Nerve Entrapment Specialist
Are you an athlete who participates in sports that invovle repetetive overhead movements like swimming, volleyball, baseball or tennis? If so, you may be at risk of developing a pinched nerve in your shoulder called suprascapular nerve entrapment. This condition can cause upper back and shoulder pain and even loss of shoulder function. Shoulder nerve entrapment specialist, Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who have suprascapular nerve entrapment, or a compressed nerve in their shoulder. Contact Dr. Williams’ team today!
What is suprascapular nerve entrapment?
The suprascapular nerve arises from the middle of the cervical spine and innervates the supraspinatus and infraspinatus muscles of the rotator cuff. This nerve provides both motor and sensory information to these muscles in order to stabilize arm movements that occur at the shoulder joint. Suprascapular nerve entrapment, also known as suprascapular neuropathy, is a condition that results from impingement or damage to the suprascapular nerve. Conditions that are associated with suprascapular neuropathy include: rotator cuff tears, shoulder dislocation, fractured scapula fractures (shoulder blade), clavicle (collarbone) fractures, nerve stretch injuries, direct shoulder trauma, stab wounds and gunshot injuries. The patient with suprascapular nerve entrapment usually presents with shoulder pain and weakness. The signs of suprascapular neuropathy overlap with other more common shoulder conditions; this rare condition can often be overlooked or misdiagnosed. If suprascapular nerve entrapment is suspected, it is important to seek immediate medical attention from a medical professional or orthopedic shoulder specialist to prevent further damage to the suprascapular nerve. Dr. Riley J. Williams, orthopedic shoulder specialist serving patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, has the knowledge and understanding, as well as substantial experience, in treating patients who have experienced suprascapular nerve entrapment.
What is suprascapular nerve compression?
Suprascapular nerve compression occurs when another anatomic structure presses directly on the nerve. Such structures include local ligaments (i.e. the suprascapular ligament) that can thicken and trap the suprascapular nerve. The nerve is also commonly entrapped at the spinoglenoid notch as it passes through to the infraspinatus muscle. Tumors, ganglion cysts, labral cysts and other structural irregularities of the scapula can cause suprascapular nerve compression.
Are there certain populations at greater risk for suprascapular nerve entrapment?
Yes. Since repetitive stretching of the suprascapular nerve can result in suprascapular neuropathy, athletes who consistently perform repetitive overhead movements (volleyball, baseball, weightlifting, swimming, tennis) are at high risk of developing suprascapular nerve entrapment. However, individuals with certain underlying health conditions that lead to the weakening of the scapular muscles, abnormal bone development, or scapular ligament irregularities are also at an increased risk for developing suprascapular nerve entrapment.
What are the symptoms of suprascapular nerve entrapment?
A common complaint of suprascapular neuropathy is a burning pain that radiates to the affected arm, neck, or back. Other symptoms of suprascapular nerve entrapment include:
- Shoulder pain, upper back discomfort
- Pain that generally worsens with shoulder movement
- Weakness of the affected shoulder or arm, especially external rotation of the arm
- Atrophy or deterioration of the affected shoulder muscles
- Partial or complete loss of shoulder function
How is suprascapular nerve entrapment diagnosed?
Because the symptoms of suprascapular neuropathy overlap with common shoulder conditions, it is important to seek prompt medical attention from an orthopedic shoulder specialist familiar with this condition. Dr. Williams will obtain a comprehensive medical history and perform a thorough physical examination. Specialized diagnostic imaging will be obtained to confirm damage to the suprascapular nerve. These imaging techniques may include radiographs, ultrasound, electromyography/nerve conduction study, and magnetic resonance imaging (MRI).
What is the treatment for suprascapular nerve entrapment?
Non-surgical treatment:
If a diagnosis of suprascapular nerve entrapment is confirmed, and the symptoms do not interfere with activities of daily living, conservative therapies may be sufficient in treating this condition. A combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) are encouraged to control pain and to fdecrease inflammation. Applying heat prior to any shoulder stretching or strengthening activities is also recommended. Physical therapy aimed at increasing mobility, strength, and range of motion of the shoulder is recommended.
