Case Study: Hard Labor Leads to Rotator Cuff Tear

A 50 year old male laborer came to our office following an injury at work. The patient felt a sudden pain while pulling a heavy object on wheels when the injury occurred.  We suspected a rotator cuff tear based on the symptoms he described. The rotator cuff is comprised of 4 muscles and keeps the shoulder stable and in place.

The patient’s symptoms included:
-          Great difficulty raising his arm overhead.
-          Significant pain and weakness in the shoulder.
-          Intense pain at night that caused difficulty sleeping.
-          Inability to raise arm above shoulder level.

Before Surgery

Before Surgery

After a thorough examination, we sent the patient for an MRI to confirm and determine the severity of the injury.  An MRI of his shoulder revealed a very large full thickness tear involving 2 out of the 4 rotator cuff tendons. Based on these findings, we recommended the patient undergo arthroscopic surgical repair and the patient agreed.

The patient underwent a shoulder arthroscopy; which included removal of a bone spur above the tear and a rotator cuff repair. In our practice, we strive to restore the natural anatomy of the body in any surgical procedure. In this case, we used bio-absorbable anchors and sutures to re-attach the torn tendons to the anatomically correct location of the bone. Anatomic re-attachment helps promote healing and reduces the risk of subsequent injuries.

Following surgery, the patient was placed in a sling for 4 weeks and began physical therapy 3 weeks after surgery. We have seen great success in keeping the shoulder protected for 3-4 weeks following a rotator cuff repair. This allows the shoulder to heal and reduces the risk of repeat tears, shoulder weakness and decreased range of motion. In a recent study at the Center for Special Surgery, this was protocol confirmed as the preferred option to beginning physical therapy sooner. (Click to view full article from the Center for Special Surgery)

After Surgery

After Surgery

Approximately three months post-surgery, the patient was able to lift his arm above his head without difficulty or pain and was able to return to light work duty. Five months post-op, the patient returned to work full duty without restrictions; including heavy lifting and repetitive overhead activities. After completing 5 months of on-going physical therapy, the patient continued to perform strength training exercises on the rotator cuff at home and tells us he is completely healed. He has his full strength back and is very pleased with the outcome of the procedure.

It is important to note that upon the conclusion of formal physical therapy, continued strength training at home is necessary to ensure a full recovery. Most rotator cuff repairs require a full year of healing before full strength returns. By being diligent and continuing a home-based strength training routine, a patient can increase his/her chances for a full recovery without any lingering symptoms. (Click here for some simple strength training exercises for the rotator cuff)

Our office specializes in injuries of the shoulders and knee. We treat each patient as an individual and carefully evaluate the best treatment plan in each case. If you would like to make an appointment, please call 973-300-1553 or visit www.advocareorthosportsmed.com to learn more.

Rotator Cuff Tears

Rotator cuff tears are one of the most common injuries of the shoulder. The anatomy of the shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rotator cuff is comprised of 4 muscles and keeps the arm in the shoulder socket and provides stability.
 

There are two main types of tears:

1. Partial Tear
2. Full Thickness or Complete Tear

Tears are primarily caused by acute injury or overuse. Acute tears are the result of injury, such as falling on an outstretched arm or lifting a heavy object. With acute injuries, it is not uncommon to see other injuries present as well. 

Tears caused by overuse or degeneration occur over time and can be the result of the following:

•  Repetitive motion of the shoulder (i.e.  lifting, throwing, overhead work)
• Blood supply – as we age, the blood supply to the rotator cuff tendon decreases leaving the rotator cuff more susceptible to injury
• Shoulder impingement

Symptoms of a rotator cuff tear include:

• Pain at rest and/or at night
• Pain with lifting
• Weakness
• Cracking in the shoulder

Treatment of rotator cuff tears depends on the severity of the tear. Partial tears can often be treated non-surgically with physical therapy, rest, ice and anti-inflammatory medication. For full thickness tears, surgical intervention is recommended. Surgery is performed arthroscopically through a small incision in the shoulder. 

In surgical repair, bio-absorbable anchors are used to reattach the rotator cuff to its anatomically correct position. In our practice, we use a “double row” technique to reinforce the repair, reduce the risk of a repeat tear and enable healing. 

Some physicians recommend moving the shoulder immediately following surgery, however, we disagree. We recommend immobilizing the shoulder for approximately 3-4 weeks post-op. The Center for Special Surgery agrees and published an article on how immobilization following rotator cuff surgery leads to better healing. For a full overview, please see our previous post from August 2012. 

Rotator cuff tears are common and treatable. Early intervention in the case of degenerative tears can help prevent the need for surgical intervention. Advocare Orthopedic and Sports Medicine is here to help. Call to schedule your appointment: 973-300-1553 or follow us at facebook.com/johnvitolomd.

What is the Rotator Cuff?

The rotator cuff is a part of the shoulder that is necessary for stability and movement. The rotator cuff allows for lifting and rotation of the arm.  According to the American Academy of Orthopedic Surgeons, the rotator cuff sent approximately 2 million people to the doctor in 2008.[i]

Anatomy

The shoulder is a ball-and-socket joint made up of bones, muscles and tendons. The rotator cuff keeps the arm in the shoulder socket and is comprised of 4 muscles and tendons.

The three bones of the shoulder:

1. Humerus (upper arm bone)
2. Scapula (shoulder blade)
3. Clavicle (collarbone). T

The 4 muscles of the rotator cuff are:

1. Teres Minor
2.        Infraspinatus
3.        Supraspinatus
4.        Subscapularis.

The muscles of the rotator cuff attach to the scapula. Each muscle also has a tendon that attaches to the humerus. The tendons form a cuff around the shoulder joint, which provides stability for the shoulder joint and allows movement. Another important part of the shoulder is the bursa. The bursa is a sac that lies between the acromion (the upper bone in the shoulder) and the rotator cuff. The bursa allows the tendons to move easily.

Common injuries of the rotator cuff are tendonitis, bursitis and tears. Causes of injury include age, overuse or acute injury (fall on outstretched hand). Many conditions/injuries of the shoulder can be treated non-surgically, but more serious tears are typically treated with arthroscopic surgery.

In upcoming posts, we will discuss these injuries and conditions in more detail. If you feel that you have injured your rotator cuff, it is important to consult a physician. Advocare Orthopedic and Sports Medicine, the office of John Vitolo, MD is available to treat any orthopedic issues.

 

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[i] http://orthoinfo.aaos.org

Proper Protocol Following Rotator Cuff Surgery

For years, my practice has found that immobilizing the Rotator Cuff for 3-4 weeks after surgery has led to more positive post-surgical results.  Recently a study was released from the Center for Special Surgery that confirms doing this leads to more favorable healing. 

The rotator cuff consists of 4 small muscles in the shoulder blade and allows the arm to rotate.  A rotator cuff tear occurs when the muscles are torn from the bone in the upper arm. When torn, surgery is often needed to repair the injury.  Surgery is performed to reattach the torn muscle to the bone. 

Historically, many surgeons have pushed to have the patient start physical therapy one week post-surgery. However, we have found that allowing the rotator cuff to stay immobile for 3-4 weeks has led to better post-operative results. 

Recent studies have shown that up to 20-40% of Rotator Cuff Repairs fail or patients experience decreased strength and range of motion.  Due to this alarming number, the Center for Special Surgery conducted a study on post-operative protocol and found that immobilization for a longer period, does help the healing process. 

At Skyview Orthopedic, we strive to offer our patients the highest quality care and stay current with all the latest advances in orthopedic care.  We are proud to see that new studies confirm the protocol that we use is the best option for our patients.

www.skyvieworthopedic.com