Hair stylist concerned about arthroscopic surgery for shoulder

May 23rd — admin

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.

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.

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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?

April 12th — admin

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. 

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.

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I’ve been told that an open repair of my torn rotator cuff is best, but I would like a smaller incision. Is the open method really so superior?

April 11th — admin

I’ve been told that an open repair of my torn rotator cuff may give the best long-term results. But I like the idea of a smaller incision with the less invasive operations. Is the open method really so superior that I should take the cut?

The open rotator cuff repair has been the standard operation for many years. Long-term studies show it has an 85 to 95 per cent success rate. Patients experience pain relief and improved function.

At the same time, arthroscopic surgery has made it possible to do a mini-open rotator cuff repair. This procedure still provides good pain relief and even better functional results. Studies show 93 per cent improved function at mid-term follow-up.

Studies comparing the two methods still conclude that the open repair has the best long-term results. The success of the operation depends on three basic factors. These include the strength of the tendon-to-bone fixation, strength of the suture, and strength of the suture-to-tendon fixation.

Failure of fixation after the first rotator cuff repair occurs in 13 to 68 per cent of all cases. The wide variability in this failure rate is affected by these three factors. Results after re-repair aren’t very good. There’s only a 20 per cent chance of a good to excellent result.

Using the right sutures and suture placement is important in getting a fixation strength that’s equal to or greater than the force of the muscle pull. An open repair makes it possible for the surgeon to see everything more clearly and make the best repair for the damage present.

Massive rotator cuff tears are still largely done with the open method. Arthroscopic techniques are confined to small tears that can be repaired easily.

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.

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After my son injured his knee in a soccer game, the MRI showed a medial meniscus tear, but an arthroscopic exam revealed no tear. Why?

March 1st — admin

My son injured his knee in a soccer game. The arthroscopic surgery showed there was nothing wrong despite chronic swelling and pain. The MRI showed a tear of the medial meniscus. Why was the arthroscopic exam normal?

Arthroscopic examination of the knee is done with a needle inserted into the joint. There’s a tiny TV camera on the end of the scope giving the doctor a view inside the joint. The test is usually very accurate.

The arthroscopic exam may be considered “negative” (normal) if and when the tear is small and remains flat against the rest of the meniscus. This is called a nondisplaced tear.

Meniscal tears are graded based on their location, direction of tear, and depth of injury. A horizontal partial-thickness tear may remain undetected when nondisplaced.

It’s also the case that mild tears can become severe tears with re-injury. If your arthroscopic surgery was done before the tear was complete then a false-negative test may be obtained. This means the test was negative for a meniscal tear when there was a tear after all.

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.

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Can arthroscopy procedures be done for hips?

February 17th — admin

I’ve heard of arthroscopy done for shoulders and knees, but never for hips. Why is that?

Arthroscopies are usually done for the knees and shoulders because of the way the joints are formed – they are easier to access with the small instruments used. However, the procedure is done on other joints, such as the hips, as surgeons learn the best ways to do them and for what reasons.

A small study done recently found that patients with certain types of hip problems did benefit from arthroscopies in helping determine their diagnosis and treatment.

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.

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Can a retear of rotator cuff surgery be predicted?

February 2nd — admin

I had arthroscopic surgery to repair a torn rotator cuff in my right shoulder. Two months later, it tore again. I wasn’t expecting that to happen at all. Was there any way to predict that was going to happen?

Retears of the torn rotator cuff vary from patient to patient. It can be difficult to predict who might be at risk. Patients with severe or massive tears are certainly at increased risk. Small tears are less likely to retear. Conversely, large tears are at increased risk for rerupture.

 Only about five per cent of the patients with small tears retear at a later time. That’s compared to 40 per cent for patients with massive, complete tears. As you might expect, the condition of the tendon at the time of the surgery makes a difference.

Size of the tear and tissue quality must be considered. A tendon with frayed and retracted ends can be a problem. The surgeon may not be able to sew the ends together or attach the tendon to the bone where it belongs. Shoulders with poor tendon quality and severe muscle degeneration are more likely to need traditional open surgery. Arthroscopic repair may not be adequate.

Some surgeons are using a double-row of sutures now to help stabilize the repair site. Studies have shown greater fixation strength using this method. The contact area is improved with double- versus single-row sutures.

So you see, there are many factors to consider. And we haven’t even mentioned patient compliance with the rehab process. Patients who don’t follow the surgeon or the therapist’s directions are also at increased risk for rerupture.

The surgeon may be able to identify the risk factors at play in your case. You may want to ask him or her this question at your next follow-up appointment.

 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.

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Anthroscopic surgery for a frozen shoulder.

