Tag Archive: shoulder specialist

FAQs on Rotator Cuff Repair in Arizona

Rotator cuff repair surgery is used to repair a torn shoulder tendon or muscle, or to repair a group of tendons and muscles. This procedure is done with a large open incision, or through a buttonhole-sized incision via shoulder arthroscopy.

What is the rotator cuff?

The rotator cuff is a group of muscles and tendons that form a cup over the shoulder joint. These structures hold the arm bone (humerus) in the rotator cuffglenoid joint (shoulder area). One or more of the tendons and muscles can be torn from trauma or overuse.

How common is a rotator cuff tear?

In a recent study, researchers evaluated rotator cuff tendinopathy. They found that the annual prevalence was 1-7%, and some evidence suggested that the incidence increased with age.

Does the procedure hurt?

You will receive general anesthesia before the rotator cuff surgery. You will be asleep and have no pain. After surgery, you will be given pain medicine to alleviate discomfort.

What procedures are used to repair a torn rotator cuff tendon?

Three main types of surgeries are:

  • Open repair – With traditional surgery, a large incision is made over the shoulder. The deltoid (large muscle) is moved to the side so the tendon can be repair. This procedure is used for large or complex tears.
  • Arthroscopy – With this procedure, a small incision is made, and a scope is inserted into the joint. The camera projects images on to a TV monitor, so the doctor can use tiny instruments to make repairs.
  • Mini-open repair – This procedure involves using an arthroscope and a couple of small incisions to repair the rotator cuff.

How is the rotator cuff repaired?

Rotator Cuff TearTo repair the rotator cuff, the tendons are re-attached to the bone if possible. This is done using small rivets (suture anchors) that hold the tendon in place. These are made of metal, or they can be made with dissolvable materials. At the end of surgery, the incisions are closed and a dressing is applied.

What can I expect before the rotator cuff repair surgery?

After the Phoenix shoulder doctor diagnoses a rotator cuff tear, you meet with the orthopedic surgeon to discuss surgery. Two weeks before the procedure, you must stop taking any medicine that thins the blood (aspirin, ibuprofen, and naproxen). Be sure to discuss all allergies and medications with the doctor. You cannot eat or drink for 8 hours before your surgery, and should leave all valuables at home the day of surgery.

What can I expect after the rotator cuff repair procedure?

You will wake up from sedation or anesthesia with a bulking bandage on your shoulder, your arm in a sling, and an immobilizer on your arm. This is to protect the shoulder while it heals. Most patients are discharged home the day of surgery. Recovery may take up to six months, and you will wear the sling for 4-6 weeks. The doctor gives you medications for pain, and you will follow-up with a physical therapist who helps improve strength and function in the shoulder joint.

What is the prognosis after the rotator cuff repair surgery?

Surgery to repair a torn rotator cuff is successful for relieving shoulder pain. The procedure usually returns strength to the shoulder structure. Rotator cuff repair requires an extended recovery period, and not everyone heals the same. The doctor will advise you on which activities you can and cannot perform following recovery. Poorer results often are related to:

  • Advanced age
  • Large tears
  • Weak or previously torn rotator cuff
  • Not following aftercare instructions
  • Smoking

Orthopedic and Sports Performance Institute provides  rotator cuff repair procedures with expert shoulder surgeons in Arizona. Most insurance is accepted, with the procedures being offered in a minimally invasive fashion. Call us today!

Resources

Littlewood C, May S, & Walters S (2013). Epidemiology of rotator cuff tendinopathy: a systematic review. Shoulder & Elbow, DOI: 10.1111/sae.12028.

Treatment Options for a Rotator Cuff Tear in Arizona

Rotator Cuff info from OSPI in Gilbert Arizona

 

A rotator cuff tear is a common cause of disability and pain. A torn rotator cuff can weaken your shoulder, causing problems performing simple daily activities, such as getting dressed or brushing your teeth.

How common are rotator cuff tears?

According to a study in 2008, around 2 million people visit their doctors due to a rotator cuff problem. In cadaver studies, researchers found that 39% of deceased individuals older than Rotator Cuff Tear60 years had full-thickness rotator cuff tears. The incidence in the general population is around 20% for partial and full tears.

What structures are affected by a rotator cuff tear?

The shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The shoulder forms a ball-and-socket joint, with the ball being the head of the humerus and the socket being a groove in the scapula.

