Naples Orthopedic Surgeon - Dr. Robert J. Zehr » shoulder joint

Robbery results in rotator cuff tear

admin — Wed, 24 Aug 2011 11:00:45 +0000

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.

Arthroscopy vs. open repair for rotator cuff tear

admin — Fri, 19 Aug 2011 11:00:12 +0000

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.

How to determine if total shoulder replacement will relieve your pain

admin — Mon, 18 Jul 2011 11:39:51 +0000

At what point do the doctors decide to replace a joint like the shoulder? Mine’s been hurting for what seems like forever, but my doctor says that he doesn’t think a shoulder replacement would help.

Joint replacements can be a wonderful life-changing surgery. By removing the painful joints and replacing them with mechanical ones, people can regain proper movement with little pain. However, joint replacements are not for everyone. The treating doctor has to assess if the injury or deterioration in your shoulder is something that would be fixed by a replacement – not all shoulder problems are. The doctors also have to look at risk when assessing if a patient is medically well enough to undergo surgery and if providing surgery may or may not cause complications. Finally, some doctors want patients to wait as long as they can before performing a replacement because the new joints have a certain life span and the doctors would prefer to avoid having to do a second surgery down the line, if at all possible.

If you are not happy with your care, perhaps you should seek a second opinion and you may ask the doctor as many questions as you feel are necessary.

Torn rotator cuff? Reverse total shoulder replacement may be the answer

admin — Wed, 13 Jul 2011 11:33:24 +0000

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.

What’s the difference between shoulder replacement and resurfacing?

admin — Wed, 29 Jun 2011 10:52:47 +0000

What’s the difference between shoulder replacement and resurfacing?

Shoulder replacement is the removal of the shoulder socket and head of the humerus (upper arm bone). These parts are replaced with an artificial implant.

On the shoulder socket side, a cup-shaped metal or ceramic implant is pressed or cemented into the bone. On the humeral side, an implant shaped like the head of a humerus with a long stem is inserted down into the shaft of the humerus. New bone from the humerus grows into and around the implants.

With joint resurfacing, the surgeon removes any bone spurs and smooths the joint surface. Then the joint surface is covered with tissue from some other part of the body. This could be a piece of tendon, flap of muscle, or rim of meniscus. The tissue usually comes from a donor bank.

Biologic resurfacing is also known as interpositional arthroplasty. It has been around in one form or another since the mid-1800s. It is one alternative to a total joint replacement for young, active adults. Less bone is removed. This makes it possible to convert to a total shoulder replacement later, if needed.

How many patients who have surgery for shoulder dislocation develop arthritis?

admin — Fri, 24 Jun 2011 10:47:39 +0000

About five years ago, I dislocated my shoulder repeatedly. Eventually I had surgery to clean out the joint and tighten it up. I’m starting to notice some crackling noise in that joint when I move my arm overhead. Does this mean something has come loose? Do I need to do something for this before it becomes a problem?

You may be noticing some early signs of joint degeneration. Arthritic changes aren’t uncommon after shoulder surgery for recurrent shoulder dislocations. In fact, some studies show up to 20 per cent of patients who have surgery for shoulder instability develop postoperative arthritis.

Sometimes early arthritic changes are already present in the shoulder before the surgery. This has been observed in about nine per cent of patients with chronic shoulder instability. Loss of shoulder motion and function seem to be linked with deficiencies leading to arthritis.

A follow-up visit with your orthopedic surgeon may be in order. At the very least, an X-ray of the joint will be done to rule out fracture or loose fragments in the joint. The X-ray can also confirm the presence of arthritic changes.

Early diagnosis of orthopedic problems is always recommended. Taking care of a minor problem can help prevent major problems later.

When can patient play tennis again after arthoscopic shoulder surgery?

admin — Tue, 21 Jun 2011 10:42:15 +0000

I’m going to have an arthroscopic surgical procedure for a problem with a chronic left shoulder dislocation. I’d like to get back on the tennis court in time for the adult summer league. What kind of rehab program should I expect?

Rehab programs after a shoulder stabilization procedure may be the same whether it was an open versus closed procedure. Sometimes this depends on the surgeon’s preferences. Type of sutures used, amount of damage to the soft tissues, and condition of the joint capsule are only three of the important considerations.

