee and Shoulder Institute, led by committed board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and other towns and communities in this area of the southwest.

 

Frozen Shoulder Surgery

An arthroscopic capsular release is the standard surgical treatment of a frozen shoulder. This arthroscopic surgery involves inserting a tiny camera within the shoulder joint. The surgeon can also insert other instruments through these tiny incisions to address the concern.

A frozen shoulder occurs due to a tight shoulder capsule. Therefore, the treatment involves cutting the tight capsule to enable the shoulder joint to move more freely. The instruments that are inserted into the socket cut away the capsule surrounding it.

A vital facet of an arthroscopic release is to make sure that the enhancements in shoulder mobility remain following the surgery. At times, the patient will need to have their arm especially splinted to enable the capsule to help the shoulder remain stretched.

In general, physical therapy will start immediately after the surgery to ensure that the scar tissue does not redevelop around the joint.

 

Arthroscopic Release Alternatives

Manipulation under Anesthesia

The manipulation under anesthesia (MUA) procedure has been less commonly used since arthroscopic treatment became a standard procedure. It is effectively the passive stretching of the shoulder while the patient is asleep.

The benefit is that the joint capsule gets a much better stretch. However, there are potential complications associated with this procedure. There may be pain after this procedure. However, if too much force is used, it may cause the bones to fracture under pressure. The MUA procedure is usually performed following an arthroscopic capsular release.

 

Open Capsular Release

Since arthroscopic treatment has become a standard treatment for frozen shoulder, Open Capsular Release is less commonly performed.

Similar to an arthroscopic procedure, the shoulder capsule is divided. However, in this case, the surgeon views the inside of the shoulder directly. Arthroscopic surgery is typically considered superior as it leads to less pain and is less invasive while allowing full access to the shoulder joint.

 

Conclusion

Surgery is not a common treatment for a frozen shoulder. However, sometimes nonsurgical treatments are unable to provide the patient with relief. In such cases, surgery is recommended as a treatment option.

An important part of any surgery for frozen shoulder treatment is to make sure that the patient starts moving the shoulder as soon as possible following the procedure to preserve any gains in movement and prevent the development of new scar tissue within the shoulder joint.

Cordial board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and other cities and neighborhoods in this section of America for orthopedic treatments.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Arthroscopy For Shoulder Dislocation | Las VegasShoulder dislocation refers to injuries that occur when the ball of the ball-and-socket joint of the shoulder moves out of the socket. The most suitable treatment approach for this condition depends on various factors.  

Key factors may include the cause of the shoulder damage, the number of dislocations that have occurred, the patient’s age, sports or activities performed, and other variables. The patient should consult their doctor to understand the best treatment approach for them.

Thomas and Bigler Knee and Shoulder Institute, led by compassionate board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and other towns and neighborhoods in this area of the US.

 

Sling for Shoulder Dislocation

Immediate shoulder dislocation treatment includes the placement of a sling around the shoulder to enable the inflammation to decrease. Subsequently, the patient will start progressive exercises until they can resume their routine activities. There is no research indicating the ideal duration for sling used to treat shoulder dislocation.

 

Physical Therapy

An injured individual can regain their movement and strength following shoulder dislocation with physical therapy. In cases of shoulder dislocation, the damage may cause the likelihood of repeat dislocations.

Physical therapy can strengthen the muscles that help the shoulder remain in position to make up for the ligaments that have become compromised due to the dislocation injury.

While physical therapy is commonly used in the treatment of shoulder dislocation and it is quite helpful in regaining mobility and strength, it has not been shown to decrease the probability of a repeat dislocation.

In general, the treatment recommendation for this condition is for the patient to undergo physical therapy after an initial dislocation. In case there is a second dislocation, the patient should proceed with surgery.

 

Brace for Shoulder Dislocation

At times, bracing is recommended for treating a shoulder dislocation. A brace is typically used for an in-season athlete who dislocates their shoulder. For such patients, surgical intervention would mean the end of the season. Therefore, a brace may be recommended to prevent this condition.

Braces can prevent the shoulder from being in a position where there is a likelihood of dislocation. Braces cannot prevent all shoulder dislocations. However, they can reduce the overall probability of shoulder dislocations in athletes.

A significant drawback of bracing is that athletes participating in sports usually find it challenging to wear a brace while competing effectively. Braces are particularly unwieldy for athletes performing overhead movements such as throwing. A majority of athletes are unable to resume their sport while wearing a brace for shoulder dislocation.