Surgical treatment:
In the event of severe nerve compromise, or if conservative therapy was unsuccessful, Dr. Williams may recommend an arthroscopic procedure to decompress the suprascapular nerve. Once the area of nerve compression is identified, Dr. Williams is able to expose the area and relieve the local nerve compression using minimally invasive instrumentation. This minimally invasive surgical approach is an effective technique for suprascapular nerve decompression. The arthroscopic approach shortens the recovery time for patients to return to their normal daily and athletic activities.
For more information on suprascapular nerve entrapment, or the excellent treatment options available, please contact the office of Dr. Riley J. Williams, an orthopedic shoulder specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
Pectoralis Major Tendon Repair Surgeon
A pectoralis major tendon injury occurs when the tendon is pulled away from its attachment site on the humerus (upper arm bone). Pectoralis major tears are often seen among individuals involved in weight-lifting and labor-intensive work. While a partially torn tendon or a tendon strain can be treated conservatively, completely torn pectoralis major tendons require surgery. Pectoral tendon surgeon, Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who have sustained a pectoralis major tendon injury. Contact Dr. Williams’ team today!
What is a pectoralis major tendon injury?
Located on the anterior (front) chest wall are two large, fan-shaped muscles. These muscles are part of the pectoral major complex and are also known as the “pecs”. The pectoralis major muscle originates from the center of the sternum (chest) and clavicle (collarbone). The muscle travels along the chest wall where it ultimately anchors to the humerus (upper arm bone) by means of the pectoralis major tendon. The pectoralis minor muscle originates from the third, fourth, and fifth ribs and attaches to the coracoid process of the scapula (shoulder blade). These muscles work in concert to provide strength and stability to the shoulder when lifting or pushing heavy objects. A pectoralis major tendon injury occurs when the tendon is pulled away from its attachment site on the humerus. Pectoralis major tears are often seen among individuals involved in weight-lifting and labor-intensive work. This type of injury results when the force applied to the pectoralis major muscle exceeds the strength of the pectoralis major tendon’s attachment to the humeral bone. A partial tendon tear may only affect the sternal head of the pectoralis major tendon, whereas a complete tendon tear involves both the sternal head and the clavicular head of the pectoralis major.
What is the treatment for a pectoralis major tendon injury?
A pectoralis major tendon strain, partial tendon tear, or muscle strain/tear can generally be treated conservatively. Patients are encouraged to decrease or avoid activities that initially caused the injury or exacerbate the pain. A combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) is also recommended for pain management.
Most pectoralis major tendon injuries will require surgery to repair the tendon. Surgical intervention is the most reliably successful method for repairing a pectoralis major tendon injury. Surgical repair of the tendon involves reattaching the tendon to its the correct anatomical position on the humerus. The goal of surgically repairing a pectoralis major tendon injury is to restore stability and strength to the shoulder. A chronically torn pectoralis tendon is a debilitating condition. Dr. Riley J. Williams, orthopedic shoulder doctor, treats patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, who have experienced a pectoralis major tendon injury and need a surgical repair.
How is a pectoralis major tendon repair performed?
Pectoralis major tendon repair requires a small incision near the native insertion of the tendon on the humerus. Prior to the procedure, the patient is placed under light sedation and regional anesthesia is administered. A small incision is made over the anterior shoulder. The dissection localized and identifies the torn tendon edge. After removing the devitalized tissue on the lateral margin of the torn tendon, it then reattached to the humerus using strong sutures and anchors that are placed within the humeral bone.
Patients who present with a chronically torn pectoralis major tendon may experience shortening or scarring. In these circumstances, a tendon graft, either from the patient (autograft) or a donor (allograft), may be necessary to facilitate the proper reattachment of the tendon to the humeral shaft. This tendon graft is then sewn into the native pectoralis major muscle prior to bony reattachment. To prevent pectoralis major tendon retraction and scarring, patients who have experienced a pectoralis major tendon tear are strongly encouraged to seek immediate medical attention as these can make for a difficult surgical repair.
