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

August 29th — admin

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.

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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Robbery results in rotator cuff tear

August 24th — admin

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.

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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Arthroscopy vs. open repair for rotator cuff tear

August 19th — admin

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.

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

July 26th — admin

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.

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 you have a torn rotator cuff and not know it?

July 21st — admin

Is it really possible to have a torn rotator cuff and not know it? My aunt tells me she was diagnosed with this type of injury. But they aren’t going to treat it because it doesn’t hurt. Does that seem reasonable to you?

Rotator cuff injuries can be difficult to diagnose. It is indeed true that many older adults with degenerative soft tissue changes have no symptoms. They are said to be asymptomatic. Studies show that it is possible to have a full-thickness tear of the rotator cuff without any symptoms. Finding a clinical test that can accurately diagnose a rotator cuff tear has been a challenge. There are four different tendons that form the rotator cuff. There’s a different clinical test for each one. But sometimes it’s impossible to separate out the supraspinatus from the infraspinatus (two of the commonly involved tendons). The surgeon may have to rely upon ultrasound or other more advanced imaging to make an accurate diagnosis. Many prefer arthroscopic exam because the repair can be done at the same time. Ultrasound does have the advantage of being able to compare one side to the other without invasive 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 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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Torn rotator cuff? Reverse total shoulder replacement may be the answer

July 13th — admin

My father is going to have a shoulder replacement but the doctor said it is a “reverse” replacement. What does that mean?

While regular shoulder replacements can be very successful for the right patients, if the patients have torn rotator cuffs, this is not the ideal solution. The movement of the shoulder places a lot of strain on the rotator cuff. The regular shoulder replacements include replacing the ball at the top of the humerus (the upper arm bone) with a metal ball. The socket in the scapula (shoulder blade) is replaced with a plastic socket. However, if the patient has a torn rotator cuff, this replacement can come loose. In the reverse replacement, the ball is at the top, where the scapula is, and the socket is part of the humerus. With this arrangement, the upper arm muscle, the deltoid takes on the responsibility of the movement rather than the rotator cuff.

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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Is 83 too old for rotator cuff repair?

June 3rd — admin

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.

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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Why bone may need to be removed during a rotator cuff surgery.

January 28th — admin

After my rotator cuff repair, the surgeon showed me on the X-ray how much bone had to be removed. I wasn’t really understanding why the bone was taken out. I thought it was just the muscle that was torn. Can you explain this?

Rotator cuff tears occur most often in young athletes and sports participants. The force of a stress greater than the strength of the muscle/tendon unit results in a tear of the tissues where the tendon joins the muscle.

The most common site of injury is the myotendinous junction. This is a region of highly folded tissue between the end of the muscle fiber and the tendon. These folds increase the surface area for force to be transmitted through the soft tissues. The junction of tendon to muscle is especially vulnerable to injury where the inflexible tendon meets the stretchy muscle.

In older adults, changes in the surrounding structures may contribute to rotator cuff tears. For example, bone spurs often form. Jagged edges rub against the tendon and cause the tissue to tear or rupture. In such cases, it’s not enough to repair the torn tissue. It is necessary to remove the bone spur(s) to keep it from happening again.

In other cases, the tissue gets stuck or impinged between two moveable parts of the shoulder complex. Sometimes the surgeon has to shave the bone down or even remove the end of the bone to keep this from happening.

When you see your surgeon again, don’t hesitate to ask him or her to explain again what happened in your case. The more you can understand about your own injury and recovery, the better. Preventing rerupture or other injuries from happening is an important part of patient education.

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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Age may be a factor in loss of motion following rotator cuff surgery

November 23rd — admin

Mother is 77-years young (as she likes to say) and very active. She tore her rotator cuff playing tennis and had surgery to repair it. Unfortunately, it’s been six months and she still has not regained her motion. Her shoulder pain seems worse than before the operation. Is this typical in someone her age?

It may be difficult to answer your question directly without knowing more about the shoulder injury and type of surgery done. In general, older adults have degenerative changes in the joint and soft tissues around the joint. Rotator cuff tears (RCTs) are common.

There can be tears in the joint cartilage or just frayed edges that need smoothing down. Sometimes repairing the torn rotator cuff is all that’s needed. If the torn cartilage isn’t bothering the patient, then it’s not always in their best interest to repair it. The result can be the loss of motion and worsening of symptoms you described.

In other cases, the rehab program after surgery is the key factor. The patient must follow the surgeon’s and the physical therapist’s directions carefully. Too much movement too soon can cause the repair to fail. With the right program, loss of shoulder motion can be avoided.

It might be best to make a follow-up appointment with the surgeon and go with your mother. Her age may be a factor; sometimes older adults just need more time to progress through the rehab program. She may need an extra step in the rehab process.

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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