Shoulder Injuries

Acromioclavicular (AC) Joint Separation

The acromioclavicular (AC) joint is the joint located at the top of your shoulder that connects the clavicle (collarbone) to your acromion (the top part of your shoulder blade). The AC joint is stabilized by multiple ligaments including the joint capsule and coracoclavicular ligaments. 

AC joint injuries (AKA shoulder separation) occur most commonly after a fall directly onto the shoulder. There is a spectrum of severity of AC joint injuries, ranging from a mild sprain to a dislocation of the AC joint with disruption of all of the stabilizing ligaments.

Most AC joint injuries are mild and can be treated without surgery. However, higher grade injuries with significant displacement of the clavicle and disruption of the stabilizing ligaments typically benefit from surgery in order to decrease pain and preserve the long-term function of the shoulder.

AC Joint Repair and Reconstruction

AC joint repair is a surgery in which the AC joint is reduced and held in place using high-strength suture devices, allowing your own ligaments to heal naturally. AC joint repair is indicated for acute, high-grade injuries, when surgery can be performed within a few weeks. 

AC joint ligament reconstruction, on the other hand, is a surgery in which AC joint is again reduced and held in place using high strength suture devices, but with the addition of a tendon graft to create new ligaments that will heal to your bones over time. AC joint reconstruction is indicated for chronic injuries in which the native ligaments are of poor quality due to the buildup of scar tissue or in injuries that are particularly severe in which the addition tendon graft is necessary to provide long term support.

Recovery after AC Joint Surgery

Our surgeons perform AC joint surgery in the outpatient surgical center and patients are able to go home the same day. As a part of a multi-modal pain control protocol, our team uses a nerve block for all of his shoulder surgeries. A nerve block is a procedure in which the anesthesiologist injects numbing medication around the nerves that go to the shoulder and arm. This results in excellent pain control with minimal to no pain for the 1-3 days after surgery.

In general, patients are in a sling for 6 weeks after surgery, at which time physical therapy is initiated. Once recovered, patients are allowed to go back to all activities, including weightlifting and contact sports.

Pectoralis Major Tendon Tears

The pectoralis major is one of the muscles on the front of the chest. It is attached to the upper arm via the pectoralis (pec) tendon. The pectoralis major is responsible for giving strength to the arm with chest movements such as push-ups or bench press. 

Tears of the pec tendon are more common in males and occur when the pectoralis muscle is activated while it is being stretched at the same time (such as a “negative rep” or the lowering phase during a bench press). Patients typically feel a pop followed by pain, swelling, and bruising.

Treatment Options for Pectoralis Major Tendon Tears

While partial tears can sometimes improve with physical therapy, full tears do not heal on their own and surgical repair is generally recommended. Without surgery, patients can expect weakness in the upper arm as well as loss of the normal chest contour.

Our surgeons typically obtain an MRI to confirm the diagnosis and to locate the position of the torn and retracted tendon. Once the tear is confirmed, surgery is recommended and is ideally performed within 2 weeks of the injury. 

Although surgery may be possible up to 6 weeks from the injury, waiting is not recommended as this can lead to significant scarring of the tendon, increasing the tension on the surgical repair. Beyond 6 weeks the tear is considered chronic and a primary repair may not be possible. At that point, a reconstruction using a donor tendon may be necessary.

Our surgeons utilize the latest technology to perform pec tendon repairs, including high strength suture and the most advanced suture buttons to give you the strongest repair possible. Pec tendon repairs are performed in the outpatient surgical center, and patients are able to go home the same day. 

Patients are in a sling for 4-6 weeks and physical therapy generally lasts 2-3 months. Once recovered, patients are allowed to go back to all activities including weightlifting without restriction.

Superior Labrum (SLAP) and Bicep Tears

The labrum is a ring of soft tissue that surrounds the socket of the shoulder. The labrum can be broken up into three general parts: anterior, posterior, and superior. The anterior and posterior labrum contain the attachments of the ligaments that stabilize the shoulder joint and are involved in providing stability to the shoulder joint. 

The superior labrum sits at the top part of the socket and contains the attachment of the long head of the biceps tendon. The biceps is a muscle in the front of the arm and has two attachments around the shoulder joint – one outside of the shoulder joint along front of the shoulder blade (known as the short head of the biceps tendon) and one inside the shoulder joint attached to the superior labrum (known as the long head of the biceps tendon).

An injury to the superior labrum is known as a SLAP tear (or Superior Labral Anterior to Posterior tear). A SLAP tear may be the result of an acute injury or the result of a chronic degenerative process. A tear of the superior labrum often occurs in conjunction to an injury or tear of the attachment of the biceps tendon. 

Patients with a SLAP tear complain of pain, often in the front of the shoulder, especially with weight-lifting and other overhead activities. Patients may also experience painful popping or clicking within the shoulder.

Diagnosis & Treatment of SLAP Tears

Physical exam and clinical presentation may be suggestive of a SLAP tear, however the diagnosis ultimately is made by obtaining an MRI of the shoulder.

Patients with a SLAP tear may elect to undergo an initial trial of non-operative management. This typically includes a course of physical therapy and may include a steroid injection to decrease local inflammation. While most patients experience subsidence of the initial pain over a period of weeks, many still complain of reproducible anterior shoulder pain with certain activities despite adequate physical therapy. In those patients with persistent symptoms, surgery is recommended in order to get patients back to their pre-injury activity level.

SLAP Repair and Biceps Tenodesis

Historically, tears of the superior labrum were treated with an arthroscopic SLAP repair. This involved placing suture around the labrum and attempting to re-attach it to the socket of the shoulder. While this worked for some patients, many failed to heal their repair and subsequently had to undergo a second surgery to fix the problem.

Dr. Contreras prefers to treat most SLAP tears with an arthroscopic debridement of the torn tissue along with removing the attachment of the biceps tendon from the labrum and re-attaching the biceps lower down in the arm, a procedure known as a biceps tenodesis. Removing the attachment of the biceps tendon from the superior labrum prevents the biceps from pulling on the torn labral tissue, allowing it to heal in place and removing the source of pain from the SLAP tear. 

Dr. Contreras then performs a biceps tenodesis using minimally invasive techniques through a small cosmetic incision lower down the arm near the axilla in order to reattach the biceps to the humerus. Performing a biceps tenodesis preserves the function and strength of the biceps while removing the painful symptoms of a SLAP tear. Biceps tenodesis has been shown throughout the scientific literature to have excellent results with a lower re-operation rate when compared to SLAP repair, including in high level and overhead throwing athletes.

Recovery After SLAP Tear and Biceps Surgery

Dr. Contreras performs SLAP tear and biceps surgery in the outpatient surgical center and patients are able to go home the same day. As a part of a multi-modal pain control protocol, Dr. Contreras uses a nerve block for all of his shoulder surgeries.

In general, patients are in a sling for only 2 weeks after biceps tenodesis, at which time physical therapy is initiated. Once recovered, patients are allowed to go back to all activities including weightlifting and contact sports.

Shoulder Injury Treatment & Surgery in Bergen County, NJ

The team at Cahill Orthopedic treats a full range of shoulder injuries, including AC joint separation, pectoralis major tendon tears, and SLAP tears. Our surgeons include Dr. James Cahill, a fellowship trained sports medicine specialist, and Dr. Erik Contreras, a fellowship trained shoulder and elbow surgeon.

To schedule an appointment with one of our surgeons, please call our office at (201) 489-0022.