What is the recovery period like after a pectoralis major tendon repair?
The recovery period following a pectoralis major tendon repair is dependent on the injury severity and chronicity. Most patients can expect a return to normal daily activities in approximately 6 weeks. A full recovery, including sports, typically takes 4-6 months. In general, patients in New York can expect the following:
- Immobilization of the shoulder joint, with a sling or other device, immediately following surgery and remain immobilized for 2 weeks.
- A combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) will be used to control pain and decrease inflammation. Dr. Williams may prescribe stronger pain medication to be taken as directed.
- Active participation and completion of the physical rehabilitation program detailed by Dr. Williams is the key to a successful recovery. Passive and active shoulder exercises are carefully performed with the help of the physical therapy team to re-establish shoulder strength, mobility, and range of motion. Formal PT starts one week after surgery and continue for approximately 3 months.
For more information on pectoralis major tendon repair, or to discuss your pectoralis major tendon treatment options, please contact the office of Riley J. Williams, MD, orthopedic shoulder doctor at the Hospital for Special Surgery (HSS), serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
Clavicle Fracture Specialist
A clavicle or collar bone fracture can occur from a fall, trauma, work injury or from a direct blow, experienced during work or a sports collision. Common symptoms of a fractured clavicle include sharp pain at the time of injury and difficulty with pain when moving the arm. Collar bone fracture specialist Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who have sustained a clavicle injury or broken collarbone. Contact Dr. Williams’ team today!
What is a clavicle fracture?
The clavicle (collarbone) is a long s-shaped bone that connects the upper limb to the thorax. Together, the clavicle and the scapula (shoulder blade) form the shoulder girdle. The clavicle is often broken when the shoulder experiences trauma such as a direct blow or a fall onto an outstretched arm. Clavicle fractures are common, and account for 5% of all adult bone fractures. Dr. Riley J. Williams, orthopedic shoulder specialist serving patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, has the knowledge and understanding, as well as substantial experience, in treating patients who have experienced a clavicle fracture.
Are there different types of clavicle fractures?
Classification of clavicle fractures is based on the anatomical location of the fracture, as follows:
- The fractured portion of the clavicle occurs in the middle of the bone; this area is the most common location of a break. If the bones remain in the correct anatomical position with minimal displacement, midshaft fractures can be treated without surgery.
- Lateral/Distal. The fractured portion of the clavicle occurs at the point furthest away from the body’s midline near the top of the scapula. Surgery may be necessary depending on the location of the fracture and the associated bony displacement.
- The fractured portion of the clavicle occurs at the point closest to the neck. These fractures are rare and account for approximately 2-4% of all clavicle fractures.
Are there certain populations more at risk for a clavicle fracture?
Although the majority of clavicle fractures are the result of a traumatic event, there are certain groups of individuals that are at a higher risk of experiencing a clavicle fracture. They are as follows:
- Children and Teens. The bones of individuals between the ages of 10 and 19 are still growing and thus have a lower density. These factors make bones more susceptible to fracture.
- Male athletes who participate in contact sports or high-impact activities, such as football, soccer, or wrestling, are three times more likely to experience a clavicle fracture.
- Older Adults. The density of bones decreases with the natural aging process and even minor traumas can result in a clavicle fracture.
What are the symptoms of a clavicle fracture?
A sharp pain of the clavicle immediately following an injury is the most common complaint of a clavicle fracture, although symptoms can vary depending on the severity of the injury. Other common symptoms of a clavicle fracture include:
- Obvious visual deformity of the clavicle
- Pain with arm movement
- Pain, bruising, redness, and swelling of the affected clavicle
- Difficulty with rotating or lifting the affected arm
- Downward shoulder sag
- Shoulder stiffness
How is a clavicle fracture diagnosed?