January 17th — admin

Next week I’m going to have arthroscopic surgery for a frozen shoulder. The surgeon has explained everything to me. Just the front part of my shoulder capsule will be cut. I’m wondering if they don’t release the back part, too will I still get my full motion back?

Frozen shoulder also known as adhesive capsulitis is used to describe a loss of shoulder motion caused by changes in the shoulder joint capsule. The capsule is an envelope of connective tissue that surrounds the shoulder joint.

Injury and inflammation can start the process leading to adhesive capsulitis. Painful motion causes the person to stop moving the shoulder, and it gets bound down. It can also occur as a result of other conditions such as diabetes, heart disease, and lung disease.

It was once thought that changes throughout the capsule are what caused the tightness. It is true that with a frozen shoulder, there is fibroplasia throughout the capsule. Fibroplasia refers to the formation of fibrous scar tissue.

But surgeons found that by releasing just the anterior (front) part of the capsule restores shoulder motion. Further research showed that a particular protein called vimentin is what really leads to anterior contracture (tightness) of the capsule.

By releasing the anterior capsular structures, motion is restored throughout the joint for most people. Frozen shoulder can range from loss of external rotation and abduction (moving the arm away from the body) to a complete loss of all motion. More extensive surgery may be needed for more extreme cases.

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.

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Rehab sports-loving shoulder surgery patient like a soldier

November 15th — admin

I’d like to know what’s the fastest recovery time possible for shoulder surgery? I’m having a labral tear repaired and I want to get back to sports absolutely as fast as possible.

Your recovery time may depend on the type of surgery you are having. Labral tears of the shoulder can be repaired using an open versus an arthroscopic method. The final results are nearly the same, but studies show the arthroscopic group has fewer problems afterwards. There is also a shorter hospital stay and less blood lost with arthroscopic surgery.

If we use the military model, expected return to full athletic participation would be after four to six months. Since the goal of military medicine is to return the soldier to duty as soon as possible, it makes sense to use this model with young, athletes in equally good shape.

The rehab program after labral tears in the military is broken down into three main phases. Each stage lasts about four weeks (one month). During Stage 1, the patient is immobilized in a sling. Special shoulder and elbow exercises are allowed as taught by the physical therapist.

Stage 2 works to restore motion without damaging the repair. The therapist will teach you how to protect the surgical site while gaining shoulder motion. Stage 3 focuses on strengthening the muscles around the shoulder. The program progresses from there until the patient is ready for full, active duty. In your case, that would be a return to your preinjury levels of sports play.

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.

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Bristow procedure linked to higher rate of arthritis

September 23rd — admin

Thirty years ago I had a special operation called the Bristow for a shoulder dislocation. It seems to have held up pretty good but now I’m getting some arthritis. Is that from the surgery or the dislocation?

Cases of joint arthritis after a traumatic injury are very common. This is true for any joint, not just the shoulder. The type of operation you had is also linked with a higher rate of arthritis afterwards.

The Bristow procedure named after W. Rowley Bristow, MD was used most often back in the 1970s when shoulder repairs were done with an open incision. Today, arthroscopic surgery has replaced open procedures in many cases.

The Bristow procedure transferred the tip of the coracoid process to the front of the shoulder socket. The coracoid process is part of the scapula (shoulder blade) that juts forward toward the front of the shoulder.

The idea was to use this piece of bone to reinforce the shoulder socket. It kept the head of the humerus (upper arm) from popping out of the socket. Usually a piece of muscle was also attached like a sling to help as well.

The Bristow procedure is still used in Europe but has been replaced by other methods now in the U.S. There were concerns about restricted motion and arthritis leading to the development of other methods of surgical repair. The coracoid transfer is still used for some patients. Long-term results have been excellent bringing this method back to the attention of orthopedic surgeons for a second look.

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.

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Will arthroscopic surgery solve problems with knee arthritis?

July 13th — admin

I have some mild, but painful arthritis in my left knee. I’m thinking about having arthroscopic surgery done. The doctor wants to take a look inside and smooth out any rough edges. Will that take care of the problem?

Short-term results (six months to two years) after arthroscopic surgery for mild to moderate arthritis are good. Reports show at least 75 percent (three-fourths) of all patients get better. The have less pain and more function.

After three years, only half the patients stay pain free. Those with rough cartilage behind the knee cap (a condition called chondromalacia) often have return of painful symptoms. Patients who are overweight have pain much more often than patients of normal weight.

Patients with mild degenerative changes but no arthritis who aren’t overweight have the best results with arthroscopic surgery.

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.

Posted in Knees. Tags: , , . No Comments »
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