Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Kenneth Trauner

Kenneth Trauner, MD

Orthopedics

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1155

See all office information »

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Overview

The shoulder is where 3 bones meet – the shoulder blade (scapula), arm bone (humerus) and collarbone (clavicle). The main shoulder joint (glenohumeral joint) is a ball and socket joint that is formed by the rounded end of your upper arm fitting into a cup-shaped socket (glenoid) in the shoulder blade. It is your most moveable joint, allowing you to raise, twist, and bend your arm forward, to the side and behind you. This flexibility, however, makes your shoulder vulnerable to injury and overuse. 

Another joint in the shoulder is the acromioclavicular (AC) joint. The AC joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). Strong ligaments hold the joint together.

Shoulder dislocation

Dislocation occurs when the upper arm bone comes out, either partially or completely, of the shoulder socket (glenohumeral dislocation). The bone may dislocate in a number of ways. Most commonly, the upper arm bone dislocates forwards. This is called an anterior dislocation. A shoulder dislocation is usually a medical emergency that requires treatment in the Emergency Department. 

Occasionally the bone moves back into place by itself, or people are able to move the bone back themselves. However, if you suspect you have had a dislocation, you should seek medical treatment even if the bones seem to be back in their correct position. Most often, we need to perform a procedure called a closed reduction to move the upper arm bone back into the socket. The procedure can be performed in the Emergency Department most of the time.

Shoulder separation

A shoulder separation occurs when the ligaments holding the AC joint together stretch or tear, usually after a fall onto the shoulder. The weakened ligaments are no longer able to support the joint securely and the collarbone (clavicle) separates from the highest part of the shoulder, the acromion.

Shoulder separations can vary in severity, depending on how seriously the ligaments are damaged, and we usually classify them as Type I, II, III, IV, V or VI. Most separations are Type I to III. Types IV, V and VI are very rare. 

The various types of injuries may include the following:

  • A Type I separation involves a mild sprain or incomplete tear of the acromioclavicular (AC) ligament. 
  • If we describe your injury as a Type II separation, the AC ligament has torn all the way through and the coracoclavicular (CC) ligament may be torn.
  • When the AC and CC ligaments are both torn, completely separating the collarbone from the acromion, we refer to the injury as a Type III separation.
  • Separations that are more serious usually involve injury to the shoulder muscles as well as the ligaments. These are very rare injuries.

Symptoms

Shoulder dislocation

Most people who dislocate their shoulders report sudden severe pain and a sensation that their shoulder is unstable. Your arm may feel weak or you may be unable to move it at all. As the upper arm moves out of its normal position, it can press on nerves. This can cause tingling or numbness. Swelling is also a common symptom.

Shoulder separation (AC joint separation)

Pain is also the main symptom of a shoulder separation. If the ligaments are strained but not torn, pain may be the only symptom. However if the injury has torn the ligaments, you may have a small visible deformity such as a small or large bump at the top of the shoulder, as well as bruising and swelling.

Diagnosis

We will ask you how you injured your shoulder and conduct a full physical examination of the affected area.  

Physical examination

During a physical examination we will:

  • Look at your shoulder and compare it with your other shoulder.
  • Assess your ability to move your shoulder in various directions.
  • Touch your shoulder to assess any tenderness and/or swelling.
  • Check the strength of your shoulder muscles.
  • Check the stability of your shoulder joints.
Additional tests
  • X-ray. We will likely order an X-ray of your shoulder. An X-ray is important to evaluate the degree of AC joint separation, or, in the case of a suspected dislocation, confirm that the upper arm bone has moved out of the socket. The X-ray is necessary to guide our treatment.
  • Magnetic Resonance Imaging (MRI). We may order an MRI if you continue to have pain or problems after the initial treatment, especially if we are concerned that your condition might require surgery. MRI allows us to evaluate structures such as the labrum (cartilage), an important structure for shoulder stability. Occasionally, we may order an MRI to confirm that a dislocation occurred. This is particularly helpful if the upper arm has moved back into the correct position before we see you. An MRI can help us see common signs of a dislocation, like an indentation in the edge of the glenoid, called a Hills-Sachs lesion. A Hills-Sachs lesion is caused by the head of the upper arm hitting the edge of the glenoid as it dislocates out of the socket. 