A comprehensive medical history will be obtained, and Dr. Williams will perform a thorough physical examination. An x-ray of the affected clavicle will be completed to confirm the diagnosis. Additional diagnostic testing, such as magnetic resonance imaging (MRI) scan or CT scan may be requested to rule out any damage to the other structures within the shoulder girdle, and to better understand the morphology of the fractured clavicle.
What is the treatment for a clavicle fracture?
Non-surgical treatment:
If a patient experiences a minor clavicle fracture that did not result in bony displacement, conservative therapies can be effective in resolving symptoms during the healing process. The affected arm will be placed in a sling to keep the clavicle in an acceptable position while healing. A combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) is recommended for pain and inflammation management. When the pain and inflammation subside, physical therapy is encouraged to restore strength to the shoulder girdle.
Surgical treatment:
Athletic or high demand individuals may be best treated with surgery for clavicle fractures. Clavicle fracture surgery enable the surgeon to achieve anatomic positioning of the affected bone. Shortening of the clavicle after nonoperative treatment may result in anterior displacement of the scapula and chronic posterior shoulder pain. Other circumstances such as failed conservative therapy, a dislocated clavicle, excessive fragment displacement, or open fractures should also be considered for surgical intervention. The clavicle fracture repair (open reduction and internal fixation) procedure utilizes special plates and screws to realign and fix the bone fragments in their proper position.
This procedure is typically done on an outpatient basis using light sedation and regional anesthesia. Most patient will require a sling for approximately two weeks. Home based motion exercises are start immediately following surgery. Formal physical therapy starts approximately one week after surgery. Bony healing usually occurs 6-8 weeks after surgery. Most patients will require some physical therapy for 2-3 months following this procedure to achieve a full recovery.
For more information on clavicle fractures, or the excellent treatment options available, please contact the office of Dr. Riley J. Williams, an orthopedic shoulder specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
Frozen Shoulder Repair Doctor
Have you been diagnosed with adhesive capsulitis or frozen shoulder? If so, you may be eligible for a shoulder treatment called arthroscopic capsular relase. When conservative measures have failed to eliminate shoulder pain and restore range of motion, surgical intervention may become necessary. Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who have adhesive capsulitis or frozen shoulder. Contact Dr. Williams’ team today!
What is a frozen shoulder?
Frozen shoulder occurs when the connective tissues surrounding the shoulder joint (shoulder capsule) thicken and shorten due to chronic inflammation. This condition is also known as adhesive capsulitis; frozen shoulder causes pain and motion loss in the affected shoulder. In more severe cases, there is a complete loss of shoulder function; simple activities of daily living (hygiene, sleep, dressing, eating) can be difficult and painful.
Frozen shoulder typically has an insidious onset. Although the development of adhesive capsulitis is not completely understood, some underlying health conditions are associated with an increased risk of developing a frozen shoulder. They are as follows:
- A lack of shoulder movement for an extended period, often from a prior injury or surgery, can cause a frozen shoulder.
- Age and sex. A frozen shoulder is more commonly seen in women over the age of 40.
- A frozen shoulder is seen more often in patients with diabetes; these patients typically experience a more severe form of the disease and longer-lasting symptoms.
- Prior surgery to the shoulder girdle or chest area (breast reconstruction).
- Radiation therapy
What are the stages of adhesive capsulitis or frozen shoulder?
There are four stages in the gradual development of adhesive capsulitis:
- Inflammatory phase: characterized by increasing pain with little motion loss. Sleep in difficult.
- Freezing phase: shoulder pain increases resulting in disuse of the affected limb and progression motion loss
- Frozen phase: The affected shoulder is significantly less painful but function is limited because of the motion loss associated with this phase.
- Thawing phase: the patient slowly recovers shoulder motion as the condition wanes.
Most patients will progress through these phases over 2 years without intervention.
What is the treatment for a frozen shoulder?
