Orthopedic Treatment For Shoulder Separation

by Administrator 24. April 2017 11:01

Shoulder Separation is a condition in which the clavicle (collarbone) and acromion (end of shoulder blade) are torn apart. Depending upon its severity, the condition can be classified into type I, type II and type III injury.  In type I the acromioclavicular (AC) ligament is partially torn, but the coracoclavicular (CC) ligament is intact.  In type II injury the AC ligament is completely torn. Type III injury occurs when both AC and CC ligaments are completely withered.

Risk Factors

  • Males are more likely to have Shoulder Separation
  • The injury is common in teenagers
  • Weak shoulder muscles
  • Shallow joints and loose ligaments


  • A car accident or a sudden fall
  • An injury while playing contact sports such as rugby, football, wrestling, hockey, etc.


  • Pain on the top of the shoulder
  • Limited movement of the affected arm
  • Swelling, cuts or bruises at the affected area
  • An upward pointing lump on the top of the shoulder due to separated collar bone
  • Tenderness at the junction of the displaced joint
  • Numbness or weakness in the affected arm due to nerve damage
  • Popping sensation


In order to diagnose the condition the doctor may ask the patient to hold weight and get an x-ray.  Holding weight allows the shoulder to move and the separation is clearly visible in the scan. To evaluate further damage to the tissues or ligaments, the doctor may ask for an MRI or CT scan as well.

Non-Surgical Treatment

  • Medication - The doctor may prescribe certain pain relieving medicines to alleviate affliction.
  • Rest – The patient may be asked to wear a sling and immobilize the arm for a while. This may allow the scar tissue to heal the injured ligaments and ensure speedy recovery.
  • Ice – In order to reduce inflammation from the affected area the doctor may ask the patient to apply ice after every 15-20 minutes. Icing increases the rate of blood flow to the affected area.
  • Rehabilitation Exercises - Stretching and strengthening exercises may be recommended to the patients to regain the lost functionality of the joint.

Surgical Treatment –

In severe cases a surgery may be recommended by the orthopedic surgeon. He may trim the end of the clavicle so that it does not rub against the acromion.  In some cases, the ligaments present underside of the clavicle may be stitched back together to ensure faster healing.

  • Open- Weaver- Dunn is another surgical procedure that can be recommended by the orthopedic surgeon.  In this method –
  • The surgeon may make a longitudinal incision over the AC joint to find the ruptured clavicle.
  • He may then obliquely excise the clavicle.
  • CC ligament may then be mobilized with a small amount of bone from acromion.
  • Holes may be drilled into the clavicle
  • Polydioxane (PDS) cord may be passed through the holes to put back dislocated clavicle and acromion.

To schedule an appointment with Dr. Kulwicki, the shoulder and elbow injury specialist in Flower Mound, TX, call at (972) 899 – 4679.

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Shoulder Instability: Causes, Symptoms And Treatment

by Administrator 26. October 2016 08:07

Shoulder is a ball and socket joint which helps in the movement and rotation of arms. Shoulder Instability is a condition that occurs when the arm bone or (humerus) moves out of the shoulder joint. Overuse or sudden impact can cause injury to the shoulder leading to pain and inflammation.

Types of Shoulder Instability

  • Anterior instability: When the upper arm bone moves out of the shoulder socket in forward direction.
  • Posterior instability: When the ball moves out of the shoulder joint in backward direction 
  • Multi-directional instability: Dislocation of shoulder in different directions in known as multi-directional instability.


  • Repetitive stress to the shoulder joint
  • Shoulder dislocation
  • Accidents
  • Previous injury to the shoulder


  • Pain and swelling in the shoulder 
  • Weakness
  • Numbness
  • Bruising 
  • Difficulty in shoulder movement


The doctor may conduct physical examination of the patient and ask about his medical history. He may move the shoulder and check for the mobility and strength. Imaging tests such as X-rays, MRI may be recommended by the doctor to identify the underlying cause and severity of the condition.