The arm bone is held in the socket by the rotator cuff, which is a network of four muscles and several tendons that form a covering around the humeral head. This cuff attaches the arm bone to the shoulder blade, and it helps elevate and rotate the arm. The lubricating sac of the joint is called the bursa, and it lies between the acromion bone (at the top of the shoulder) and the rotator cuff

How does a rotator cuff tear occur?

If one of the rotator cuff tendons tears, the tendon can no longer attach to the humerus head. Most tearing occurs in the tendon or the supraspinatus muscle. A partial tear involves only soft tissue, and it is not completely severed into two pieces. A full-thickness tear involves splitting into two pieces of soft tissue. The causes of a rotator cuff tear are:

  • Injury – Includes a fall onto an outstretched arm, or from lifting something heavy in a jerking motion. This often occurs along with a dislocated shoulder or broken collarbone.
  • Degeneration – Most rotator cuff tears occur from wearing down of the tendon that occurs gradually over time. Degeneration is related to aging. The factors that contribute to degeneration include repetitive stress, lack of blood supply, and bone spurs.

What are the risk factors for rotator cuff tears?

Certain people have a greater chance of suffering a rotator cuff tear. Risk factors include:

  • Aging – Normal wear-and-tear occurs with aging, so people age 40 and older are at greater risk.
  • Certain activities – People who do overhead activities and repetitive lifting are at risk, including carpenters, painters, and laborers. In addition, athletes who use their arms/shoulders (tennis players and baseball pitchers) are also at risk.

What symptoms are associated with rotator cuff tears?

The most common symptoms are pain at rest, particularly at night with lying on affected shoulder, pain with lifting and lowering the arm, weakness when rotating the arm, and crackling sensations (crepitus) when moving the shoulder through certain positions.rotator cuff

How is a rotator cuff tear diagnosed?

The doctor will ask you questions about your activities, inquire about your symptoms, take a medical history, and conduct a physical examination. The doctor checks for deformities, tenderness, and range of motion. In addition, the doctor checks arm and muscle strength. Tests used to make the diagnosis include:

  • X-rays – Do not show soft tissues of the shoulder but show bony deformities and fractures.
  • Magnetic resonance imaging (MRI) scans – Used to show rotator cuff tears, and shows if the tear is old or new. Also, it can dhow the quality of the rotator cuff muscles.

How are rotator cuff tears treated?

The goal of treatment is to restore arm and shoulder function, as well as to relieve pain. In planning your therapy, the doctor will consider your activity level, general health, age, and grade of tear you have. Treatment options include:

  • Medications – Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen will reduce swelling and pain. Narcotic analgesics can be prescribed short-term for severe pain.

 

  • Physical therapy – Special exercises are used to strengthen the shoulder and restore movement. The exercise program involves stretches that improve range of motion and flexibility, and strengthening exercises that enhance strength of muscles that support the shoulder to prevent further injury.

 

  • Corticosteroid injection – The doctor can inject the shoulder with a corticosteroid, with or without an anesthetic. This anti-inflammatory drug relieves irritation and swelling. In a review of several clinical trials comparing steroid injection to placebo injection, studies found significant benefit of steroid injections.

 

  • Suprascapular nerve block – This involves injecting a long-acting anesthetic agent near the affected nerve. The doctor will use x-ray guidance (fluoroscopy) to assure correct needle placement. In a large clinical study, patients receiving this block were followed for 12 weeks. Statistically significant improvements in disability and pain scores were observed, along with improved range of motion scores.

 

  • Surgery – If pain continues and does not improve with nonsurgical efforts, surgery may be required. Surgery is a good option if your symptoms have persisted for 6-12 months, you have a large tear, your tear was caused by a recent, acute injury, and/or you have significant loss of shoulder function. The tendon is reattached to the humeral head if possible. If the tear is severe, a graft may be used to replace the tendon.

Orthopedic and Sports Performance Institute offers comprehensive treatments for all types of shoulder conditions including arthritis, rotator cuff tears, labral tears and more. OSPI offers pain management, physical therapy and orthopedic surgeons in Gilbert AZ as well! Call us today.

What You Need to Know About Shoulder Separation

A shoulder separation involves separation of the clavicle (collarbone) and the acromion (end of the shoulder blade). This injury can be partial or complete, painless or painful, and mild or severe.

What body structures are involved in a shoulder separation?

