A 54 year old, fell playing ice hockey and now feels a “squishy” sensation in his shoulder. What should he do?

March 3rd — admin

I’m 54-years old and still like to get out on the ice and play broom ball or a little pick up game of ice hockey. Last season, I fell onto my elbow and felt a squishy sensation in my shoulder. Now I can hardly lift my arm up and hold it there without pain and weakness. What should I do?

If you haven’t already seen either your primary care physician or an orthopedic surgeon, that might be your first step. A clinical exam and some imaging tests (X-rays, MRI) will probably help identify the problem.

A traumatic injury through the elbow to the shoulder can cause damage to a number of different structures in the arm. The doctor will make sure there isn’t a fracture that hasn’t healed. The muscles, ligaments, and shoulder capsule will need to be examined.

The most common shoulder injury from this type of fall is a rotator cuff tear. Painful and weak motion suggests a major tear in one or more of the four muscles of the rotator cuff. Painless and weak is more typical when the tendon has ruptured completely.

The rotator cuff covers the shoulder and helps stabilize the head of the humerus (upper arm) in the shoulder joint. Sometimes other injuries accompany a rotator cuff tear. This is impossible to tell without further testing.

Sometimes a specific rehab program can give good results. But in some cases, surgery is needed. Again, a medical exam is needed to know for sure the cause of your symptoms and the best course of action.

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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My sister and I have rotator cuff tears. Hers is getting worse, but mine isn’t. Will this happen to me?

February 10th — admin

My sister and I both have rotator cuff tears. I’ve had mine for about 10 years but I’m still getting along fine. She’s only had hers for two years but they’re talking about doing a shoulder replacement. They say she’s had progressive joint damage from the tear. Why did this happen to her but not me? Will I eventually have the same problem?

Your sister may have a condition called rotator cuff tear arthropathy. This refers to an insufficient (weak) muscle that doesn’t hold the head of the humerus firmly inside the socket. The humeral head may even slide up out of the center of the socket. Uneven wear over time can cause joint damage. All of these changes are part of the arthropathy.

Doctors aren’t sure why this condition develops in some people with a rotator cuff tear but not others. There may be subtle anatomic changes that make a difference. For example, the geometry (shape) of the bones that form the socket and bony arch over the shoulder might be a factor.

Or perhaps the length of the ligaments varies enough to change the compressive forces in the shoulder. Anything that alters this force generated by the rotator cuff can contribute to an imbalance and instability of the shoulder.

Repetitive use of the shoulder and age are additional factors. The natural history of rotator cuff tears (in other words, what happens over time) isn’t well-known. Many people have rotator cuff tears and don’t even know it.

At this point in time, there’s no way to predict what will happen for you. Most experts would advise you to establish an exercise program to keep up the motion and strengthen in both your shoulders. It won’t hurt and it may help prevent future deterioration or injury.

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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Could your rotator cuff tear actually be rotator cuff tear arthropathy?

February 7th — admin

What is a rotator cuff arthropathy? I know I’ve had a large rotator cuff tear for years. Now the doctor is saying I have rotator cuff tear arthropathy.

Arthro refers to the joint. Path lets us know there is some pathology or damage done. In the case of rotator cuff tear (RCT) arthropathy, there has been some wear and tear on the joint because of the RCT instability.

When the four muscles of the rotator cuff function normally, they hold the head of the humerus inside the shoulder socket. This stable compression allows the shoulder to move easily in so many directions.

Without this compressive stability, the head of the humerus can start to slide up and out of the socket. This movement is called migration. Eventually the head of the humerus comes up against the bottom of the acromion. The acromion is the piece of bone that comes across the top of the shoulder from the scapula (shoulder blade).

The patient has pain, loss of motion, and loses function. Many other changes occur inside the joint. Tiny pieces of cartilage break lose inside the joint. The lining of the joint called the synovium starts to thicken. Calcium crystals form, further damaging the joint and soft tissues.

Rotator cuff arthropathy can be treated with a conservative management program. Non-steroidal antiinflammatories and a rehab program with a physical therapist are advised. If this doesn’t work, then surgery may be needed.

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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Classification of rotator cuff tears?

January 12th — admin

My doctor says I have a grade 2 rotator cuff tear. What does that mean?

There are many ways to describe and classify rotator cuff tears (RCTs). In most cases, the surgeon first determines if the tear is a partial or full-thickness tear. They look to see which side the tear occurs on (bursal or articular).

In other words, is it right next to the bursa or on the side where the tendon attaches to the joint? The bursa is a small fluid-filled sac located at the point where a muscle or tendon slides across bone. The bursa reduces friction between the two moving surfaces.

Using an arthroscopic exam, the surgeon identifies the size, shape, and depth of the tear. A commonly used method to describe location of RCTs is the Patte classification. Tears are classified as stage one (I), two (II), or three (III). In stage I, the tendon is torn close to the place where it inserts into the bone.