Non-surgical treatment

  • Medications: Anti-inflammatory non-steroidal medications prescribed by the doctor may help to relieve discomfort. Cortisone injections may be administered in case of severe pain.  
  • Ice and heat therapy: Application of ice packs at regular intervals can be beneficial to ease inflammation. Heat therapy may also help to reduce pain and discomfort.
  • Exercise: The orthopedic doctor may recommend strengthening exercises to improve shoulder stability. These exercises may also enhance flexibility and range of motion.
  • Immobilization: Wearing a shoulder strap may help to restrict the shoulder movement and promote healing. Shoulder brace and cast may  also be used for immobilizing the shoulder joint. 
  • Activity modification: Providing rest to the shoulder joint and avoiding activities that aggravate the condition. 

Surgical treatment:

  • Bankart repair: The surgeon makes small incisions in the shoulder joint and repair the damaged tissues. This helps to provide stability to the shoulder joint.
  • Capsular shift:  When shoulder instability is caused due to loose shoulder joint capsule, this surgery may be recommended. In this procedure, the surgeons tighten the shoulder capsule to provide stability.

For complete diagnosis and treatment of Shoulder Instability, visit Dr. Kulwicki. To schedule an appointment with the orthopedic surgeon you can call at (972) 899 – 4679 or visit 4951 Long Praire Road Suite 100, Flower Mound, Texas 75028.

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Sports-Related Shoulder Injuries

by Administrator 18. December 2015 11:30

The shoulder is a ball and socket joint consisting of three main bones:

  • Upper arm bone, also known as Humerus
  • Collar bone, known as Clavicle
  • Shoulder blade or the Scapula

These bones are held together by muscles, tendons as well as ligaments and provide an extended range of motion to the shoulder joint. This highly mobile nature of this joint makes it prone to get injured when used excessively, particularly in sportspersons. Sports that involve throwing, stretching, picking heavy weights etc. put pressure on the joint and make it more susceptible to injuries. Below is a list of some of the most common sports-related shoulder injuries:


Complete or partial (subluxation) dislocation may occur when the shoulder suffers a sudden jerk while playing sports. If the humerus pops out, fully or partially, it is advisable to seek immediate medical supervision. A popping sound accompanied with acute pain indicates that the upper arm portion may have dislocated from the joint.

Rotator Cuff Strain

Rotator cuff muscles provide a cushion to the bony area and help in rotation of the shoulder. The condition is common in sports which require rotation of the shoulder joint like bowling in cricket, swimming or kayaking. A sudden pain in the shoulder, accompanied by a feeling of tearing may be experienced after a Rotator Cuff Strain. Sleeping on the affected shoulder may also become difficult.

Glenoid Labrum Tear

Glenoid Labrum is a ring of tissue which is attached to the rim of the shoulder socket where the ball of the humerus sits. Repetitive overhead throwing or catching heavy objects with an overstretched arm are common causes of this tear. Pain in the joint, feeling of instability, decreased range of motion etc. are common symptoms of a Glenoid Labrum Tear.

AC (Acromioclavicular) Joint Injury

Also known as Shoulder Separation, the injury occurs due to a fall on an outstretched shoulder or through trauma in contact sports. If the injury is severe, one may feel a small lump on top of the shoulder joint. The pain may occur in the entire shoulder area specifically starting from where the collar bone meets the shoulder joint.

Dr. Kulwicki provides comprehensive treatment for sports injuries affecting the shoulder joint. To schedule an appointment with the orthopedic surgeon in Flower Mound, TX, you can call at  (972) 899-4679.

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Radial Tunnel Syndrome: Orthopedic Flower Mound, TX

by Administrator 23. November 2015 12:36

Radial Tunnel Syndrome is a condition caused by an increased pressure on the radial nerve which runs from neck to the back of the upper arm. It occurs due to repetitive motions such as pushing, pulling, twisting, gripping of the hand or bending the wrist.

Risk Factors

  • People involved in activities involving strenuous wrist and forearm movements.
  • Athletes involved in contact sports such as soccer, rugby etc.
  • Poor muscle strength and flexibility.