The clavicle and scapula (shoulder blade) are connected by the acromioclavicular (AC) joint. Shoulder painThis joint is held together by the coraclavicular (CC) and acromioclavicular ligaments. With an acromioclavicular joint injury (shoulder separation), these ligaments are partially or completely torn.

How are shoulder separations classified?

A shoulder separation is classified by how severely the ligaments are injured. The classes are:

  • Type I injury – The AC ligament is partially torn, but the CC ligament remains intact.
  • Type II injury – The AC ligament is completely torn, and the CC ligament is partially torn or not injured.
  • Type III injury – Both the CC and AC ligaments are completely torn. The acromion and clavicle are separated.
  • Type IV – Involves tearing of deltoid and trapezius muscles as well as CC and AC ligament tearing.

What causes a shoulder separation?

Traumatic acromioclavicular joint dislocations can occur during athletic events. A direct blow to the shoulder or a fall onto the shoulder can cause shoulder separation. The injury requires excessive force. Shoulder separations are common injuries in sporting activities.

How common are shoulder separations?

According to a recent study of shoulder problems, intra-articular injuries were found in 18% of patients, and co-occuring injuries to the shoulder girdle occur frequently.

What are the symptoms of shoulder separation?

The symptoms and signs of a separated shoulder include:

Pain at the time of injuryAC Joint Injuries

  • Limited shoulder movement related to pain
  • Swelling
  • Bruising
  • Tenderness over the AC joint
  • Possible deformity with the clavicle appearing out of place

How is a shoulder separation diagnosed?

The doctor will inquire about your injury, take a medical history, and conduct a clinical examination. The doctor will check for a bump or deformity, the shoulder range of motion, blood flow, and muscle strength. In addition, he will perform certain test to assess nerve function. X-rays are taken to assess fractures and dislocation.

How is a shoulder separation treated?

Treatment of a shoulder separation depends on the extent of injury. For type II and II injuries, AC Joint Injurythe shoulder is rested and supported with a sling, and the patient must undergo physical therapy. The therapist helps the patient strengthen the shoulder and regain range of motion. This is important for prevention of frozen shoulder syndrome.

Surgery is reserved for patients with type III and IV injuries. Surgery is performed on type I and II injuries that do not respond to non-surgical treatment, or when pain continues after 2-3 months. Surgery involves reconstruction of the CC and AC ligaments using screws or sutures to stabilize the joint. The procedure may be performed using the arthroscopic technique, where the surgeon makes several small incisions around the joint, and inserts a tiny camera to view the structures. Small instruments are also inserted to make necessary repairs.

OSPI offers top orthopedic surgeons in the East Valley serving Gilbert, Chandler, Mesa, Queen Creek and surrounding areas. All types of sports injuries such as shoulder separations are treated, including all levels of AC joint injury. For the top Arizona sports medicine surgeons, call OSPI today!

Resources

Tischer T1, Salzmann GM, El-Azab H, Vogt S, & Imhoff AB (2009). Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med, 37(1):136-9. doi: 10.1177/0363546508322891.

Shoulder Arthroscopy and Debridement with Top Arizona Orthopedic MDs

Shoulder arthroscopic debridement is a procedure used to relieve pain and restore function to the shoulder joint. This surgery is best for patients who have rotator cuff tears that cannot be fully repaired. The procedure is followed by a long course of physical therapy.Shoulder Surgeon Mesa AZ

What is debridement?

Debridement is the process of removing damaged tissue and debris from the shoulder joint. Considered a minimally invasive procedure, shoulder joint debridement involves use of small tools to surgically clean the area.

Who is a candidate for shoulder arthroscopic debridement?

Tissue damage of the shoulder joint occurs due to various reasons. The most common reason for tissue damage is degeneration from osteoarthritis. However, damage can also occur due to trauma or injury. As the tissue of the joint deteriorates with normal wear-and-tear as the body ages, debris and loose tissues form in the joint. This can lead to impaired shoulder range of motion and significant pain.

What is the success rate of shoulder arthroscopy and debridement?

Based on clinical studies, shoulder arthroscopic debridement has over a 70% success rate with orthopedic surgeons in Gilbert and Chandler AZ. This success rate is based on reduction in pain and return to normal activities.

What type of anesthesia is involved?

Shoulder ArthroscopyShoulder arthroscopy and debridement is usually done using general anesthesia, and the total procedure takes approximately one hour. For pain relief after the procedure, a local anesthetic and or regional anesthetic (nerve block) may be used. Regional anesthesia is used for patients who have certain medical conditions and those who wish to avoid post-operative side effects.

