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

June 24th — admin

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.

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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When can patient play tennis again after arthoscopic shoulder surgery?

June 21st — admin

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.

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

June 16th — admin

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.

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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Ski jump results in torn cartilage plus frozen joint, how is this possible?

June 8th — admin

My 21-year-old son hurt his arm during a ski jump last winter. At first the surgeon thought he had a labral tear. But now his arm is frozen with no movement past 90 degrees. Does this makes sense? How can you have a torn cartilage and a frozen joint?

The labrum is a dense fibrocartilage ring that is firmly attached around the acetabulum (shoulder socket). It provides both depth and stability to the normally shallow acetabulum.

A labral tear can result in a painful and unstable shoulder. A stiff, painful (frozen) shoulder is not uncommon after shoulder trauma. This may be the body’s protective response. It is usually self-limiting. This means it will eventually get better on its own.

If conservative care does not take care of the problem, then surgery may be needed. The surgeon may just manipulate the shoulder. This is a careful moving of the shoulder through its full motion while the patient is anesthetized. If that doesn’t help, then incision and release of the anterior shoulder capsule 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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College basketball player dislocated shoulder, is surgery necessary?

May 31st — admin

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.

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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Rehab sports-loving shoulder surgery patient like a soldier

November 15th — admin

I’d like to know what’s the fastest recovery time possible for shoulder surgery? I’m having a labral tear repaired and I want to get back to sports absolutely as fast as possible.

Your recovery time may depend on the type of surgery you are having. Labral tears of the shoulder can be repaired using an open versus an arthroscopic method. The final results are nearly the same, but studies show the arthroscopic group has fewer problems afterwards. There is also a shorter hospital stay and less blood lost with arthroscopic surgery.

If we use the military model, expected return to full athletic participation would be after four to six months. Since the goal of military medicine is to return the soldier to duty as soon as possible, it makes sense to use this model with young, athletes in equally good shape.

The rehab program after labral tears in the military is broken down into three main phases. Each stage lasts about four weeks (one month). During Stage 1, the patient is immobilized in a sling. Special shoulder and elbow exercises are allowed as taught by the physical therapist.

Stage 2 works to restore motion without damaging the repair. The therapist will teach you how to protect the surgical site while gaining shoulder motion. Stage 3 focuses on strengthening the muscles around the shoulder. The program progresses from there until the patient is ready for full, active duty. In your case, that would be a return to your preinjury levels of sports play.

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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No shoulder surgery needed for teenage football player

July 27th — admin

My 17-year old son separated his shoulder playing football. The doctors say ‘no surgery’ just rest and let it heal on its own. Could he get back to playing football sooner with an operation?

There are lots of problems with operations trying to repair the AC (acromioclavicular) joint. In fact more than 60 different ways to surgically repair the AC joint have been tried.

Wires and screws don’t seem to hold. They break or move causing problems. Sutures to hold the joint together don’t seem strong enough. Many times the joint starts to move apart again.

Surgery isn’t an option unless the person doesn’t recover with conservative care or the injury is so severe an operation is the only way to treat it.

If your son follows his doctor’s instructions he should heal in two to six weeks. Rehab should be completed before resuming football to prevent re-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 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 long is the recovery period after shoulder surgery?

April 2nd — admin

I’m going to have arthroscopic surgery to repair a torn rotator cuff. I really need full motion to do my job. How long will it take to get it back?

Right after surgery, you’ll probably be wearing a sling. This is kept on for a week to ten days according to your comfort level. You will be allowed to move your shoulder in two directions so long as it doesn’t hurt. The first is shoulder flexion (forward) and the second is outward rotation (elbow is held next to the body, hand moves away from the body).

By the end of the month, you may be given exercises using as much motion in all directions as pain will allow. Your full motion should be returned by 12 weeks. A recent study showed that patients who have a rotator cuff repair using only arthroscopic surgery regain motion faster. Patients who have an open incision get back their full motion, but it takes longer.

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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