Options for hang glider who crashed, tearing rotator cuff

August 30th — admin

I’m a certified hang gliding instructor with 20 years of experience. Even so I hit an updraft and crashed, tearing three of the tendons in my shoulder. I’ve had two surgeries to try and repair this massive tear. They didn’t work. Are there any other options left to me?

Repair of massive tears of the rotator cuff can be problematic. In some cases they are considered irreparable. Studies have been done trying different surgical methods of treatment for this problem. So far there hasn’t been a single type of surgery that works best.

For the most part the best approach seems to be cleaning up the damaged tendons. This is called debridement. Then the bone across the top of the shoulder (acromion) is removed. This is called an acromioplasty. If just the underside of the acromion is shaved, it’s called a subacromial decompression.

When any part of the rotator cuff is torn and can’t be repaired, an imbalance occurs at the shoulder. That’s why the rest of the rotator cuff can get impinged. Reducing or removing the acromion leaves room for the remaining tendons of the rotator cuff to slide and glide without getting pinched.

Other surgeries used to reconstruct massive rotator cuff tears include tendon transfers, fusion, and tendon grafting. No one method seems to have better results than the others.

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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Rodeo rider may want shoulder replacement, not fusion

August 25th — admin

I’m a professional rodeo rider and had a bad calf roping accident. My right shoulder was dislocated severely and the muscles around the joint ruptured. After three surgeries already I’m going to have it fused. How do they do this operation? What can I expect during recovery?

Shoulder fusion is not used as commonly as it once was. Shoulder replacement has replaced fusion in many cases. If you haven’t already talked to your surgeon about a total shoulder replacement, you may want to ask about this as an option before shoulder fusion.

Shoulder fusion or arthrodesis is called a salvage procedure. The arm is saved from amputation but full shoulder motion isn’t preserved. You may not have enough motion to swing a rope over your head or enough strength to wrestle a calf to the ground.

The fusion is done using metal plates and screws. The reconstruction plate is actually one normally used in the hip or pelvic area. It goes up along the outside of the upper arm and over the top of the shoulder along the bony ridge of the shoulder blade. Screws help compress the bones together to fuse the area. Sometimes bone grafts are used to fill in any spaces left open.

Your arm will be immobilized for at least eight to 10 weeks. Some doctors use a special abduction pillow. Others put the arm in a full cast from wrist to shoulder. Once there is evidence of fusion on X-ray, rehab exercises can begin.

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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Baseball pitching’s effect on shoulder

August 12th — admin

When I watch my son wind up and throw the ball when he’s pitching, I can’t help but wonder how that extreme motion is going to affect his shoulder joint years from now. Are there any studies to show what happens inside the joint?

There are some long-term effects of throwing in the shoulders of throwing athletes. The glenohumeral (shoulder) joint comes under high joint forces, speed, and stress during this activity.

Extreme positions of motion may actually alter the shape of the joint capsule and surrounding ligaments. Joint stability may even be compromised. Right now all we have are theories. Evidence to prove any of these changes occurs is lacking. Even the idea that the soft tissues “stretch out” after long-term throwing remains unproven.

In a recent study of elite baseball pitchers, physical therapists from the University of Florda offer some insight. They measured the joint motion and stiffness of 34 professional baseball pitchers. They found the same amount of motion on both sides (throwing versus nonthrowing shoulders). What they noticed was that the pitching arm had more external rotation. The nonthrowing arm had more internal rotation.

The front portion (anterior capsule) was stiff in both arms. This stiffness gave the joint greater stability. There was less risk of injury. The risk of arthritis in the adult years with overhead pitching in young children isn’t known yet. More long-term studies are 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 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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Simple movements can stress shoulder

August 4th — admin

I’m in a sling after shoulder surgery for the next six weeks. I’d really like to just try out my new arm. Is it such a bad thing to move it around?