Stage II describes a tendon tear close to the level of the humeral head. The humeral head is the round knob at the top of the humerus (upper arm bone) that fits into the shoulder socket.

Stage III is a RCT much closer to the shoulder socket called the glenoid cavity. The glenoid is part of the shoulder blade.

You may have to ask your surgeon to explain a grade two tear based on whatever system he or she is using.

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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Too old for rotator cuff repair surgery?

December 28th — admin

I’m 73-years old and just diagnosed with a rotator cuff tear (left shoulder). I’m normally right-handed so it doesn’t seem like a big deal. The orthopedic surgeon who saw me assured me that I’m not too old to have surgery to repair this problem. What do you think?

The majority of studies show that age does not affect long-term outcomes for this type of surgery. Outstanding workers’ comp claims is a bigger predictor of poor outcome. Most older adults are not involved in this type of controversy.

Older adults are more likely to experience rotator cuff problems. In a review of 50 studies, only four per cent of the patients under the age of 40 had a rotator cuff tear. This was compared to 54 per cent in patients more than 60 years old.

Older adults report improved pain relief and function after rotator cuff tear repairs. Even with poorer tendon quality due to aging, results after surgical repair can be very good. Younger patients are more likely to report satisfactory results but that doesn’t mean older adults can’t have excellent outcomes.

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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What is rotator cuff disease?

December 1st — admin

What is rotator cuff disease?

The rotator cuff (RTC) is a group of four muscles and their tendons that surround the shoulder. The RTC forms an envelope around the shoulder joint to help support and move it. This structure also compresses the head of the humerus to hold it in the shoulder socket.

RTC disease can refer to any number of problems in the RTC. This could be a tendinitis, acute strain, or tear of one or more of the tendons. Rotator cuff tears can be partial-thickness or full-thickness depending on whether or not the tear goes all the way through the tendon. A full-thickness tear is also called a tendon rupture.

Making a correct diagnosis is often difficult. Using the term rotator cuff disease identifies the general (but not the specific) problem. Sometimes this term is used as a provisional diagnosis. Further imaging testing or arthroscopic exam is needed to identify the exact diagnosis.

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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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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Is it possible to rehab a torn rotator cuff without surgery?

November 10th — admin

I’ve heard it’s possible to rehab a torn rotator cuff without surgery. How is that possible?

The rotator cuff is a group of four muscles and tendons that converge on the shoulder. Together they form a sheath or envelope that wraps around the shoulder. The fibers interlock and crossover forming layers that are all connected together.

This protective overlap makes it possible for one muscle to take over and help function for another. This concept is called redundancy in function. Rehab can focus on strengthening the muscles that aren’t torn and restoring the torn tendons as much as possible.

A physical therapist can perform a special massage called transverse friction massage to help align the healing fibers. Instead of adhesions and scarring going in all directions, the fibers line up in parallel. This helps keep the shoulder supple and moving smoothly.

Not all tears do heal without surgery. Various factors such as patient age, condition of the tissue, and depth of the tear determine the final outcome. Results also depend on whether more than one tendon is involved and the location of the tears.

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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Why can’t torn rotator cuff be repaired?

November 5th — admin

My 72-year old mother has been told her torn rotator cuff cannot be repaired. She seems in good health and she’s fairly active for her age. Why can’t this be fixed?

Massive, chronic tears of the rotator cuff (RCTs) can’t be repaired in the standard, conventional way of reattaching the torn tendon where it belongs. In older adults, the tear may have been present for so long that the area has filled in with fatty tissue. In such cases, the rate of retear is very high when a repair is attempted.

Treatment is possible but just what’s the best treatment is judged on a case-by-case basis. After the surgeon examines the patient, imaging studies are taken. X-rays, CT scans, and MRIs each give a slightly different view of what’s going on inside and around the shoulder joint.

Arthritis in the joint makes the treatment decision more difficult. The patient’s age, activity level, amount of muscle atrophy, and fatty infiltration are all taken into consideration. Sometimes the best treatment plan is nonoperative. Inflammatories, steroid injections, and physical therapy may be advised.

When surgery is recommended, it may be to debride the area (clean it up). Or a tendon transfer may be possible. In this case, the surgeon takes a muscle from some other area and transfers it to the shoulder. The transferred tendon functions like the torn tendon of the rotator cuff. A tendon transfer is a complex operation. A long rehab program is likely so the patient must be motivated and active enough to do it before tendon transfer is considered.

When the shoulder is unstable and the rotator cuff tear is inoperable, then a shoulder replacement may be the best treatment choice. Many irreparable RCTs can be managed nonoperatively. This may be what your mother’s surgeon was suggesting.

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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