Patients with a frozen shoulder are generally able to recover with conservative therapy. The goal of conservative treatment is the resolution of shoulder inflammation and the restoration of shoulder range of motion. A combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) can be used as part of an initial treatment strategy. The judicious use of intraarticular injections of corticosteroids can also be of great value in treating symptomatic adhesive capsulitis patients. Corticosteroids are effective agents that work to decrease the excessive inflammatory process that is characteristic of frozen shoulder joints. Once the inflammation and associated pain have diminished, physical therapy and a home exercise and stretching program are indicated.
What is shoulder arthroscopy with capsular release?
In those circumstances where conservative measures fail to adequately alleviate symptoms, surgical intervention may be necessary to treat the affected shoulder. Surgery for adhesive capsulitis is geared toward removing inflammatory tissues, releasing the shoulder capsule and restoring normal shoulder range of motion. Surgical repair is typically performed at the “freezing” or “frozen” stage of adhesive capsulitis. Frozen shoulder repair is also known as arthroscopic shoulder capsule release. Manual manipulation of the shoulder and an arthroscopic release of the tight ligament around the shoulder are performed together to restore normal shoulder kinematics. Dr. Riley J. Williams, orthopedic shoulder doctor, treats patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, who have experienced a frozen shoulder and need surgical repair.
How is a frozen shoulder surgery/capsular release performed?
The surgery to repair a frozen shoulder is generally performed as an outpatient procedure as an overnight hospital stay is not required for recovery. Prior to the procedure, the patient is sedated and regional anesthesia is administered. Dr. Williams then manipulates the shoulder and carefully moves the shoulder through a sequence of positions to restore range of motion and stretch the inflamed connective tissues. This manual manipulation of the shoulder releases the tight shoulder capsule, improves range of motion of the shoulder, and decreases shoulder pain. Once the manual manipulation is complete, Dr. Williams creates small “keyhole” incisions surrounding the shoulder. A continuous circulation of a sterile solution is introduced into the shoulder joint to enhance visualization of the shoulder joint structures. A small camera (arthroscope) is then inserted through a portal and the images are relayed onto a screen for Dr. Williams to methodically examine the muscles, tendons, and ligaments of the shoulder joint. A radiofrequency probe is then introduced when the shoulder capsule has been identified. This probe uses radiofrequency waves to sever and cauterize the tissue capsule allowing the joint to move more freely. This device is also used to cauterize all inflamed appearing tissues in the shoulder. Once the shoulder capsule has been stretched and released, the arthroscope and surgical instruments are removed, and the incisions are closed with sutures or steri-strips. The shoulder is once again manipulated to confirm the restoration of full passive range of motion of the shoulder joint.
Why is shoulder manipulation important?
Shoulder manipulation under anesthesia as a single operation was the standard procedure for patients with a frozen shoulder. This manual manipulation of the shoulder releases the tight shoulder capsule, improves range of motion of the shoulder, and decreases shoulder pain. When shoulder manipulation was later combined with the arthroscopic capsular release procedure, patients had more successful recovery outcomes.
What are the benefits of arthroscopic capsular release surgery?
Dr. Williams favors the arthroscopic surgical approach as the arthroscope allows for a precise and well-controlled release of the shoulder capsule. The radiofrequency probe implemented in this procedure cauterizes the tissue as it cuts, therefore reducing the bleeding within the joint. Due to the small incisions, this minimally invasive procedure results in a faster recovery period compared to open procedures. Arthroscopic capsular release also minimizes the risk of blood loss and infection as well as decreased pain and inflammation following surgery.
What are the benefits of arthroscopic capsular release surgery?
Dr. Williams favors the arthroscopic surgical approach as the arthroscope allows for a precise and well-controlled release of the shoulder capsule. The radiofrequency probe implemented in this procedure cauterizes the tissue as it cuts, therefore reducing the bleeding within the joint. Due to the small incisions, this minimally invasive procedure results in a faster recovery period compared to open procedures. Arthroscopic capsular release also minimizes the risk of blood loss and infection as well as decreased pain and inflammation following surgery.
