Naples Orthopedic Surgeon - Dr. Robert J. Zehr » arthroscopic surgery

Can I have arthroscopic surgery without anaesthesia?

admin — Thu, 03 Nov 2011 10:10:25 +0000

I usually have my dental work done without novacaine. Can I have arthroscopic surgery without anesthesia?

Not likely but you can ask. Sometimes orthopedic surgeons work with anesthesiologists who use acupuncture instead of anesthesia. Surgery is rarely done without an anesthesia and for good reasons. If the patient suddenly feels pain and jerks away, the surgeon’s knife or other tools can sever (cut) a nerve or blood vessel.

Some of the structures in and around the knee are very sensitive. Others are not. At least one surgeon mapped the sensitive structures of the knee without using an anesthetic. The doctor did this to himself. He probed his own knees without anesthesia.

He found that the fat pads were very sensitive tissue. So were the synovial tissues that protect the joint. The joint surface itself and the cartilage weren’t very sensitive. The bone just under the cartilage was very painful when overloaded. This happened most often when the cartilage was damaged.

All in all, even with a high tolerance for pain, it’s probably best to be numb when this operation is done. Too many things can go wrong when a patient isn’t anesthetized.

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.

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.

What is an “incomplete” repair of the meniscus?

admin — Wed, 27 Jul 2011 11:27:32 +0000

Three years after a meniscal repair I started having painful clicking in my knee again. The doctor says the repair was “incomplete.” What does that mean? I may have to have another operation to repair the problem.

Incomplete healing of a torn mensicus is usually found by having a second arthroscopy.

The surgeon makes one or more puncture holes in the skin and inserts a long, thin needle called a cannula into the joint.

Tiny tools can be passed through the cannula including a miniature TV camera to take a look inside the joint. What the surgeon sees as an incomplete healing of meniscal tears is a cleft or gap at the site of the tear. It may go down 10 to 50 percent of the thickness of the meniscus.

A gap of more than 50 percent is a nonhealed repair. A second operation is often needed in such cases.

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.

Benefits of repairing meniscus with arthroscopy

admin — Fri, 22 Jul 2011 11:22:35 +0000

What’s the advantage of having a meniscus repaired by arthroscopy? Are there any problems with this kind of surgery?

There are several benefits to this type of surgery. First of all, only a few small puncture holes are needed to slip the surgical tools into the joint. No large scars are needed. The back of the knee doesn’t have to be opened to tie the sutures. Healing time is shorter.

There’s less risk of damaging nerves or blood vessels with arthroscopy. The risk of infection is also less. The disadvantages may be just coming to light.

The first long-term studies are being reported. After about 10 years of using special devices that allow for an all-inside or all-arthroscopic repair, it’s clear that the repair is incomplete for many patients. A second operation may be needed to repair or remove the re-injured meniscus.

When can patient play tennis again after arthoscopic shoulder surgery?

admin — Tue, 21 Jun 2011 10:42:15 +0000

I’m going to have an arthroscopic surgical procedure for a problem with a chronic left shoulder dislocation. I’d like to get back on the tennis court in time for the adult summer league. What kind of rehab program should I expect?

Rehab programs after a shoulder stabilization procedure may be the same whether it was an open versus closed procedure. Sometimes this depends on the surgeon’s preferences. Type of sutures used, amount of damage to the soft tissues, and condition of the joint capsule are only three of the important considerations.

Most often, the protocol used during the early phase of rehab is one that can be modified for each patient. Your therapist will advance you along as quickly as possible. The rehab protocol is really just a guideline.

Most likely you will be put in a shoulder immobilizer (sling) in the operating room. This is worn for two to four weeks. Exercises are started at two weeks. Passive and active-assisted partial range of motion is allowed. Full, active range of motion is permitted at six weeks.

The therapist will progress you to and through a series of strengthening exercises. The speed at which you will be able to advance may depend on your level of pain, degree of stiffness, and strength. You will be able to start training for tennis participation between eight and 12 weeks. If there are no complications or problems, you may expect to return to your sport about four months after surgery.

Arthroscopic vs. incision approach for golfer’s shoulder, which is better?

admin — Thu, 16 Jun 2011 10:37:00 +0000

I’m a semi-pro golfer with a bad shoulder from chronic dislocations. The surgeon has offered to do a stabilization procedure with either an open incision or arthroscopically. Is there much difference between these two operations?

