Missed Early Detection of Shoulder Ligament Tear: A Cautionary Tale

Q: Missed Early Detection of Shoulder Ligament Tear: A Cautionary Tale

Hello： Grandma's old shoulder injury has resulted in limited joint mobility, preventing her from lifting. <br>I can only suggest that she actively engage in rehabilitation exercises. <br>Most of these exercises are focused on weight-bearing knee joints, and ligament replacement i

Shoulder ligament tear, missed early detection?

Hello Doctor: My grandmother is in her seventies.
About a year ago, she fell and landed on her left arm, after which she has been complaining of left shoulder pain.
Initially, she visited an orthopedic clinic where the doctor suggested an injection directly at the site for effective pain relief, but if she was hesitant, she could start with medication and observe.
Due to her fear of injections, she chose to only take medication and observe.
Since then, despite her daily pain and difficulty raising her arm, she has not sought further medical attention due to her fear of injections and other reasons.
Recently, she finally returned for a thorough examination, and the results revealed a torn ligament.
The doctor informed her that due to the prolonged duration, the ligament had atrophied too much for any treatment, and the only option left was to manage the pain with medication.
Hearing this diagnosis was truly disheartening.
I researched online and found that there seems to be a method involving the replacement of the damaged ligament with one taken from a healthy area, such as the thigh.
I would like to ask how valid this information is, or if there are other options available? Additionally, should we seek a second opinion from another physician before concluding that my grandmother's shoulder is beyond help? Thank you!

yien, 20~29 year old female. Ask Date: 2012/05/10

Dr. Hong Ximing reply Orthopedics

Hello: Grandma's old shoulder injury has resulted in limited joint mobility, preventing her from lifting.
I can only suggest that she actively engage in rehabilitation exercises.
Most of these exercises are focused on weight-bearing knee joints, and ligament replacement is not suitable.
In addition to pain medication, local steroid injections can also be administered to effectively reduce pain.
Wishing her a speedy recovery! Hong Hsi-Ming

Reply Date: 2012/05/10

More Info

It sounds like your grandmother has been experiencing significant shoulder pain for over a year following a fall, and unfortunately, it appears that the delay in seeking further medical evaluation has led to a diagnosis of a torn ligament that is now too degenerated to be treated effectively. This situation highlights the importance of timely medical intervention, especially in older adults who may be more susceptible to complications from untreated injuries.

When it comes to shoulder injuries, particularly in the elderly, the shoulder joint is complex and involves various structures, including ligaments, tendons, and muscles. A tear in the shoulder ligaments can lead to chronic pain, limited range of motion, and functional impairment. The initial recommendation for pain management, such as injections or medications, is common, but it is crucial to follow up with further evaluations, especially if symptoms persist.

Regarding your question about the possibility of using ligaments from other parts of the body for reconstruction, this is indeed a method known as ligament reconstruction or grafting. In some cases, surgeons can use autografts (tissue taken from the patient's own body, such as from the thigh or hamstring) or allografts (donor tissue) to replace damaged ligaments. However, the success of such procedures depends on various factors, including the extent of the damage, the patient's overall health, and the time elapsed since the injury occurred. In your grandmother's case, the chronicity of the injury and the degeneration of the ligament may limit the effectiveness of such surgical interventions.

It is also essential to consider that not all shoulder injuries require surgical intervention. In some cases, physical therapy, pain management, and lifestyle modifications may be sufficient to improve function and reduce pain. Given your grandmother's situation, it would be prudent to seek a second opinion from another orthopedic specialist. Different doctors may have varying approaches to treatment, and a fresh perspective could provide additional options or confirm the current treatment plan.

In summary, your grandmother's case underscores the importance of addressing persistent pain and seeking timely medical advice. While surgical options like ligament reconstruction exist, their feasibility depends on the specific circumstances of the injury. Consulting with another orthopedic specialist could provide clarity and potentially open up new avenues for treatment. It is crucial to advocate for your grandmother's health and explore all available options to improve her quality of life.

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