  • Direct trauma or injury
  • Sudden twisting of the arm
  • Diabetes Mellitus
  • Hypothyroidism


  • Severe pain at the top of the forearm or back of the hand
  • Muscle weakness in hands and arms
  • Lateral elbow tenderness
  • Pain that worsens when rotating the wrist


An orthopedic doctor may physically examine the patient to locate the damaged area of the nerve. He may ask about any medical history related to the condition. Tests such as Electromyography may be conducted to see if the forearm muscles are working properly. Nerve Conduction Velocity Test may also be performed to determine the severity of the condition.


  • Rest: The doctor may advise providing adequate rest to the affected area. He may also suggest the patient to discontinue the activities that can aggravate the symptoms.
  • Immobilization: Wearing splints provide support and limit the movement of the elbow joint. The doctor may also suggest wearing elbow pads to immobilize the joint.   
  • Medications: Anti-inflammatory medicines may be prescribed by the doctor to reduce inflammation and pain.
  • Exercises: Specific exercises recommended by a physical therapist can help in strengthening muscles and restoring their flexibility. 
  • Heat and ice therapy: Ice packs may be applied at regular intervals to provide relief from pain and swelling. Heat pads may also offer relaxation to muscles.

If the symptoms persist for a longer time and non-surgical treatment do not provide relief, surgery may have to be performed. The procedure aims at relieving excessive pressure on the radial nerve through incisions along the outside of the elbow, down the forearm.


  • Warm up exercises: These are necessary before performing any strenuous activity such as playing football, soccer etc. as it helps  in reducing strain to the elbow  joint.
  • Protective equipment: Wear properly fitted and padded protective equipment such as elbow pads, slash guards etc. in order to prevent this condition.

For effective treatment of Radial Tunnel Syndrome, visit Dr. Kulwicki. To schedule an appointment with the orthopedic doctor in Flower Mound, TX, you can call at (972) 899 – 4679.

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Shoulder Fracture: Orthopedic Treatment In Flower Mound

by Administrator 23. September 2015 10:51

The shoulder is a flexible joint that allows upward, downward, rotatory and twisting movement of the arm. It is made of three bones, including scapula, clavicle and humerus, which are joined together by soft tissues. Any injury or trauma to these bones can result in shoulder fracture. The injury is most commonly seen among children, sportspersons and people who suffer from degenerative orthopedic conditions.


  • Direct blow to the shoulder
  • High impact trauma
  • Tripping or falling on an outstretched hand
  • Fall from a considerable height
  • Motor vehicle accidents
  • Sports related injuries


  • Intense pain
  • Swelling
  • Tenderness around the shoulder
  • Bruising and discoloration
  • Snapping or cracking sound
  • Visible bump or deformity at the site of injury
  • Inability to move the arm


To diagnose a shoulder fracture, the orthopedic surgeon may inquire about the nature of the injury. He may examine the joint physically to look for pain, tenderness, range of motion etc. An X-ray or CT scan may also be recommended to determine the exact location and severity of the fracture.


Non-surgical treatment

Initially, the orthopedic doctor may suggest the patient to wear a splint or cast for a few weeks following the injury. This will provide support to the joint and restrict any jerky movements. He may also recommend anti-inflammatory medications to reduce pain and swelling. Applying ice packs at the site of pain can also help to ease the symptoms of shoulder fracture.  Once the pain and swelling has subsided, physical therapy may be required to restore the joint’s strength and range of motion.

Surgical Treatment

If the fractured bones have been displaced, the patient may need to undergo surgery. During the procedure, the surgeon holds the broken bone pieces together with the help of metal plates, pins, wires or screws. Shoulder replacement may be recommended if the ball portion of the upper arm is broken or crushed. After the surgery, the patient may have to wear a sling to rest the arm and promote recovery. The doctor may conduct frequent X-rays to monitor the healing process. Physical therapy may assist in restoring the original functionality of the shoulder joint.