 

Shoulder Dislocation Surgery

Shoulder dislocation surgery is usually advisable for patients who have recurrent shoulder dislocations. Some patients may be recommended to undergo surgery after an initial dislocation. Surgery is now being considered as an initial treatment approach, particularly for young athletes engaging in contact sports.

These types of athletes have such a high probability of repeat dislocation that surgery is frequently used as a first-line treatment. A surgical procedure repairs the structures that hold the shoulder in place. Common ligament damage occurs in the front of the shoulder joint. A procedure called Bankart repair is used to repair these ligaments.

 

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas in The Battle Born State for orthopedic treatments.
If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

What is a SLAP Tear of The Shoulder | Las VegasA SLAP tear is an injury to a part of the shoulder known as the labrum. The shoulder joint comprises a ball and socket joint which is similar to the hip joint. But unlike the hip joint, the shoulder joint socket is very shallow making it inherently unstable.

 

Defining this Issue

This makes the shoulder susceptible to dislocation. This injury occurs when the ball moves out of the socket. The shoulder joint has a circular cartilage rim (labrum) which forms a cup for the humerus (end of the arm bone) to move within in order to make up for the shallowness of the socket. The labrum of the shoulder effectively offers depth to the shoulder socket.

A particular type of labrum injury or labral tear is known as a SLAP tear. The term SLAP is an acronym for Superior Labrum from Anterior to Posterior. This tear develops at the juncture where the tendon of the biceps muscle inserts on the labrum.

The accomplished Thomas and Bigler Knee and Shoulder Institute, led by committed board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and other neighborhoods and suburbs in this area of America.

 

SLAP Tear Symptoms

The common symptoms of a SLAP tear include pain and a catching sensation when there is movement in the shoulder, usually due to overhead motions such as throwing. Patients typically report deep pain within the shoulder or in the back of the shoulder joint.

In general, it is hard to identify the cause of these symptoms unless the biceps tendon is also affected. If the patient has a SLAP tear along with biceps tendonitis, they may report pain over the front part of the shoulder, where the biceps tendon is located.

 

SLAP Tear Diagnosis

An expert examiner will perform several tests to diagnose SLAP tears as a part of a shoulder physical examination. In addition, they may question the patient in detail to identify symptoms pointing to a SLAP tear.

A SLAP tear diagnosis can be challenging as these injuries are may not be apparent on MRI scans. They usually show up well on MRI scans when it is performed with an injection of contrast. The patient is injected with a fluid, known as gadolinium, in the shoulder to conduct a contrast MRI. This fluid highlights tears of normal structures including SLAP tears.

Upon injecting gadolinium contrast into the shoulder before the MRI scan, the sensitivity of an MRI (the percent of times the test will highlight the tear) increases remarkably. An imaging test will not display every SLAP tear. At times, a SLAP tear diagnosis is made during the surgery.

 

SLAP Tear Treatment

SLAP tear treatment often commences with basic steps to reduce the pain and regain shoulder strength. The patient will usually be advised to undergo nonsurgical treatments for at least three months as many patients are able to resume full athletic activities in this duration without any surgical intervention.

For patients who are unresponsive to these measures, a surgical treatment called SLAP repair is commonly recommended. Sometimes when the SLAP tear leads to nerve injury and weakness in the shoulder, the patient may have a more immediate need to go into surgery.

 

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas across the landscape for orthopedic treatments.If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Arthroscopic SLAP Repair | Las VegasA majority of SLAP (Superior Labrum Anterior and Posterior) tear patients will respond favorably to conservative non-surgical treatments.

Patients of SLAP tears will be advised to rest following the injury to enable the damaged tissue to recover. Resting for a period will enable the swelling to resolve and may help mitigate the symptoms.

Thomas and Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding communities.

 

Common Treatments

Treatments that are often used to address SLAP tears are as follows:

  • Anti-inflammatory Drugs
  • Physical Therapy
  • Cortisone Injections

Patients with persistent symptoms despite these treatments may have to undergo arthroscopic surgery of the shoulder. There are multiple specific surgeries that may be undertaken.

It is vital to understand that SLAP tears usually develop along with other shoulder issues such as rotator cuff tears, and shoulder arthritis. For such patients, the surgical treatment will have to account for these conditions as well.

 

SLAP Tear Surgery

The main surgical options for the treatment of SLAP tears are as follows:

 

Debridement of the SLAP tear

In case a SLAP tear is debrided, the torn part of the labrum is trimmed away to develop a smooth edge. This treatment is appropriate only for minor tears that do not affect the biceps tendon. For the debridement surgery to be successful, the biceps tendon within the shoulder joint (known as the biceps anchor) should be stable.

