Naples Orthopedic Surgeon - Dr. Robert J. Zehr » Shoulders

Is it safe to try climbing walls after rotator cuff injury?

admin — Thu, 01 Sep 2011 11:00:27 +0000

I have a buddy who wants me to try climbing walls at his gym. I’m really tempted but I had a rotator cuff injury several years ago. Is it safe for me to try this activity?

Arm injuries are common in sport climbing, especially injuries of the shoulder. The rotator cuff is a prime area for tendon damage and impingement (pinching) syndrome. Some of the stresses on the shoulders and arms depend on the angle and/or incline of the climbing wall. Ease with which handholds and footholds can be reached is another potential factor. Coordinated movements of the shoulder are needed for this sport.

The rotator cuff must function with just the right amount of muscle contraction and cocontraction. Cocontraction refers to muscles on the opposite sides of the joint contracting at the same time. Climbing techniques require a lot of body pull-up motions. The shoulder muscles must be strong enough to lift the entire body against gravity.

The best way to find out if your shoulder is stable enough for climbing activities is to have the muscles tested. Physical therapists offer isokinetic testing (e.g., Cybex system) to evaluate muscle strength under load. Any weakness or imbalance will be revealed with this type of testing. It’s possible a strength training program could prepare you for this vigorous sport.

One study comparing shoulder muscle strength of climbers versus nonclimbers found overall shoulder strength much greater among climbers. Shoulder extensors were twice as strong as the flexors. Training toward this ratio may help prepare you and protect you once you get started. Start with the easiest climbing walls first. Gradually increase the speed and level of difficulty based on the results of your muscle testing and endurance during the activity. If there is any question or doubt about your ability or preparation for this actvity, an evaluation with an orthopedic surgeon might be a good idea first before participating in this actvity.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com. The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of a visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Rotator cuff injury is two years old, too late for surgery?

admin — Mon, 29 Aug 2011 11:00:46 +0000

I injured my rotator cuff about two years ago. At that time, I didn’t have insurance to pay for the surgery. Now with a new job, I want to get this taken care of. But I’m wondering if I waited too long. Do the results depend on the timing of the surgery?

Outcomes of surgery for a rotator cuff tear depend on a wide range of factors. Patient age, duration of symptoms, and time from injury to surgery can make a difference. Even more important is the type and severity of injury.

Most rotator cuff tears affect the supraspinatus tendon. If the force of the injury is enough, the tear can extend posteriorly (backwards) to include the supraspinatus tendon. Less often, the subscapularis tendon is injured. If the force is great enough, the tear extends anteriorly. The long head of the biceps can be damaged. This causes a condition called biceps tendon disorder.

Early surgical repair is advised for tears that extend through half (or more) of the tendon. With no delays in treatment, there is less muscle atrophy, less fatty infiltration of the tendon/muscle unit, and less scarring in the area. After three to six months from the time of the injury, pain and loss of motion are signs that surgery is still needed. More than six months after the injury, the surgeon will want to re-evaluate the shoulder and see if the tear can be repaired. Sometimes severe tears cannot be repaired. Instead, shoulder rehab is needed to regain as much motion and function as possible.

Robbery results in rotator cuff tear

admin — Wed, 24 Aug 2011 11:00:45 +0000

I was robbed while standing at the ATM machine last night. The robber pulled my arm back, grabbed the money, and ran. The shoulder didn’t dislocate but I felt something pop. Today I can hardly move it. It especially hurts if I try to reach into my back pocket for my comb or my wallet. What do you think got hurt?

You’ll need a medical examination to find out what soft tissue structures might have been injured. With the mechanism of injury you describe, it sounds like a possible rotator cuff injury. The rotator cuff is a group of four tendons and the muscles that envelope the shoulder and hold it in place.

Along with stabilizing the shoulder joint in the socket, each one of the tendons has a specific job. Placing your hand behind your back requires medial (internal) rotation of the shoulder. The primary muscle for that movement is the subscapularis. Subscapularis injuries occur when the shoulder is suddenly laterally (externally) rotated or hyperextended with force. The arm is next to the body at the time of the injury. With an injury to the subscapularis, there is weakness in internal rotation and excessive shoulder external rotation.

An orthopedic surgeon will test each muscle of the rotator cuff to determine what might be wrong. Usually the history and clinical tests are enough to make a diagnosis. X-rays can rule out fractures. An MRI or a CT scan may be ordered, especially if the surgeon is considering surgery as a possible treatment option.