Improvements in both surgical procedures has narrowed the gap of advantages of one over the other. The arthroscopic approach uses two or three puncture wounds to insert a long, thin scope into the joint. It has been suggested that this approach has a more pleasing appearance and shorter operative and recovery time.

The incision approach uses a fairly small open incision to access the joint. The main difference is that the subscapularis muscle is split during the open surgery. Some surgeons feel this puts the patient at a strength disadvantage.

To check out this theory, a team of surgeons and sport medicine staff from Canada put it to the test. They compared before and after muscle strength of the shoulder for an equal number of patients treated arthroscopically versus with an open incision.

They were surprised to find out that patients in both groups had significant strength deficits. External rotation was affected more than internal rotation for both groups. But there wasn’t a discernible difference between the two groups. The reason for these two findings remains unknown but a point of interest for future research.

Is 83 too old for rotator cuff repair?

admin — Fri, 03 Jun 2011 10:14:42 +0000

At age 83, am I too old for a rotator cuff repair? I’m not a senior athlete but I’d sure like to do more with this bum shoulder.

An orthopedic surgeon would be the best one to answer your question. Age is an important variable but there are many other factors to consider. The condition of the torn tendon is one. Excessive scar tissue, weak tendon fibers, and poor bone quality can reduce the changes of a successful repair.

The location and extent of your tear must be considered. The surgical technique used may depend on these factors. There are numerous types of sutures and anchors used to repair the tear. Placement of the fixation may affect the outcome.

Many surgeons use a double row of sutures. This can be done arthroscopically or through a mini-incision. A newer technique of suture anchor without knots has simplified the arthroscopic procedure. Fewer anchors are needed and they are easier to make. They also withstand greater loads than previously used corkscrew anchor repair.

Some methods of repair seem to work better for younger patients. Your surgeon will take into consideration both anchor and suture designs for your particular rotator cuff tear. Future improvements are needed to reduce the friction between the suture and anchor. Research is ongoing to find ways to increase the strength of the suture against rubbing.

Hair stylist concerned about arthroscopic surgery for shoulder

admin — Mon, 23 May 2011 10:48:50 +0000

I need to have surgery on my shoulder because it clicks and hurts whenever I raise my arms over my head. Since I work as a hair dresser, I use this motion all day long. The surgeon I saw wants to put two puncture holes in my shoulder to repair this problem. Should I go through with it? Will the holes cause problems later?

It sounds like your surgeon is suggesting arthroscopic surgery. A long needle with a tiny TV camera on the end is inserted through the skin into the joint. The surgeon can see on a screen what is going on inside the joint.

The scope makes it possible to find and repair damage to the joint capsule, cartilage, and ligaments or tendons in the area. Studies show this type of surgery is very successful. There is no need for a large, open incision. Rehab and recovery is faster because major muscles haven’t been cut through.

The two or three puncture holes needed for placement of the scope usually present no problems. There is a small risk of infection at those sites. Usually, they just fill in with collagen fibers and scar tissue. They may only be visible on close inpsection.

The recovery process does take some time. Depending on what the surgeon has to do, you probably won’t be able to go back to work right away. Most patients are placed in a sling with a pillow under the arm.

You’ll probably see a physical therapist several weeks after the operation. The focus of rehab will be on restoring range of motion, strength, and function. Specific exercises may be prescribed to help you prepare to return to overhead work.

After using an ice pack on my knee, the joint feels really frozen. Is there any actual change in the temperature inside the joint? Or is it just the skin that gets cold?

admin — Tue, 12 Apr 2011 16:15:53 +0000

After using an ice pack on my knee, the joint feels really frozen. Is there any actual change in the temperature inside the joint? Or is it just the skin that gets cold?

Today’s technology has brought us new temperature measuring systems. These tools allow scientists to measure and graph temperatures inside the knee joint. This is helpful because keeping a cool joint can help prevent painful swelling after surgery.

A recent study from Spain measured the temperature inside the knee joint. Measurements were taken during and after arthroscopic surgery. A temperature probe in the joint fluid took the joint temperature every 30 seconds during the operation.

They found the temperature inside the joint was lowered by four degrees after using a saline solution to flush the joint out. The saline solution was kept at room temperature. Other studies also show that the normal temperature inside the knee joint is lower than normal body temperature.

Normal core body temperature is between 97 and 99 degrees F for most people. Internal knee temperature is between 90 and 95 degrees. The difference is most likely due to a fact lack of blood supply to the cartilage in the normal knee.