In case the biceps anchor is not stable, merely debriding out the torn part of the labrum is not likely to address the symptoms of pain. Patients who undergo isolated debridement recover quicker than those who require surgical repair.

 

SLAP Repair

A SLAP repair refers to an arthroscopic procedure that utilizes sutures to rejoin the torn labrum to the shoulder socket. For patients who have an otherwise healthy shoulder but who want to remain active athletically, this procedure is most suitable.

In this procedure, the surgeon uses a surgical implant to reconnect the compromised labral tissue to the shoulder socket’s bone. Surgeons typically use a device known as a suture anchor for this surgery. The anchor is inserted into the bone, and then the sutures are wrapped around the labrum and tied firmly to the bone.

 

Biceps Tenodesis

This surgery involves cutting the biceps tendon in the area where it connects to the labrum and reinserting it in another site. The premise behind biceps tenodesis is that by reducing the forces that put a strain on the SLAP area, the symptoms will be resolved.  

In general, patients above 40 years of age or those with associated biceps tendonitis or tearing typically undergo a biceps tenodesis. This procedure can be performed by placing a tiny incision over the top portion of the shoulder, or arthroscopically.

The choice of technique to perform biceps tenodesis will depend mainly on the other conditions that are undergoing treatment within the shoulder joint.

 

Outcomes of Surgery

The outcomes of various surgical procedures have been reported in many scientific research studies. SLAP repair is the most frequently analyzed surgical procedure.

Over 90 percent of patients receiving an arthroscopic SLAP repair with modern suture anchors have reported good outcomes while over 85 percent are able to resume competitive sports activities.

 

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas for orthopedic treatments.If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Types of Shoulder Surgery | Las VegasMany common shoulder conditions that are unresponsive to conservative therapy may require surgical treatment.

These surgical procedures can range from minimally invasive arthroscopic procedures involving a scope and surgical tools being inserted via keyhole incisions into the shoulder to traditional open surgeries.

Every shoulder surgery technique has its benefits, limitations, and appropriate uses. Thomas and Bigler Knee and Shoulder Institute, led by prudent board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations in The Silver State.

 

Arthroscopy for Impingement Syndrome

Impingement syndrome refers to rotator cuff tendonitis and bursitis. In this condition, the arthroscopic procedure is used to treat impingement (subacromial decompression). This surgery aims to increase the space between the rotator cuff and the shoulder’s top part (called the acromion).

In performing subacromial decompression, the surgeon may excise the bursa alone or some of the acromion undersurfaces. This will create space for the rotator cuff to move without getting impinged between the bone.

 

Arthroscopic SLAP Repair

A SLAP tear refers to an injury to the rim of cartilage encircling the shoulder socket or the labrum.

An arthroscopic procedure may be performed to restore the labrum back to its appropriate position at the shoulder socket’s rim. The surgeon will fix the bone to the cartilage with sutures after the repositioning. The patient may require additional surgery if the damage encompasses the biceps tendon.

 

Arthroscopy for Shoulder Dislocation

A shoulder dislocation injury involves the ball of the shoulder joint moving out of the socket.

The damage typically occurs at the labrum in young athletes. A surgery known as a Bankart repair can reattach the labrum to the joint capsule in place to treat this condition.

Multidirectional instability is a condition involving the generalized laxity of the shoulder ligaments. This makes the shoulder joint prone to moving n and out of the socket quite readily. In such cases, the joint capsule is tightened surgically.

 

Arthroscopy for Frozen Shoulder

The capsule surrounding the shoulder joint becomes constricted and tight in a condition known as frozen shoulder. The objective of the surgery is to make the contracted tissue looser and enable the shoulder to move smoothly.

The surgeon achieves this by cutting the capsule around the ball of the shoulder. This is a technically challenging procedure as space within the joint is very tight.

 

Rotator Cuff Repairs

The surgery aims to identify the damaged area of the rotator cuff and to clean and reconnect any damaged or torn tendons. After locating the healthy tissue, the surgeon will employ multiple techniques to treat the tendon without stretching the remaining tissues excessively.

 

Acromioclavicular (AC) Joint Repairs

The acromioclavicular joint, commonly called the AC joint, is the point at the end of the collarbone (clavicle) and acromion. Various problems can develop at the AC joint. The patient may undergo an open surgery to remove the end of the clavicle and widen the AC joint space.

