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

What are the activity limits after rotator cuff surgery?

admin — Fri, 30 Jul 2010 14:00:27 +0000

I’m in the early weeks of recovery from surgery for a rotator cuff tear. Just how much activity can the repair take? I’d like to know what are the limits.

Each surgical repair is different based on a few factors. First is the size of the tear and the method used to repair it. Second is the timing. You mentioned being in the early weeks of recovery. The amount of load the repair can handle increases as the tissue heals. In the first six weeks the load limits are much less than after six to eight weeks.

For example the load on the repair is much less with forward flexion of the arm compared to other shoulder movements. Passive motion (someone else moves the arm) versus active movement (you move the arm) has different load limits.

Your surgeon should have given you some idea of the limits both in terms of motion and lifting. Sometimes patients don’t realize the paperwork they take home with them has this information in it. Read everything given to you. Contact your surgeon directly if you don’t find what you are looking for.

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 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.

No shoulder surgery needed for teenage football player

admin — Tue, 27 Jul 2010 14:00:39 +0000

My 17-year old son separated his shoulder playing football. The doctors say ‘no surgery’ just rest and let it heal on its own. Could he get back to playing football sooner with an operation?

There are lots of problems with operations trying to repair the AC (acromioclavicular) joint. In fact more than 60 different ways to surgically repair the AC joint have been tried.

Wires and screws don’t seem to hold. They break or move causing problems. Sutures to hold the joint together don’t seem strong enough. Many times the joint starts to move apart again.

Surgery isn’t an option unless the person doesn’t recover with conservative care or the injury is so severe an operation is the only way to treat it.

If your son follows his doctor’s instructions he should heal in two to six weeks. Rehab should be completed before resuming football to prevent re-injury.

MRI or MRA to diagnose rotator cuff tear?

admin — Thu, 22 Jul 2010 14:00:39 +0000

I’m going to be seeing the doctor for a shoulder exam. I’m pretty sure I have a torn rotator cuff. Should I ask for an MRI?

Your surgeon will know the best tests to order based on your history and the examination. MRIs give good contrast of the soft tissues. It’s an ideal way to see inside the joint without actually opening it up.

MRIs are only 84 to 96 percent accurate in finding rotator cuff tears (RCT). Magnetic Resonance Arthrography (MRA) may be a better choice if a RCT is suspected.

MRA uses the natural fluid in the joint as a way to look for “holes” in the capsule from a RCT. A contrasting agent is injected into the joint. Any fluid that shows up outside the capsule must have moved through the defect.

MRA isn’t available everywhere. Ask your surgeon if it’s available in your area and if it’s recommended for your situation.

No advice from friends on total shoulder replacement surgery

admin — Mon, 19 Jul 2010 14:00:35 +0000

When I had my knee replaced many of my friends had already had this same operation. They gave me lots of advice and information. Now I’m getting ready for a shoulder replacement. I can’t find even one friend or relative who’s had this surgery. Are folks who have this done happy with the results?

It’s true that the number of hip and knee replacements far out pace the number of shoulder replacements. The number of shoulder replacements is increasing every year. Last year more than 10,000 were done in the United States.

Long-term studies 20 years down the road aren’t available yet. But short- to mid-term results are in. Most patients have a good result with decreased pain and improved movement. These two results also mean better function and higher quality of life for most people.

As with any surgery, problems can occur. In a small number of patients blood clots, infection, or fracture can cause death or delay recovery. The risk of technical difficulties is greater with shoulder replacement surgery compared to hip and knee.

Overall, patients report improved quality-of-life with a shoulder replacement. If they had to do it over again, they would have the same operation.

Can a small business owner save money on shoulder surgery?

admin — Wed, 14 Jul 2010 14:00:45 +0000

As a small business owner, I am self-insured. Is there any way I can save money on my upcoming shoulder repair surgery?

You’ll want to bring this up with your surgeon. Perhaps your injury can be treated with a more conservative, less expensive approach. If not, then you may want to look at the differences in cost for an open versus closed operation.

With an open repair, the patient has general anesthesia. The surgeon makes an open incision to make the repairs. The operation is done in the hospital. There is often an overnight stay required.

With the closed (arthroscopic) method, regional anesthesia is used. The patient goes home the same day. There is usually a charge associated with pain relievers used for a few days.

All of these decisions are based on the type of problem you have and what your surgeon can do.