Causes

Shoulder dislocations and separations usually occur during contact sports such as football and basketball. However, any fall onto the shoulder or arm can force the upper arm bone out of the socket, or force the collarbone away from the acromion. There are a number of factors that can increase your risk of these types of shoulder injury:

  • Previous dislocation or separation. These injuries damage the tendons and ligaments that hold the shoulder joints in place. Weakened tissue is less able to hold the joints securely which makes it more likely that the shoulder will dislocate or separate again. 
  • Genetics. Your family history may increase the risk that your shoulder will dislocate. For example, some people are born with shallow sockets that are more prone to dislocation. 
  • Rotator cuff problems. The rotator cuff ligaments help to hold the head of the upper arm bone inside the glenoid. If these ligaments are torn or weakened, the upper arm bone can move out of the glenoid more easily.

Prevention

There are some steps you can take to avoid future shoulder problems. These include: 

  • Avoid lifting objects that are heavier than you are accustomed to lifting.
  • Avoid performing repetitive overhead movements, such as weight lifting, for prolonged periods. Be sure to use proper form for activities such as weight lifting and throwing a ball.
  • Avoid sports where high impact falls are common.
  • Slip-proof your home to prevent falls.
  • Avoid sudden jerking motions like pulling on a lawn mower starter.
  • Quit smoking. Smoking prevents optimal blood supply from reaching the tendons. This can increase your risk of tendon and muscle tears.
  • Maintain good posture. Bad posture, such as slouching, can push the shoulder forward, making impingement worse. If you maintain good posture and stand up straight, this helps to open the shoulder up, creating more space between the ball of the upper arm bone and the acromion.

Treatment

Shoulder dislocation

We will attempt to maneuver the ball of the upper arm back into the socket manually. This is called a closed reduction. We may do this by moving your arm away from your body and combining pushing and rotating movements until the arm pops back in. We will give you pain medications or use conscious sedation during the procedure.

If this process is too painful, or the shoulder has dislocated in an unusual way, we may need to correct the dislocation surgically, using general anesthesia. Once you are unconscious, we can place additional pressure, or even traction, on the shoulder joint to force the upper arm back into position.

Recovery and rehabilitation

Once your upper arm is back in the correct position, we will place it in a sling to keep it still while the tissues in your shoulder heal. How long you need to wear this will depend on the severity of your dislocation. For example, if the upper arm (humerus) did not come completely out of the socket and was straightforward to maneuver back into place, you may only need to wear the sling for several days.

We will also recommend a number of treatments and therapies to protect and support your shoulder while it heals. These may include: 

  • Rest. Avoid lifting, reaching and making overhead motions. You may need to restrict your movements for a number of weeks or months. This will depend on the severity of your dislocation. We will monitor your progress to evaluate when you can resume normal activities.
  • Take over-the-counter (OTC) pain medications such as ibuprofen or naproxen. These medications can help manage your pain or discomfort. Even though you do not need a prescription for OTC drugs, you should still be careful to consult the directions on the package so that you take the correct dose. Also, please be aware that OTC drugs can interact with other medicines you may be taking, and cause problems for people with various medical conditions. If you have a complex medical condition, or if you are pregnant or trying to get pregnant, or if you have been taking OTC medications and they do not relieve your symptoms, please let me know so that I can recommend an alternative.
  • Rehabilitation. We will supervise your activity while you are recovering. Rehabilitative exercise is very important if you intend to resume sports activities. For many people, a home-based exercise program may be sufficient. Performing exercises to strengthen the muscles in your shoulder may help to minimize future problems. It is very important that you continue your exercises as directed and follow the activity restrictions that we recommend. The shoulder is stabilized by the bony structures as well as soft tissues (muscles and tendons). Maximizing the strength of the surrounding musculature can significantly reduce the risk that your shoulder will dislocate again and minimize sensations of instability.
  • Icing. We may recommend that you massage your shoulder with ice several times a day.
  • Corticosteroid injection. If you do not get relief from these activities, we may prescribe a corticosteroid injection that will bring pain medication directly into the joint.
Surgery