In general, shoulder separation can be addressed nonsurgically. However, severe cases may warrant surgical intervention to reconstruct or repair the ligaments that support the end of the collarbone.

 

Kind board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and other towns and cities in this region of the southwest for orthopedic treatments. If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Defining Radial Tunnel Syndrome | Las Vegas, NevadaRadial tunnel syndrome is also known as a radial nerve entrapment. This condition refers to radial nerve compression or restriction in the tunnel that it passes through.

Rotation of the wrist/lower arm rather than repetitive movement such as in tennis elbow is usually the reason for this elbow injury. However, the symptoms of radial tunnel syndrome and tennis elbow can sometimes be quite similar.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations in The Silver State.

 

Radial Tunnel Symptoms

Radial nerve entrapment symptoms are similar to those associated with tennis elbow. Therefore, it may be challenging to identify which of these two conditions is leading to the pain in the elbow.

Other symptoms of this condition are tingling or pins and needles in the hand and outer forearm.

The patient may experience tenderness in the upper forearm muscles with the maximum tenderness occurring around four to six cm down from the lateral epicondyle. In case of tennis elbow, the point of maximum tenderness is right underneath the bone. This condition may also cause wrist pain which may radiate towards the upper arm.

Radial nerve entrapment can be diagnosed with a specific test which reproduces pain on turning the palm of the hand up and extending the middle finger against resistance or resisted supination.

The radial nerve bifurcates into two branches at the elbow, namely the posterior interosseous nerve (PI nerve) and superficial radial nerve. Radial tunnel syndrome occurs when the PI nerve in the forearm gets compressed. This compression of the PI nerve can occur at various locations in the upper forearm and elbow.

This condition frequently occurs in those who turn the hand over or pronate and supinate the arm in a repetitive manner. On the other hand, tennis elbow typically manifests due to repetitive wrist extension or bending of the wrist backwards.

 

Treatment

Radial nerve entrapment treatment comprises a combination of rest and discontinuing any repetitive wrist motion. The application of ice therapy to the forearm and elbow may also offer relief from the symptoms.

 

Ice and Compression

The patient should apply the principles of P.R.I.C.E. (Protection, Rest, Ice, Compression, and Elevation) in the initial 72 hours following the injury. The application of a cold compression wrap should not be done for over 15 minutes as the injured tissues are located close to the skin and do not require a longer application.

 

Protection

If the patient wears specialist elbow support, it can reduce the pressure on the tendon expediting the healing process. This involves the application of compression around the injured site creating pressure on the compromised tendon. Change in the way forces are transferred through the tendon allows the injured tissues to rest.

 

Rest

The most crucial part of the treatment and usually the most challenging is allowing the injured tendons to rest. In case the patient continues the offending activities with the painful elbow, it will not recover fast and become chronic and hard to treat.

The doctor may prescribe anti-inflammatory meds, and a professional therapist may perform soft tissue massage to free the supinator muscle which typically causes the entrapment.

The patient may also undergo neural stretches within the physical therapy treatment. If the condition is persistent or severe, the patient may require surgical intervention to decompress the nerve which usually resolves the condition.

But if the patient requires surgery, they may take around eight weeks to recover. Kind board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada, and other towns and cities in this region of the southwest.

 

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

The Affliction of Tennis Elbow | Las Vegas, NevadaTennis elbow, also known as lateral epicondylitis or extensor tendinopathy, is a common term used to describe pain in the outer elbow.

It usually occurs because of tendon swelling or degeneration in the area where the extensor muscles insert into the elbow. Tennis elbow may develop due to sports such as tennis or other activities that strain the muscles of the elbow.

 

Not Just in Tennis Players

This condition, contrary to its name, does not manifest only in tennis players. It also affects people engaged in other sports or recreational activities involving repetitive stress on the muscles surrounding the elbow, such as decorating or heavy lifting.

It can be challenging to treat a tennis elbow, particularly if it becomes chronic. Therefore, it is essential to get it medically assessed at the earliest. This condition can develop gradually (chronic) or over a few days or weeks or quite suddenly (acute).

Thomas & Bigler Knee & Shoulder Institute, led by caring board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding communities in this region of The Battle Born State.

 

Symptoms

The primary symptom is pain around one to two cm below the bony part located on the outside of the elbow (lateral epicondyle).

The patient may also experience weakness in the muscles around the wrist and forearm rendering it challenging to perform routine activities due to weakness in gripping objects such as opening a door handles or holding a racket. A professional therapist or doctor may conduct various assessment tests to diagnose tennis elbow.