Should West Point cadet have open or closed shoulder surgery?

admin — Fri, 09 Jul 2010 14:00:33 +0000

I’m a West Point cadet with a torn shoulder labrum in need of surgery. The doctors have told me about open versus closed methods of repair. Which is best to get me back to full speed ahead?

There are plusses and minuses for both operations. Closed surgery with an arthroscope is less invasive. There’s a reduced risk of getting osteoarthritis in that shoulder later.

The down side of the closed repair is a higher rate of recurrent dislocations or subluxations (partial dislocation). Researchers report about seven to 17 percent of the closed cases have this problem. Only three to five percent of the open repairs partially or fully dislocate.

Many surgeons advise using the closed repair for young patients or extremely active patients. It sounds like you might be in this group. Your surgeon will probably make a recommendation for you based on your age, the injury, and your goals for rehab.

When to cross over from partial shoulder replacement to total shoulder replacement

admin — Tue, 06 Jul 2010 14:00:29 +0000

I had a partial shoulder replacement six months ago and I’m not happy with the results. My shoulder is stiff, sore, and painful all the time. It’s worse than before the operation. I’m ready to just go for a total shoulder replacement. What do you advise?

About 20 percent of the patients who have a partial replacement or hemiarthroplasty cross over to a total shoulder arthroplasty (TSA). Pain and stiffness are the reasons given most often for the conversion.

Most patients cross over after having the hemiarthroplasty two years. A few patients have converted as early as 12 months. Most surgeons would advise continued rehab between six and 12 months. Bone healing can take a full year.

Muscle and joint stiffness is common with aging and can make for a longer rehab process. Review all other risk factors. Eliminate all possible causes of slow healing such as tobacco use, inactivity, or poor control if you have diabetes. Nutrition can also play a key role in healing.

How many steroid injections is too many?

admin — Fri, 02 Jul 2010 14:34:57 +0000

I’ve had three steroid injections in my shoulder for a torn rotator cuff. I don’t really want to have surgery. The injections work for a couple months. How many total injections can I have?

Corticosteroid injections are often used for back or joint pain and swelling from an inflammatory condition. The maximum number of steroid injections that can be given safely is a debatable topic.

Some doctors advise no more than two to three to the same joint in one year. The concern is for systemic side effects of the steroids. Steroids can also thin the skin and underlying layer of protective fat in the area of the injection.

Steroid injections have the best chances of helping patients when used early on in the condition. They are not as helpful in chronic conditions. They seem to work best when combined with pain relievers and physical therapy. The goal is to reduce pain, thereby increasing motion and function. The need for surgery can be avoided in some cases.

Partial vs. total shoulder replacement

admin — Fri, 25 Jun 2010 19:18:24 +0000

I have severe pain and limited motion in my left shoulder. My problems all come from arthritis. My doctor thinks I should have a partial shoulder replacement. If the arthritis gets worse I can always have a total replacement later. Does it really work that way?
Many doctors hold to this idea. A recent review of the studies on partial (hemiarthroplasty) versus total shoulder replacements might call that plan into question.

Some studies show that even with a hemiarthroplasty the surface of the shoulder socket continues to wear down and deteriorate. Then when it’s time to convert to a total shoulder, there isn’t enough good, solid bone for the implant.

On the other hand, starting with a total shoulder arthroplasty (TSA) leaves the patient with no place to go if problems occur. There isn’t a good replacement for the replacement.

Overall the studies done comparing hemiarthroplasty to a TSA show the TSA gives patients better function over a longer period of time. More studies are needed to fully compare these two treatment options.

Is it ever too late for surgery to repair torn rotator cuff?

admin — Tue, 22 Jun 2010 11:36:31 +0000

I have a large rotator cuff tear in my left shoulder. I’ve been putting off surgery and trying everything else first. I’m ready to throw the towel in and have the surgery. How do you know when it’s too late for an operation to help?

There’s nothing wrong with trying conservative care before going for a rotator cuff repair. In some cases, anti-inflammatory drugs help. In other cases, cortisone injections or physical therapy can make a difference.

But for patients who still have pain, loss of motion, and reduced function, surgery may be the best option. Many patients put it off for months and even years. They still report a good result after the operation.

New methods using arthroscopic surgery and tiny incisions have changed the results of this operation. Even full-thickness tears or tendons that have retracted far away from the place where they normally attach can have a good outcome.