We don’t really know how much force can be applied to normal tendons much less healing soft tissues. Animal and cadaver studies have given surgeons a general idea. The amount of acceptable force will increase over time as the tissues interface with the bone.

You’re best off to follow your surgeon’s advice carefully. The healing tissue is very weak and can’t hold together with stress or pull. Even the simplest of movements can put a greater load on the surgical site than it can handle.

Most surgeons give their patients specific guidelines to follow. There are some general guidelines for everyone having the surgery you had. There are some just for you based on your age, the condition of your soft tissues and bones, and the type of surgery done. Be sure and ask if you don’t know what are the limits in your case. You wouldn’t want to undo what the surgeon just spent hours (and your money) fixing.

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 ever too late for surgery to repair torn rotator cuff?

June 22nd — admin

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.

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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Baseball injury leaves one shoulder higher than the other

June 14th — admin

I injured my right shoulder playing baseball last year. It gradually got better, but now I notice my right shoulder is higher than my left. What could be causing this?

The specific cause can’t be determined without an exam by a physical therapist or medical doctor. There is a wide range of possibilities from posture to nerve damage to muscle tear. Shoulder injuries are almost always accompanied by changes in the posture and movement of the wing bone called the scapula.

Once the cause of the problem has been identified, a physical therapist can set up a rehab program. This will restore normal motion and posture.

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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How late is too late to treat rotator cuff tear?

April 22nd — admin

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.

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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Shoulder can dislocate even after surgery

April 20th — admin

I have a chronic dislocating shoulder that needs fixing. The doctor told me there’s still a 25 percent chance the joint can dislocate again even after repair. Why is that?

Studies show that shoulder dislocation after repair occurs anywhere from 12 to 24 percent of the time. There are different reasons for this. Sometimes it depends on the type of surgery done to repair the problem.

For example, an open incision allows the surgeon to repair the tear in the cartilage and tighten up the joint capsule at the same time. Arthroscopic surgery may only include repair of the damaged soft tissue while leaving the capsular laxity alone.

Another factor in repeat dislocations after surgery is the patient. It’s important to follow the surgeon’s instructions. A shoulder sling may be needed for up to four weeks. Exercises must be done daily. Doing too much too soon is a common way to undo the benefits of the 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 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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Therapy needed for soldier with shoulder problem

April 12th — admin

I am a 24-year old soldier in the U.S. Army. During basic training, I did hundreds of push-ups in a single hour. Two days later, I developed a problem called rhabdomyolysis. I’ve been taken off all physical training and go to physical therapy instead. Will I ever be able to do push-ups again?

Yes. Military physical therapists have a special program worked out for soldiers with this problem. Rehab begins with range of motion exercises and works toward getting back full motion. Stretching and resistive exercises are slowly added.

Push-ups are also added slowly and start with a modified form. Modified push-ups include wall push-ups, then push-ups done from a high table top. Before going to regular push-ups, the exercise is done from a low table. When the patient is ready, wide arm, “diamond,” and single-arm push-ups can be included.

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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Muscles can heal, but shoulder surgery may be necessary

February 4th — admin

I’m a construction worker. I tore my right biceps muscle lifting a heavy cement block. Can the muscle heal by itself?

Muscles in the arms and legs can heal after injury but it’s very slow. Recovery usually takes four to six weeks and may not be complete. You may have some loss of strength. Re-injury is common after these types of muscle strains.

Healing occurs in several steps or phases. First there’s bleeding at the site of injury. A bruise or bleeding into the muscle called a hematoma may occur. Some muscle cells will die, then inflammation occurs. Special cells called phagocytes clean up any damage or debris. Scar tissue forms to fill in the damaged area. Small blood vessels also form to supply the new tissue with blood.

The final result depends in large part on how severe the injury is. Good nutrition and rest are important to promote healing. The right amount and kind of movement can also help muscles heal at the right length-tension ratio needed for normal range of motion. In some cases, surgery is an option to reattach the tendon and muscle unit.

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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