 

Types of Tennis Elbow

Acute Injuries

Acute injuries occur suddenly after an activity such as using a poor technique to hit a backhand shot. The extensor muscles behind the forearm (wrist extensors) suddenly become overloaded. This causes micro tears of the tendon where it inserts into the elbow.

 

Chronic Injuries

Chronic injuries develop gradually over a few days or weeks. It is usually preceded by bouts of intense exercise or activity that the patient is not accustomed to, such as lifting heavy furniture while moving.

 

Treatment

Tennis elbow treatment involves measures to reduce pain and swelling through rest and application of ice or cold therapy. Gradually, the load through the elbow is increased via exercises to a level where the patient can resume routine training and competition.

A doctor or professional therapist may prescribe drugs such as Ibuprofen to mitigate the symptoms in the initial stages.

 

Exercises

Stretching and strengthening exercises form the basis of the rehabilitation program and are vital to recovery. The patient should perform these exercises as soon as the pain reduces and continue until and beyond the level of full fitness.

The most important part of the rehab program is wrist extension stretches and exercises. These aim to slowly increase the load transferred through the tendon and its extension while remaining within the limits of pain. Static exercises (also called isometric) are done initially.

These involve muscle contraction without actually causing movement in the wrist. These exercises should only commence after the initial swelling and pain have subsided.

 

Surgery

When it comes to surgical intervention, golfer’s elbow and tennis elbow are treated similarly. Most tennis elbow cases are unresponsive to conservative treatments involving ice, rest, ultrasound, and at times, a steroid injection.

But if the patient requires surgery, they may take around eight weeks to recover. Devoted board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada, and other suburbs and cities in the southeast part of Nevada.


If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

The Ordeal of Arm & Elbow Pain | Las Vegas, NevadaInjuries of the arm and elbow are classified into lateral elbow pain (on the outer side of the elbow), medial elbow pain (inside the elbow), posterior elbow pain (at the back portion of the elbow), acute elbow injuries (sudden pain), forearm pain and upper arm injuries.

The most common reason for pain on the outside of the elbow is the Tennis elbow.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations.

 

Lateral Elbow Pain

Tennis elbow, medically known as lateral epicondylitis, is a commonly used term to describe pain on the outside of the elbow. But various other causes lead to lateral elbow pain. These reasons should be considered along with acute elbow injuries such as fractures and ligament sprains.

 

Tennis elbow

Tennis elbow is a commonly used term to describe outer elbow pain. It frequently occurs due to tendon swelling or degeneration in the wrist extensor muscles as they connect with the elbow.

 

Radial Tunnel Syndrome

Radial tunnel syndrome, also known as radial nerve entrapment, occurs when the radial nerve gets restricted or compressed within the tunnel that it passes through.

 

Medial Elbow Pain

Medial elbow pain occurs in the inside of the elbow. In general, the onset of the pain is gradual and due to overuse. However, it can also happen because of an acute injury, especially in throwers. The most common name given to this condition is thrower’s elbow or golfer’s elbow. It refers to the swelling or degeneration of the flexor tendon.

 

Golfer’s elbow

Golfer’s elbow (medial epicondylitis) is an injury brought about by overuse similar to the tennis elbow. However, it leads to pain on the inside of the elbow rather than the outside.

 

Medial Elbow Ligament Sprain

This condition happens due to a tear to the medial collateral ligament (MCL) located on the inside portion of the elbow. It may occur unexpectedly due to an impact, accident, or even repetitive overuse due to, say, poor throwing technique.

 

Posterior Elbow Pain

This pain occurs at the back of the elbow and may be acute. It can manifest suddenly or slowly over time. The patient may experience a chronic elbow injury after an acute injury which has not been addressed appropriately or remains unhealed.

 

Elbow Bursitis – Students Elbow

Elbow bursitis (also called students elbow or olecranon bursitis) leads to swelling of the bursa. The bursa protects the bone at the back of the elbow.

 

Olecranon Fracture

The olecranon process refers to the bony prominence at the back of the elbow on the ulna forearm bone. This fracture typically occurs due to a direct fall or impact on a bent elbow.  

 

Forearm Pain

Forearm pain can be acute (sudden onset) and may involve radius or ulna bone fractures. Nerve impingements or overuse of the wrist can cause the gradual onset of forearm pain.

 

Upper Arm Pain

A common upper arm injury is a fractured humerus (broken bone). But bicep and tricep strain may also occur.  Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada, and nearby areas.


If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.