If your arm becomes unstable and dislocates continually, we may recommend surgery to repair tendons, ligaments and other structures that are contributing to instability. Sometimes, structures such as the rotator cuff may have been damaged before the first dislocation. In other cases, the repeated dislocations may have been the cause of the damage. For example, the force of a dislocation can damage the labrum, which we will need to repair to stabilize the shoulder.

Typically, we can treat a single traumatic dislocation without surgery.

Shoulder Separation

Non-surgical treatment

We usually recommend non-surgical treatments for most shoulder separations. Successful treatment consists of a combination of therapies:

A sling.

Wearing a sling stabilizes and protects your shoulder until the discomfort subsides.

Over-the-counter (OTC) pain medications.

We may recommend (OTC) non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to reduce pain, inflammation and help you sleep. Follow these guidelines when using OTC NSAIDs:

  • Over-the-counter (OTC) NSAIDs, such as ibuprofen or naproxen, can help manage your pain or discomfort. Even though you do not need a prescription for OTC NSAIDs, you should still be careful to consult the package so that you take the correct dosage.
  • Also, please be aware that OTC NSAIDs can interact with other medicines you may be taking, and cause problems for people with various medical conditions. If you have a complex medical condition, or if you are pregnant or trying to get pregnant, or if you have been taking OTC NSAIDs and they do not relieve your symptoms, please let us know so that we can recommend an alternative.
Ice packs.

Applying ice packs several times a day will help reduce pain and swelling, especially during the first few days after the injury occurs.

Rehabilitative Exercise.

Rehabilitation exercises are important in your recovery. Depending on the severity of your separation, you may be able to rehabilitate by following a home-based program provided by your clinician. If you require or request physical therapy, our physical therapists will work with you to begin moving and strengthening your shoulder as soon as you are able. 

When you wear a sling, it is very important to keep up with your shoulder exercises, to maintain full range of motion and prevent your shoulder from becoming "frozen" (also called adhesive capsulitis). You are at risk for developing frozen shoulder if you keep your shoulder still for too long and tissues become stiff and difficult to move.

Surgical treatment

The decision to proceed with surgery will depend on your medical history and lifestyle. For example, if you work in a profession or practice a sport that requires continuous heavy use of your shoulder, we may recommend surgery. However, studies suggest that for most Type I to III separations, using a sling and practicing physical therapy to strengthen and stabilize the shoulder may be just as effective at allowing the shoulder to heal.

For Type IV, V and VI separations, which are much less common, surgery is usually necessary. Our objective, during surgery, is to reconnect the clavicle with the acromion, so that you can regain full use of your shoulder. We may use screws, surgical tape, and/or sutures to reconnect the torn structures within the joint. 

Additional References:

Lifestyle Changes and Management

Once you have had a dislocation or separation, you are at risk of having another injury. There are some things you can do to minimize the risk.

Avoid:

  • High-risk activities that make your shoulder pain worse or increase your risk of falling. Do this at least until your shoulder has completely healed.
  • Lifting objects that are heavier than you are accustomed to lifting.
  • Performing repetitive overhead movements such as weight lifting, for prolonged periods. Use proper form for activities such as weight lifting and throwing a ball.
  • Playing sports where high impact falls are common.
  • Sudden jerking motions like pulling on a lawn mower starter.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

We may ask you to come in 30 minutes before your appointment so that we can take X-rays of your shoulder. During your office visit, we will review any X-rays and discuss your medical and family history and I will examine your shoulder. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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