Is it safe to try climbing walls after rotator cuff injury?

September 1st — admin

I have a buddy who wants me to try climbing walls at his gym. I’m really tempted but I had a rotator cuff injury several years ago. Is it safe for me to try this activity?

Arm injuries are common in sport climbing, especially injuries of the shoulder. The rotator cuff is a prime area for tendon damage and impingement (pinching) syndrome. Some of the stresses on the shoulders and arms depend on the angle and/or incline of the climbing wall. Ease with which handholds and footholds can be reached is another potential factor. Coordinated movements of the shoulder are needed for this sport.

The rotator cuff must function with just the right amount of muscle contraction and cocontraction. Cocontraction refers to muscles on the opposite sides of the joint contracting at the same time. Climbing techniques require a lot of body pull-up motions. The shoulder muscles must be strong enough to lift the entire body against gravity.

The best way to find out if your shoulder is stable enough for climbing activities is to have the muscles tested. Physical therapists offer isokinetic testing (e.g., Cybex system) to evaluate muscle strength under load. Any weakness or imbalance will be revealed with this type of testing. It’s possible a strength training program could prepare you for this vigorous sport.

One study comparing shoulder muscle strength of climbers versus nonclimbers found overall shoulder strength much greater among climbers. Shoulder extensors were twice as strong as the flexors. Training toward this ratio may help prepare you and protect you once you get started. Start with the easiest climbing walls first. Gradually increase the speed and level of difficulty based on the results of your muscle testing and endurance during the activity. If there is any question or doubt about your ability or preparation for this actvity, an evaluation with an orthopedic surgeon might be a good idea first before participating in this actvity.

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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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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Could intraoperative fracture during total shoulder replacement have been prevented?

May 26th — admin

We are really bummed as a family. We all encouraged Mom to have a shoulder replacement and then her upper arm broke during the surgery. Is this a fluke? Could it have been prevented?

There are many possible reasons why a bone fracture occurs intraoperatively. Sometimes it’s completely unavoidable. There are some known risk factors such as decreased bone mass (osteopenia or osteoporosis). Shoulder instability from a previous rotator cuff tear can make a difference.

Fractures of this type occur most often during a total shoulder replacement (versus a hemiarthroplasty where only one side of the shoulder joint is removed and replaced). Sometimes the surgeon has trouble getting to the shoulder socket. The angle and force needed may be too much for the brittle bones.

Older women seem to be at increased risk for humeral (upper arm) fractures. They are especially at risk if they also have rheumatoid arthritis or other health issues such as diabetes contributing to delayed or poor healing.

Surgeons must be aware of potential risk factors for fracture. Surgical approach and techniques must be chosen carefully with these risks in mind. Patient position during the operation is important. The elbow should never be used as a lever to get increased shoulder motion when under anesthesia.

Soft tissue release around the shoulder may be needed before moving the arm through its full range of motion. Special care must be taken when reaming out the humeral bone to place the stem of the implant inside. Hand reaming instead of power reaming is advised. The bone should be compressed, rather than removed, in patients who have low bone density.

These are just a few of the many considerations surgeons must include in the surgical process. When many risk factors present at the same time, then the risk of fracture goes up. Even being aware of all the risks doesn’t guarantee complications won’t occur. The surgeon can’t always predict who might develop intraoperative fractures.

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 injured my rotator cuff two years ago. I couldn’t afford to have surgery at that time, but now I can. Did I wait too long?

May 10th — 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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