Studies show that early diagnosis and treatment yield the best results. Don’t wait too long before you have someone look at this and at least give you a diagnosis. It’s possible with time and a rehab program, healing and recovery will occur without surgical intervention. But getting started while the body is in a reparative stage is important.

Arthroscopy vs. open repair for rotator cuff tear

admin — Fri, 19 Aug 2011 11:00:12 +0000

I injured my rotator cuff years ago. I probably tore it more than once as it was healing. My surgeon has suggested doing a procedure to repair the damage and restore some function in that arm. I’d be happy just to have less pain at night. I know they can do these operations now without even opening you up. Do you think I can have that kind of surgery?

You may be referring to an arthroscopic procedure. The surgeon makes two or three puncture holes and slips a long, thin needle into the damaged area. A tiny TV camera on the end of the scope provides a look inside the joint. The type and location of tendon damage can be assessed using this technique.

But an open repair has some advantages. In this procedure, the surgeon can see the full extent of any damage. Details of the injury are clear and nothing is missed. Results are actually better after open repair compared to arthroscopic repair. There are fewer retears after open repair.

The main disadvantage of the open repair is that the deltoid muscle is split in half to give the surgeon access to the shoulder. The muscle is sewn back together afterwards, but it leaves the arm at a mechanical disadvantage until healing and full recovery take place.

Some surgeons begin with an arthroscopic examination. If the injury can be repaired arthroscopically, then they go ahead and complete the operation. But if the damage is extensive, then the shoulder can be opened up and the procedure completed. Magnetic resonance imaging (MRI) can help in the decision-making process. The MRI helps the surgeon assess tendon damage, healing, and anatomy. Size and location of the tear can be established. It can be determined whether the tear is partial or full-thickness. This makes a big difference in planning the surgical repair.

Will shoulder surgery sideline 67-year old ironman competitor?

admin — Tue, 16 Aug 2011 11:00:51 +0000

I am 67-years young and training for an ironman competition. Part of the race involves swimming. If I have a shoulder replacement this year, will I be able to participate again next year?

Ironman competitions traditionally involved swimming, biking, and racing. With proper rehab and training, a shoulder replacement should not keep you out of the race. Older adults who participate in sports before surgery are more likely to return to that sport after surgery. This is when compared with patients who aren’t active before shoulder replacement.

Although swimming requires repetitive motion, it does not seem to prevent patients with total shoulder replacements from participating. The rate of implant loosening or revision surgery among swimmers is no different from non-swimmers with a shoulder implant.

In an ironman competition it can be difficult to take full strokes. With so many bodies in the water, there’s a lot of water turbulence and bumping of elbows. You may have to alter your stroke to compensate. Athletes try to conserve leg muscles for the cycling and running portions of the race. A modified stroke is also needed to enable you to lift your head above the water to see markers without interrupting your swim or wasting energy.

Expect a three to six month rehab program followed by specific training for your ironman event. A physical therapist can help you with a sports specific training program. Make sure you keep your follow-up appointments with the surgeon after the operation. This will ensure that there are no unseen complications such as implant loosening or subsidence (implant sinking down into the bone).

Golf game better after shoulder replacement surgery

admin — Thu, 11 Aug 2011 11:00:00 +0000

I’ve been a competitive (and now) recreational golfer all my life. Last month I had a shoulder replacement on my dominant arm. I’ve been carrying around a golf club for exercise and feel pretty good. How long before I’m back in full swing?

There are only two studies published on patients involved in sports and recreational activities after shoulder replacement. Both suggest from their results to expect an average of three to four months for partial return to sports. It will probably be more like six months (from the time of surgery) to full return to your game.

But the wait should be worth it. Patients who were active but limited by pain before surgery report that their game is even better after rehab and recovery. An average improvement after surgery of five strokes has been reported by other golfers who had shoulder replacement surgery. Sports specific physical therapy can be very helpful. This is the perfect opportunity to work on improving your swing and replacing bad habits with new, more effective movement patterns.

Tips for weight-lifters with “weight-lifter’s shoulder”

admin — Fri, 05 Aug 2011 11:00:23 +0000

What is weight-lifter’s shoulder, and who gets it? I’m a weight-lifter and I’d like to avoid problems of this sort.

