Naples Orthopedic Surgeon - Dr. Robert J. Zehr » rotator cuff tear

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.

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.

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.

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.

Can all rotator cuff tears be repaired surgically?

admin — Thu, 27 May 2010 12:54:38 +0000

Can all rotator cuff tears be repaired surgically?

Yes and no. Some doctors repair all types of rotator cuff tears that can be repaired. This depends on their location and if there’s enough tissue to cover the head of the humerus (upper arm bone). The decision is more complicated if more than one tendon is torn.

New surgical techniques using arthroscopy have changed things. The arthroscope is a long needle-like tool with a tiny TV camera on the end. It’s inserted into a joint and gives the doctor a view inside. The arthroscope has made it possible to repair tears that couldn’t be fixed in the past.

If a tear is left unrepaired for years, there may be too much damage to fix it later. This can happen when someone injures the shoulder, but recovers without seeing a doctor. If the joint needs replacing years later, the doctor may find the tear during the operation.

Which test is best to show torn rotator cuff?

admin — Tue, 11 May 2010 12:19:41 +0000

Is it possible to have a normal tendon show up as torn on an ultrasound study? I just had an MRI and an ultrasound. The MRI was normal but the US showed a tear in my rotator cuff. Which test should I believe?

Depend on your doctor’s final word to guide you. Doctors rarely rely on imaging studies without knowing the patient’s history and doing an exam. Many clinical tests can be done to find the exact tendon that’s involved.

A misdiagnosed torn rotator cuff usually goes the other way. In other words, there’s a tear but the image shows a normal tendon. It would be rare (but possible) to have a normal tendon diagnosed as torn. This could occur when there is what’s called an artifact, a blip in the picture. Artifacts come from extra electronic signals. Another possible reason for a wrong diagnosis is that the radiologist looking at the image can misread it.

One benefit to in-office ultrasound testing for orthopedic surgeons is the doctor’s knowledge of the patient. The patient doesn’t have to depend on the results read by a radiologist who has never seen the patient.

The surgeon has the advantage when looking at the image of knowing how the patient presented. The test can be done at the time of the exam, saving the patient from having to make another appointment on another day.

Shoulder surgery complications perhaps caused by fluid

admin — Thu, 06 May 2010 17:29:38 +0000

My father-in-law had surgery on his shoulder to repair a torn rotator cuff. Afterwards he had a lot of swelling on the back of his neck down into the back of his shoulder. What could cause this problem?

Swelling of the neck, nerve problems, and even death of skin tissue can occur after arthroscopic surgery. Evidently the surgeon pushes fluid into the joint during the operation. This helps keep the joint open. It also washes away any blood that might keep the surgeon from seeing what he or she is doing.

The longer the surgery takes, the more fluid is forced into the joint. This increases the chances of problems occurring. Surgeons are encouraged to shorten the operating time as much as possible to reduce the amount of fluid put into the joint.

How late is too late to treat rotator cuff tear?

admin — Thu, 22 Apr 2010 22:17:18 +0000

Years ago, I tore my rotator cuff while lifting and carrying children in a daycare. I couldn’t take time off from work for physical therapy or surgery then. Now, I have chronic pain that’s worse at night. Is it too late for treatment?

Maybe not. Untreated rotator cuff tears can lead to wear and tear on the shoulder joint. A chronic tear with arthritis often results in restricted and sore shoulder motions. Severe pain is reported with daily activities and at night.

Doctors offer several methods of treatment for this problem. The joint can be cleaned out, fused, or replaced. Removing fragments of tissue, scraping off bone spurs, and opening the joint space can help. Fusion eliminates pain, but also restricts motion.

Replacing the joint is a third option. One or both sides of the joint is removed and replaced. If both sides are involved, it’s called a total joint arthroplasty. If only one side is altered, it’s a hemiarthroplasty.

Shoulder surgery rehab hurts! Any alternatives?

admin — Wed, 07 Apr 2010 17:10:23 +0000

I am 66-years old and recently had shoulder surgery to repair a torn rotator cuff muscle. The physical therapist I’m seeing wants me to get down on my hands and knees to do the shoulder exercises. This is really hard on my hips. Is there some other way to do this?

Studies show that the hands and knees position puts the least amount of stress on a recovering shoulder. The patient can strengthen muscles and re-tune the joint after surgery with less risk of re-injury in this position.

However, if the position causes other problems, something different must be done. The shoulder exercises can probably be changed to a standing position with weight through the hands and arms against a wall or table. This will depend on which muscle was torn and repaired. Some muscles are more active in one position compared to others.

Putting the least stress on recovering muscle is important in the rehab of healing tendons after surgery. Too much load or force against the muscle too soon can result in a failed operation.

Bring up your concerns with the therapist and give him or her a chance to modify the program to meet all your needs.

How long is the recovery period after shoulder surgery?

admin — Fri, 02 Apr 2010 13:41:47 +0000

I’m going to have arthroscopic surgery to repair a torn rotator cuff. I really need full motion to do my job. How long will it take to get it back?

Right after surgery, you’ll probably be wearing a sling. This is kept on for a week to ten days according to your comfort level. You will be allowed to move your shoulder in two directions so long as it doesn’t hurt. The first is shoulder flexion (forward) and the second is outward rotation (elbow is held next to the body, hand moves away from the body).

By the end of the month, you may be given exercises using as much motion in all directions as pain will allow. Your full motion should be returned by 12 weeks. A recent study showed that patients who have a rotator cuff repair using only arthroscopic surgery regain motion faster. Patients who have an open incision get back their full motion, but it takes longer.