For diagnosis and treatment of shoulder fracture, visit Dr. Kulwicki. To schedule an appointment with the orthopedic surgeon in Flower Mound, TX, you can call at (972) 899 – 4679.

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Common Shoulder Injuries

by Administrator 15. July 2015 14:32

The shoulder is a complex mobile joint responsible for a wide range of motion of the arm. The shoulder bears a lot of pressure during actions such as throwing a ball, lifting boxes; paddling a canoe etc. and is susceptible to injuries during sports.

Here are some of the most common shoulder injuries suffered by athletes and sports persons:

  • Shoulder Dislocations: Due to trauma or high impact, the shoulder joint dislocates and ‘pops out’ of the joint. This may happen due to falling on an outstretched arm, hand and shoulder or sudden twisting. The main symptoms of shoulder dislocation include pain, inflammation and visible deformity. The dislocated shoulder needs to be put back and in case of recurrent instability, surgery is required to repair the torn ligaments.
  • Rotator Cuff Injuries: Rotator Cuff is a group of tendons that are responsible for the movement and stability of the shoulder. A Rotator Cuff Injury causes intense pain and may lead to disability. It is mostly repaired by keyhole surgery or open surgery.
  • Acromioclavicular Joint (ACJ) Injuries: Acromioclavicular Joint (ACJ) is a crucial joint on the top of the shoulder, which helps in overhead movement. The athletes often get the joint sprained due to overhead and throwing activities or repeated falls on the shoulder. The dislocation of the joint leads to painful lump on the shoulder. The dislocation is treated with the effective physiotherapy; however, in cases of persistent pain, the joint is removed surgically
  • Impingement Syndrome: This occurs due to repeated use of the arm overhead and impingement of the bursa or tendons in the shoulder bones. The main symptoms are persistent pain, tendinitis, bursitis and inability to carry out routine activities. The condition is often treated with medication, stretching exercises and rest.
  • SLAP Lesions: Superior Labral Antero-Posterior (SLAP) tears results due to overhead throwing, tackling sports and heavy lifting. The patient experiences intense pain inside the shoulder and often complains of a clicking sensation.
  • Labral Tears: The socket of the shoulder joint is surrounded by the labrum, which cushions the joint and protects it from injuries. Often falls and direct blows lead to labral tears, which is a painful condition. It is treated surgically or with medication.
  • Thrower's Shoulder: Stretching of the front of the shoulder due to repeat overhead throwing is known as the Thrower’s Shoulder. The condition requires expertise for proper diagnosis and treatment.
  • Bicep Injuries: The bicep muscles can rupture at the elbow during sports activities or due to a trauma. The condition is also common among old aged people and it is associated with rotator cuff tears.

Besides these injuries, bursitis and fractures are also common shoulder injuries that need to be treated surgically.

Dr. Kulwicki provides comprehensive treatment for all kinds of shoulder injuries and conditions. To schedule an appointment, you can call at (972) 899 – 4679 or visit 4951 Long Praire Road Suite 100, Flower Mound, Texas 75028.

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Shoulder Injury Prevention: Orthopedic Flower Mound

by Administrator 23. March 2015 06:47

Shoulder is one of the most mobile joint of the body and is made of ligaments, cartilages and muscles. However everyday activities, indulging in sports and accidents can stress and injure the shoulder. Here are certain tips to prevent shoulder injury.