Weight-lifter’s shoulder is a painful deterioration of the distal end of the clavicle (collar bone). The person feels an aching pain in the front of the shoulder at the acromioclavicular (AC) joint. This is where the end of the collarbone (closest to the shoulder) attaches to the acromion. The acromion is a curved piece of bone that comes from the shoulder blade across the top of the shoulder. The clavicle and acromion meet to form the AC joint in front of the shoulder. Repetitive trauma or stress from training and lifting causes tiny fractures of the bone in this area. Because the bone doesn’t have a chance to heal before the next training session begins, the bone actually starts to dissolve. Pain develops with associated weakness.

Weight-lifters aren’t the only ones affected. Female bodybuilders, air-hammer operators, handball players, and others can develop this problem. For that reason, it is also known as distal clavicular osteolysis. Osteolysis refers to the resorption of bone at the site of the injury. Avoiding overtraining and smoking are two very effective ways to prevent this condition. If it does develop, take quick steps to modify weight-lifting techniques and avoid overtraining. For example, you can narrow your hand spacing on the barbells. This takes the stress off the distal clavicle. End your bench presses two inches above the chest. Some lifters place a two-inch folded towel on the chest as a reminder. The power clean or power jerk can also be modified. Don’t rack the bar. Start with the elbows even with or above the shoulders and lift. This eliminates the power pull. Certain activities such as the bench press, dips, and push-ups should be avoided for a while. Apply an ice massage and take ibuprofen after each workout.

Can weight-lifter return to training after collarbone procedure?

admin — Wed, 03 Aug 2011 11:00:59 +0000

I’m having the end of my collarbone shaved or cut off at the end of this week. I have a weight-lifter’s competition next weekend. Will I be able to rehab and still compete in that amount of time?

You’ll want to check with your surgeon to find out his or her recommendations first. Many experienced weight-lifters are able to continue training carefully. They can resume their program as early as three days after surgery. Most are back in full swing by the end of a week. Weight-lifters are pleased that without the pain, they can quickly get back to their pre-operative level of lifting. In fact, some even report exceeding their training weight now that the pain is gone. If the surgeon knows your plans, it’s possible to modify the procedure just a bit to stabilize the joint for a quick return-to-sport. The coracoacromial ligament can be transferred over the end of the bone that has been cut. This helps protect and stabilize the joint. It makes power lifting more comfortable for many athletes.

What happens during a shoulder manipulation?

admin — Fri, 29 Jul 2011 14:16:37 +0000

Can you tell me how they do a shoulder manipulation? I know I’ll be asleep for the operation but what happens exactly?

Surgical manipulation of a joint refers to a procedure whereby the surgeon moves the joint slowly and gently through its full range of motion. The patient is anesthetized to allow for full relaxation of the muscles, which would hold and contract otherwise to avoid the pain of movement. Once you are asleep, the surgeon moves your arm carefully through each motion: flexion, extension, and rotations (internal and external). The arm will also be moved across the body. This movement is called horizontal adduction. Adhesions and fibrous scar tissue will be torn in the process. The surgeon feels and hears the snapping, popping, grating sound called crepitus that signals release of the adhesions. Once the adhesions are released, the shoulder will move more smoothly and fully. The manipulation procedure is complete when the affected shoulder has the same range-of-motion as the uninvolved side.

Which surgery method is best for golfer with torn rotator cuff?

admin — Tue, 26 Jul 2011 11:02:55 +0000

I’ve been getting ready to have shoulder surgery for a rotator cuff tear. I’m an avid (middle-aged) golfer. I’ve looked at arthroscopic surgery versus open surgery. I really want to get back on the golf course. Which one of these is better for golfers?

There’s still quite a bit of debate on this point. Studies don’t show a big difference in results between these two approaches. The arthroscopic procedure is minimally invasive. There is less soft tissue disruption and a smaller incision. But there is some concern that this method leaves some people with a repair that won’t remain stable or hold up.

Surgeons tend to use open repair techniques for over-head throwing athletes. The belief is that they need a mechanically stronger repair. But there are other surgeons who report that they are using all-arthroscopic surgeries for all patients including athletes. There are two other things to consider when making this decision. The first is return-to-sports and the level of activity you may achieve. It is possible to return to the game at your pre-injury level. But some patients who have the arthroscopic repair do so at a level below their former playing ability. And secondly, it is possible to retear the repair. Retear rates compare equally between open and arthroscopic techniques. In many reported cases, the patients with retears did not follow the rehab protocol and did more than was advised.