I have a large tear in my rotator cuff. So far I seem to be able to move my shoulder okay. Surgery has been recommended. Do I really need it?

May 5th — admin

I have a large tear in my rotator cuff. So far I seem to be able to move my shoulder okay. Surgery has been recommended. Do I really need it?

Some rotator cuff tears can be treated conservatively with rehab. But these are usually not in athletes who are using the arm repetitively and with increased loads.

If you are not an overhead-throwing athlete, then surgery may not be needed. It is possible to strengthen the other muscles of the shoulder. The goal is to keep the overall balance in all motions. If the pull of the muscles is stronger in one direction or at a certain angle, then motion may be limited and/or painful. Keeping the overall balance in motion assures there will be normal, pain free movement.

Normal shoulder function depends on an intact rotator cuff, rotator cuff muscle force, and the force or strength of the deltoid muscle. When the deltoid contracts, the arm moves away from the body in a motion called abduction.

If there’s a tear in the rotator cuff, an imbalance occurs. If the deltoid contracts without the counterbalancing contraction of the rotator cuff, the upper arm glides upward into the shoulder socket. This is called superior translation. The result of this abnormal motion can be a painful impingement syndrome.

Studies show that the uneven forces around the shoulder after a rotator cuff tear can actually lead to further damage to the rotator cuff. Early surgery to repair the tear can keep this from happening. The decision whether or not to do surgery depends on your age, level of activity, and type and size of tear.

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 rotator cuff repair didn’t hold and I’m not sure if I should have it done again. What do you advise?

April 6th — admin

I’m so frustrated because my rotator cuff repair didn’t hold. I don’t know if I should bother having the surgery done again or not. What do you advise?

There are many reasons why rotator cuff repairs fail. Knowing the mode of failure helps the surgeon determine what should be done. Did the sutures fail to hold? Where did the failure occur (tendon, bone)?

Comparing the mode of failure with the type of repair is the next factor. Did the surgeon use the three-suture or the multi-suture method? And how much of a failure occurred?

Usually failure of the cuff repair is measured by the separation of the tendon repair site. A five-millimeter (or more) gap is a partial failure. More than a 10-millimiter gap at the repair site suggests a total failure.

Bone density is another key factor. Tunnels are drilled through the bone and the sutures threaded through the tunnels. The sutures can pull through the bone if the bone density isn’t strong enough or there isn’t enough bone mass.

At your next appointment with the surgeon, ask for a review of what happened. Find out what your options are and your surgeon’s recommendation. Your decision will be influenced in part by your age, activity level, and occupation. 

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 I have a massive rotator cuff tear. What does that mean for me?

February 15th — admin

The results of my MRI came back with the report that I have a massive rotator cuff tear. What does that mean and what happens next?

Your surgeon will probably review the report with you and give you more specific and accurate details. A massive tear of the rotator cuff tendons around the shoulder usually means there are at least two tendons torn. And the tears are significant in size (length and/or width).

 There are many ways to treat a rotator cuff tear (RCT). The surgeon may form a preliminary decision based on your clinical exam and the results of MRIs. Once inside the shoulder, then the location, shape, and size of the tear guide what type of surgery is needed.

Small tears can be treated with debridement. The surgeon removes any frayed edges or free floating pieces that may have torn off completely. The edges are smoothed down in hopes that they will reattach or re-adhere to an area close by. This type of procedure is called debridement.

For larger tears, a partial or complete repair is done. The joint capsule and some of the ligaments around the joint may be cut or released. This allows the surgeon to rebalance the shoulder where it belongs. Mobility is improved and tested in the operating room. Then the surgeon uses sutures to hold it in place until everything heals again.

It’s likely you’ll be seeing a physical therapist for instructions and a rehab program. The exercises and timing of the program are determined by the type of tear and repair you have done. You can expect a three month period of rehab. This will be followed by some life-long activities and exercises needed to keep a healthy shoulder.

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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Shoulder dislocations after corrective surgery.

January 25th — admin

My hotshot basketball playing son tore his rotator cuff and the labrum of his shoulder. After a very expensive surgery, he continued to dislocate his shoulder. Now we are faced with another surgery. How do we know this next surgery will be any better?

You should really talk with the surgeon about your questions and concerns. There may be reasons why the first surgery failed that can be avoided the second time. For example, it’s very important that the patient follow the surgeon’s instructions after the procedure.

Immobilization in a sling is usually advised for four to six weeks. The patient must keep the arm next to the body at all times except when bathing under the armpit. The sling is removed once or twice a day to keep the elbow from getting stiff. But it’s very important to avoid moving the shoulder until the surgeon approves.

Sometimes the type of surgery makes a difference for this problem. Arthroscopic repairs are less invasive but have a higher risk of failure. Using this approach, it can be difficult to place sutures far enough down on the tear. Sometimes there aren’t enough sutures used. Combining any of these risk factors together can have poor results.

A recent study from California reported on 30 cases of revised Bankart repairs. All patients were athletes involved in overhead sports. After an arthroscopic repair they all had a traumatic event causing the shoulder to dislocate again. A second operation was needed.

This time they had an open revision surgery. The results were good for most of the patients. Many were able to return to their previous level of sports activity. Follow-up over the next four years showed continued good results. All patients in the study rated their satisfaction as good or excellent.

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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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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What is dead arm syndrome?

September 20th — admin

What is the “dead arm syndrome”? I heard on ESPN that my favorite baseball pitcher is benched for the season with this problem.

Dead arm syndrome starts with repetitive motion and forces on the posterior capsule of the shoulder. The posterior capsule is a band of fibrous tissue that interconnects with tendons of the rotator cuff of the shoulder. Four muscles and their tendons make up the rotator cuff. They cover the outside of the shoulder to hold, protect, and move the joint.

Overuse can lead to a build up of tissue around the posterior capsule called hypertrophy. The next step is tightness of the posterior capsule called posterior capsular contracture. This type of problem reduces the amount the shoulder can rotate inwardly — a motion needed by pitchers to throw the ball forward before releasing it.

Over time, with enough force, the player may develop a tear in the labrum. The labrum is a rim of cartilage around the shoulder socket to help hold the head of the humerus (upper arm) in the joint. This condition is called a superior labrum anterior posterior lesion. The final outcome in all these steps is the dead arm phenomenon.

The shoulder is unstable and dislocation may come next. Dead arm syndrome won’t go away on its own with rest — it must be treated. If there’s a SLAP lesion, then surgery is needed to repair the problem. If the injury is caught before a SLAP tear, then physical therapy with stretching and exercise can restore it and return the player to the field.

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 rotator cuff tear heal on its own?

September 7th — admin

I’m 23-years old and tore one of my rotator cuff tendons playing touch football with a bunch of friends. What are my chances it will heal on its own? Is my age in my favor?

There is some evidence that small rotator cuff tears of a single tendon can heal on its own. Age may be helpful in terms of good blood supply but most younger adults are also very active. Increased activity is more likely a deterrent to healing in this case.

But the biggest determining factor is the size of the tear. Tears less than 100 mm2 (less than two and a half inches) may heal. MRI’s may not be able to show a tissue defect but the new collagen tissue has reduced strength. There is always a risk of rerupture for the active, young adult.

For moderate to large sized rotator cuff tears, repair is advised. Even if it reruptures, the results are usually better than if no repair was done. And in the long run, repairing the rotator cuff seems to offer some protection to the joint from degenerative arthritic changes.

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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