  • Do proper warm up: Before playing or doing any exercise you must warm up and prepare your shoulder for the activity. Usually warm up sessions include stretching exercises, which prepare the muscles for movement and cardiovascular exercises, which increase blood circulation. An effective warm up helps in preventing injuries.
  • Stay fit and healthy: To avoid shoulder injuries, make sure you are in good physical shape. By strengthening your arm, wrist, neck, back and shoulder muscles, you can reduce stress in your shoulder and protect it. You should make sure that you do stretching and range of motion exercises to strengthen the shoulders and arms.
  • Maintain right posture: You should always stand straight so that you are relaxed and without a slouch.
  • Wear protective gear: By wearing protective gears while playing sports or participating in recreational activities, you can prevent serious shoulder injuries.
  • Avoid alcohol: It is important to avoid alcohol or any drugs before driving or playing any game, as one loses balance while intoxicated and may fall to hurt the shoulder. Consumption of alcohol also deteriorates the bone density and weakens the body.
  • Avoid lifting heavy objects: Make sure you do not lift any heavy object if you have pain in shoulder, as it could worsen the injury. In case you have to lift something heavy, ensure that you use right body movement while lifting; otherwise, you will strain your shoulder.
  • Avoid overuse: Repeated movements can injure the tendons and bursa; therefore, it is essential that you avoid overusing the arm. You should avoid all strenuous activities and make sure you alternate your hands while doing cooking, playing musical instruments or doing any other activity. You should also avoid keeping your arms raised or out to the side for long periods. Take regular breaks and use ice, elevation and compression therapy, if required.
  • Take guidance from sports training specialist: If you are a recreational or professional athlete, you should consult a sports training specialist. He will help you by offering training and conditioning schedules that will keep your shoulder in the best form.

For more prevention tips, contact Dr. Kulwicki at OrthoTexas, Flower Mound. To schedule an appointment with the orthopedic doctor, call at (972) 899.4679 or visit 4951 Long Praire Road Suite 100, Flower Mound, Texas 75028.

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Orthopedic Treatment For Frozen Shoulder

by Administrator 21. November 2014 06:18

Frozen shoulder, also known as ‘Adhesive Capsulitis’, is a common orthopedic condition characterized by pain and stiffness in the shoulder joint. It may be a result of overuse, sprain, injury or other medical conditions such as diabetes. The shoulder joint is made up of many bones, tendons and ligaments that are enclosed in a shell of connective tissues. Thickening and tightening of this shell results in restricting the shoulder’s normal range of motion, thus, causing it to freeze. The pain gradually increases with time and an orthopedic surgeon should be consulted for proper treatment.


The condition usually develops when an individual ceases using the joint normally due to injury, pain or a chronic medical condition. Other causes may include:

  • Cervical Disc Disease
  • Shoulder surgery
  • Shoulder injury
  • Open heart surgery
  • Diabetes
  • Stroke
  • Thyroid gland problems
  • Lung disease


Symptoms of frozen shoulder usually appear gradually in three different stages which are:

  • Painful stage: During this, the individual may experience pain while moving the shoulder. The range of motion of the joint also gets limited. Shoulder pain may worsen during night time, causing difficulty in sleeping properly.
  • Adhesive/ frozen stage: Pain begins to moderate at this stage. The shoulder may become stiffer and the range of motion decreases considerably.
  • Thawing stage: In this stage, the shoulder begins to restore its normal range of motion.


  • Medications: The orthopedic doctor may prescribe certain over-the-counter anti-inflammatory medications to reduce pain and discomfort associated with the condition.
  • Heat or Ice Compression: This can also help to ease the stiffness in muscles and reduce pain.
  • Exercise: Gentle and frequent exercises, as prescribed by the doctor, can also help to reinstate joint mobility.
  • Steroid injections: It may also help in reducing pain and increasing the shoulder’s range of motion.
  • Shoulder manipulation: In this, the shoulder is gently moved when the patient is under the effect of a mild anesthetic. The procedure helps to loosen the tightened tissues. 
  • Joint distension: This involves introducing sterilized water into the shoulder in order to stretch the tissue and increase the mobility of the joint.
  • Surgery: If the conservative treatment options do not provide relief from the pain, the patient may be suggested to undergo surgery. During the procedure, the orthopedic surgeon removes the adhesions and scar tissue from inside the shoulder joint.

For complete diagnosis and treatment of frozen shoulder in Flower Mound, TX, visit Dr. Kulwicki. To schedule an appointment with the orthopedic surgeon, call at (972) 899 - 4679.