Most often, the protocol used during the early phase of rehab is one that can be modified for each patient. Your therapist will advance you along as quickly as possible. The rehab protocol is really just a guideline.

Most likely you will be put in a shoulder immobilizer (sling) in the operating room. This is worn for two to four weeks. Exercises are started at two weeks. Passive and active-assisted partial range of motion is allowed. Full, active range of motion is permitted at six weeks.

The therapist will progress you to and through a series of strengthening exercises. The speed at which you will be able to advance may depend on your level of pain, degree of stiffness, and strength. You will be able to start training for tennis participation between eight and 12 weeks. If there are no complications or problems, you may expect to return to your sport about four months after surgery.

Arthroscopic vs. incision approach for golfer’s shoulder, which is better?

admin — Thu, 16 Jun 2011 10:37:00 +0000

I’m a semi-pro golfer with a bad shoulder from chronic dislocations. The surgeon has offered to do a stabilization procedure with either an open incision or arthroscopically. Is there much difference between these two operations?

Improvements in both surgical procedures has narrowed the gap of advantages of one over the other. The arthroscopic approach uses two or three puncture wounds to insert a long, thin scope into the joint. It has been suggested that this approach has a more pleasing appearance and shorter operative and recovery time.

The incision approach uses a fairly small open incision to access the joint. The main difference is that the subscapularis muscle is split during the open surgery. Some surgeons feel this puts the patient at a strength disadvantage.

To check out this theory, a team of surgeons and sport medicine staff from Canada put it to the test. They compared before and after muscle strength of the shoulder for an equal number of patients treated arthroscopically versus with an open incision.

They were surprised to find out that patients in both groups had significant strength deficits. External rotation was affected more than internal rotation for both groups. But there wasn’t a discernible difference between the two groups. The reason for these two findings remains unknown but a point of interest for future research.

Frozen shoulder follows rule of threes – do you know them?

admin — Mon, 13 Jun 2011 10:30:19 +0000

I somehow managed to get a frozen shoulder. No one seems to know what caused it. My doctor has suggested a wait-and-see approach. She says these things tend to take care of themselves, and that it will probably go away on its own. Isn’t there something I could or should be doing to get better?

A stiff and painful shoulder with limited motion is known as a frozen shoulder. It can be the result of trauma, diabetes, or from unknown causes. The condition does tend to follow the rule of threes. It has three stages that each last about three months.

The first stage is the freezing phase. The arm starts to lose motion and become painful. The second stage is the frozen phase. The pain is less but stiffness prevents functional movement. This phase lasts at least three months (sometimes longer). In the final stage, the shoulder starts to thaw. Range of motion slowly returns to normal.

The wait-and-see approach is sometimes referred to as benign neglect or supervised neglect. This treatment method seems to work about as well as any other. Some patients prefer to seek the services of a physical therapist to help them regain motion and strength.

Other forms of conservative (nonoperative) treatment may include cortisone injections, oral steroids, or nerve block. Manipulation (movement) of the shoulder can be tried under anesthesia before surgical release of the capsule is considered.

Studies have not been done to show which approach works best — or if any treatment is really even needed. Until proven differently, the wait-and-see management style is considered acceptable at this time.

College basketball player dislocated shoulder, is surgery necessary?

admin — Tue, 31 May 2011 10:08:25 +0000

Our college-aged son dislocated his shoulder playing basketball. We are trying to figure out if he needs surgery or not. The staff at the local clinic say he can wear a sling for eight weeks and come out alright in the end. Is this sound advice?

Studies show that immobilizing the arm after a primary (first) shoulder dislocation doesn’t change what happens in the long-run. Even applying the sling several weeks after the dislocation first occurred doesn’t seem to change what will happen a year or even more than a year later.

Over half of all shoulder dislocations stabilize and recover well. In fact, according to a study over a period of 25 years, many patients with a shoulder dislocation couldn’t even remember which arm was dislocated.

Some experts have advised immediate surgery for anyone with a shoulder dislocation who is an athlete, especially throwing athletes. Results of the long-term study just mentioned did not agree with this counsel. According to their data, athletic activity was not linked with recurrent shoulder dislocation.

A trial period of immobilization followed by a rehab program is considered a good first step following shoulder dislocation. Even if surgery is eventually needed, the strengthening program will prepare the shoulder for a better result after surgical reconstruction takes place.