How do I prepare for the shoulder debridement procedure?

Two weeks before your scheduled surgery, make the Chandler orthopedic surgeon aware of all your medications, and assure that he has copies of your medical records. Don’t smoke, avoid alcohol, and pass on over-the-counter medications. Do not eat or drink the night before the procedure, and leave valuables at home. Arrange to have someone to drive you home from the hospital. When you arrive, a nurse will have you sign a consent form, change into a gown, and place an IV in your arm to administer necessary medications.

How is the surgery done?

The sports medicine surgeon first makes several small incisions around the shoulder. The arthroscope is inserted so the doctor can see inside on a monitor. The first part of the procedure involves evaluating the shoulder for damaged tendons and arthritis of the joint. When shoulder ospi_smallmovement is restricted, the ligaments are released.

If the biceps tendon is trapped or painful when the arm is lifted, the tendon is also released. In order for the tendon to move adequately, a small portion of bone may need to be removed as well. After all debridement is done, the incisions are closed with sutures, and the area is covered with bandages. Then, the shoulder is placed in a sling.

What does recovery involve?

After the procedure, you are moved to a recovery room where a nurse monitors your condition for several minutes. Most patients will stay overnight in the hospital. The next day, a physical therapist works with you to teach necessary exercises for regaining strength and joint function. The sling is worn for 2-3 weeks, and at this time, you may use your hand as needed. After the sling comes off, you can drive and gradually return to usual activities over the next 3-6 weeks.

All about Partial Shoulder Replacement Surgery

The shoulder essentially comprises of a ball and socket joint, where the round end of one bone fits into the socket at the end of another bone. This is the joint which is responsible for both, arm and shoulder movement.

When it comes to replacing an arthritic or injured shoulder, the rate is highly uncommon as compared to knee or hip replacements. This means that the surgery rate is also very low. However, this doesn’t mean that an injured or arthritic shoulder cannot be treated by surgery.

Partial replacement surgery is generally recommended by Gilbert orthopedic surgeons to patients suffering from pain accompanied by arthritis or a traumatic injury to the shoulder. Exceptional care should therefore, be taken by athletes, because their shoulder joints are subjected to a lot of wear and tear, which over time, can lead to a problem.

That being said, the benefits that can be derived from other joint replacement procedures are the same as that of a shoulder replacement, i.e. restoration of normal joint movement and relief from joint pain.

What Is Included In A Partial Shoulder Replacement Procedure?

This procedure is normally used when the glenoid socket doesn’t need to be replaced because it’s still intact. Instead; in a partial shoulder replacement, the humerus is operated upon, replacing the head and implanting the humeral component.    

This means that, during the procedure, there is no need for a plastic socket, less bone is removed as compared to other surgical procedures, and it requires a smaller incision.

Because every shoulder is unique, the very first step that you should take if experiencing shoulder pain is to consult with an orthopedic surgeon in Chandler and ask for an assessment. Then the surgeon will perform an examination to find out what the condition of your shoulder is. Some common shoulder problems that require surgery are:

  • Instability of the Shoulder
  • Shoulder Tendinitis
  • Fractured Collarbone
  • Full Thickness Rotator Cuff Tear

Orthopedic Evaluation: What to Expect

The evaluation and assessment of the shoulder covers 3 essential components:

A Medical History: Typically about current complaints, the duration of symptoms, pain and limitations faced by the patient, any injuries and past surgical or non-surgical treatments.

A Physical Examination: This is done to assess the tenderness, swelling, range of motion, weakness or strength, instability, and/or deformity of the affected shoulder.

Diagnostic Tests: X-rays of the shoulder are taken in various positions and in a series of movements. An MRI scan can also be helpful in effectively making an assessment of soft tissues in the shoulder. A CT scan is sometimes used to evaluate the various bones within the shoulder.

At the end of the evaluation and assessment, your orthopedic surgeon will review the results and discuss the best treatment options with you, both surgical and non-surgical. If you opt for the surgical option of treatment, the doctor will then inform you regarding all the risks and complications that may occur, during and after surgery.

OSPI offers the top shoulder surgeons in the East Valley including Gilbert, Chandler and Mesa AZ. These shoulder specialists are Board Certified and Fellowship Trained. Call today for help with all your shoulder pain needs!

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