For more information on frozen shoulder repair, or to discuss your frozen shoulder treatment options, please contact the office of Riley J. Williams, MD, orthopedic shoulder doctor at the Hospital for Special Surgery (HSS), serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
UCL – MCL Injury Specialist
Are you an athlete or that participates in repetitive overhead motions like baseball, raquet sports or other throwing activities? If so, you may be at risk of sustaining an elbow injury to the ulnar collateral ligament, or UCL. Injury to the ULC or MCL ligament can cause elbow instability, pain and swelling. ULC/MCL specialist, Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who have sustained an injury to the ULC or MCL in the elbow. Contact Dr. Williams’ team today!
What is an ulnar collateral ligament (UCL) injury?
The ulnar collateral ligament (UCL) is a band of thick, fibrous tissue, connecting the humerus (upper arm bone) to the ulna (forearm bone on the medial side). The UCL is also known as the medial collateral ligament (MCL). The UCL is responsible for elbow stability. The UCL is most commonly injured by repetitive overhead throwing or from a traumatic injury. A fall on an outstretched arm can injure the UCL and result in an unstable elbow. The ulnar collateral ligament is divided into three bands of tissue: posterior, anterior and transverse. Injuries to these structures can result in elbow pain, instability, and dysfunction. Dr. Riley J. Williams, orthopedic elbow specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas has extensive experience in treating ulnar collateral ligament injuries.
What are the symptoms of a UCL injury?
If the injury is chronic, daily tasks will most likely still be manageable. An acute injury will greatly limit functionality, especially if an elbow dislocation has occurred concomitantly. Individuals in the New York area often report the following symptoms for their UCL injury/tear:
- Elbow joint instability
- Pain on the inside of the elbow, exacerbated by overhead throwing
- Elbow swelling
- Weakness
- Popping sound (acute injury)
- Tingling sensation in the pinky finger
- Decreased velocity while throwing or serving
How is a UCL injury diagnosed?
Dr. Williams will discuss the patient’s history and symptoms. He will also perform a physical examination of the arm, elbow, and shoulder. The valgus stress test is a common method to determine elbow instability and to determine the degree of UCL injury.
Dr. Williams uses MRI to confirm and classify the UCL tear. Radiographs are also helpful to rule out related bone injuries. CT scans are sometimes used if severe bony abnormalities are suspected. If related ulnar nerve symptoms are suspected, an EMG and nerve conduction studies may be ordered to rule out cubital tunnel syndrome.
What are the grades of a ulnar collateral ligament (UCL) tear?
Ulnar collateral ligament tears are separated into grades, depending on the severity of the tear:
- Grade 1 tear: The ligament is strained, but not notably stretched. This grade causes pain, but the elbow still functions.
- Grade 2 tear: The ligament is stretched or partially torn, but still is attached at the native insertions on the humerus and ulna.
- Grade 3: The ligament is fully torn or ruptured.
How is a UCL injury treated?
Non-surgical treatment:
If a patient sustains a first or second-degree tear, Dr. Williams may recommend a conservative treatment option of RICE: rest, ice, compression and elevation of the elbow. NSAIDs, such as ibuprofen helps to mitigate pain and swelling. Other options may include splinting the elbow to help ensure rest and proper healing followed by physical therapy, which can strengthen the muscles around the ligament. Platelet rich plasma (blood spin procedure) injections can be of some value in treating partial UCL tears; usually multiple injections are indicated followed by a period of complete rest. In general, nonoperative treatment strategies are very unpredictable for UCL tears.
Surgical treatment:
If a complete or near-complete UCL tear occurs, surgical repair is recommended. Once the UCL is repaired, complete recovery takes approximately 9-12 months. Ulnar collateral reconstruction, also known as Tommy John Surgery, utilizes a tendon from another area in of the patient’s replace the native injured UCL. This procedure is effective at returning high demand athletes to sports.
For more information on a ULC injury and the treatment options available, please contact the office of Riley J. Williams, MD, orthopedic elbow specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.