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Shoulder Dislocation: Causes, Symptoms & Treatment

by Administrator 17. December 2013 13:44

Being one of the most mobile joints in the body, the shoulder joint is prone to instability, which is why shoulder dislocations are more common than dislocation in any other joint of the body. A dislocation of the shoulder occurs when the head of the humerus (the upper arm bone) is dislocated from its socket, hence disrupting the ball-and-socket structure of this joint. These dislocations can occur in any direction, leading to the humeral head ending up at various locations, based on which the dislocation is described. Ninety percent of shoulder dislocations are anterior dislocations, which means the humeral head ends up in front of the joint.


  • The main cause of dislocations in younger people is shoulder injury caused by trauma such as that from a fall or sports injury.
  • In older people, dislocations can occur due to degenerative causes such as the gradual weakening of the ligaments and cartilages supporting the shoulder.

When you visit an orthopedic doctor in Flower Mound, you will need to provide him with accurate details of how the injury occurred so that he can be able to understand the mechanism of the injury, to be able to devise an effective treatment plan for it.


  • Shoulder dislocations are associated with significant pain, which makes it difficult to move the arm in any direction.
  • Spasms in the surrounding muscles, which make movements painful.
  • In most cases of shoulder dislocation, the arm is held slightly away from the body. A common reflex is to support this arm with the other hand.
  • The shoulder might give a square-shaped appearance, while a bulge might be visible in front of the joint.
  • Patients might also experience nausea, sweating, lightheadedness, vomiting, and weakness.

If you experience any of the above symptoms and suspect that you might have a shoulder dislocation, it is important to see an orthopedic doctor immediately.

The main goal in the treatment of a dislocated shoulder is to return the humeral head to its original position. This is usually achieved with minimum use of anesthesia, and depending on the individual case, can either be done through a closed reduction or an open reduction. The former involves correcting the positioning of the bones without making any incision or cut, while the latter involves a surgical procedure.

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Rotator Cuff: Causes, Symptoms & Treatment

by Administrator 20. November 2013 10:02

The rotator cuff is a group of tendons responsible for stabilizing the shoulder joint. The positioning of these tendons is responsible for the high range of motion of the shoulder joint, and any damage to the rotator cuff results in rotator cuff disease, which is one of the most common causes of shoulder pain. If you are experiencing shoulder pain that you believe might be caused by rotator cuff, seeing an orthopedic doctor in Flower Mound can help in the diagnosis and treatment of the condition. Here is an overview of rotator cuff disease, highlighting the causes of the disease, its symptoms, and the various treatment options for it.


  • Acute injury from falling or due to overuse in sports
  • Repetitive strains
  • Degeneration with aging
  • Inflammation resulting from conditions like bursitis, tendinitis, or arthritis
  • Muscle fatigue- This is mostly noticed in people who play overhead sports or perform repetitive overhead motions.


  • Shoulder pain that develops gradually.
  • Sudden pain during a sports activity.
  • The pain is localized around the front and outside of the shoulder, and worsens when the shoulder is moved away from the body.
  • The pain worsens at night or when pressure is applied by lying on the affected shoulder.
  • Diminished range of motion and difficulty in performing movements involving the shoulder joint.
  • Inflammation and tenderness in the area of the injured rotator cuff.


  • Mild rotator cuff can be treated with RICE, i.e. Rest, Ice, Compression, Elevation.
  • Anti-inflammatory medications can help to provide relief from swelling and tenderness in the affected region.
  • Physical therapy, gradual exercise rehabilitation, and strengthening exercises are recommended for speedy recovery.
  • In some cases, the patient might need a cortisone injection in the rotator cuff to provide relief from chronic pain.  It might be necessary to get repeated injections for prolonged pain relief.
  • Severe cases of rotator cuff disease might require surgical treatment. Subacromial decompression involving the removal of a small portion of the bone can help to relieve pressure from the rotator cuff following shoulder injury. The surgery can either be performed by open surgery methods or with the use of arthroscopy. It is advisable to undergo surgery from an experienced orthopedic surgeon to ensure minimal potential for risk, and smooth postoperative recovery.

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