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

Exercises to Prevent Shoulder Injury

One ways to prevent injury of the shoulder is to do a proper warm up and stretch before activity.  Not sure what to do?  Here are some simple warm ups and stretches to get you started. Check back soon for our next post on exercises to strengthen the shoulder muscles. 

To do these simple shoulder warm ups and stretches, all you need is a towel, yard stick or even a baseball or lacrosse stick. The goal is to warm up the muscles and gently stretch the muscles so they are ready for more vigorous activity. 

Exercise 1:  Hold the stick a little farther than shoulder distance apart. Raise arms in front of the body and above the head. 

Exercise 2:  Continue to hold the stick and raise arms side to side. 

Exercise 3:  Again still holding the stick, lower the stick behind the head. 

Exercise 4:  Finally, hold the stick behind the lower back and gently press up. 

Perform 3 sets of 10 for each motion.  Each stretch should be performed gently.  If a specific motion causes pain, stop. 

See pictures below:

Behind the Back Stretch



Behind the Neck Stretch

Side to Side Stretch

In Front Arm Raises



 

 

 

Baseball Season: Protect your Shoulder

Spring is in the air!  It is baseball season; time to get out and enjoy this classic American sport.  Many kids and adults play the game and probably give little thought to the impact playing can have on the shoulder.  It is important to be aware of the potential injuries that can occur so that a small strain does not evolve into a serious problem. 

Bursitis, rotator cuff weakness and rotator cuff tears are all possible complications from the constant throwing, batting and diving that are involved in the wonderful sport of baseball.   What are injuries should you be aware of and how are they caused? 

Rotator Cuff Weakness:  Rotator cuff weakness can be caused by a constant throwing motion.  Weakness occurs when the rotator cuff tendons become inflamed and may get pinched under the shoulder blade. 

Tendonitis/Bursitis:  Tendonitis occurs when the rotator cuff tendons and/or the bursa become irritated and inflamed.  Symptoms include extreme pain or weakness, especially when the shoulder is in motion.   These conditions often occur in conjunction with each other, but pain associated with Bursitis tends to be located just under the joint capsule. 

Rotator Cuff Tear:  Here we have the ‘worst case scenario’.   Rotator cuff tears occur when the tendon is ripped off the bone.  Symptoms include:  limited motion, decreased shoulder strength and aching and weakness when you lift your arm above your head.  Surgery is often required to fix a rotator cuff tear. 

The big question is:  how do you avoid these injuries and stay in the game? 

One great way to prevent injuries of the shoulder is Strength Training.  Around the shoulder blade (also called the scapula) are a series of muscles that together with the rotator cuff, allow a dynamic, fluid motion seen with throwing. Many athletes perform exercises that strengthen the large muscles of the shoulder, such as the pectoralis major and deltoid muscle, but ignore the rotator cuff and smaller muscles surrounding the shoulder blade.  Failure to strengthen these smaller muscles, called the parascapular muscles and rotator cuff muscles, can result in pain while throwing, and issues with shoulder function.   

Examples of rotator cuff exercises are resisted external and internal rotation exercises of the shoulder, reverse flies and seated rows (look for future posts for more details on these exercises).  All of these exercises should be performed with an emphasis on squeezing your shoulder blades together while doing each repetition.  These muscles are small in relation to other muscles in the body and do not require a significant amount of resistance.  A few pounds of weight or a light resistance band is usually adequate for strengthening. 



As a reminder, prior to performing any of these exercises it is important to see your orthopedic surgeon if you are unable to lift your arm, or if you are unable to perform these exercises due to pain or discomfort.

Prevention of these injuries is often possible.  In addition to the strength training mentioned above, here are some additional tips from STOP Sports Injuries (www.stopsportsinjuries.org):

• Warm up & stretch -  it is important to  stretch out  the shoulder and start with a few “softer” throws.
• Play various positions - this is especially important for the younger athletes.  Switching positions and using different body parts/muscles is an important component to preventing injury.  
•  DON’T play through the pain!  If pain persists, see a doctor. 
• Take time to rest.  If you are a pitcher, try to take a day or two off between games. 
• Concentrate on control, form and accuracy when throwing or pitching. 

If you suspect you or your child has a shoulder injury, we are here to help.  Skyview Orthopedic Associates is an excellent resource.  Our staff is focused on individualized, state of the art patient care and is led by John Vitolo, MD.  Dr. Vitolo specializes in injuries and disorders on the shoulder and knee.  He is board certified in orthopedic surgery and sports medicine.  Dr. Vitolo was also recently named to the NJ Top Doc list.   For additional information, visit www.skyvieworthopedic.com or call 973-300-1553.

Advances in ACL Surgery: Anatomic Reconstruction

This summer, John Vitolo, M.D. attended a conference on a new ACL reconstruction technique at the University of Pittsburgh Medical Center, home to one of the largest and most respected orthopedic clinical and research departments in the United States.  Dr. Vitolo is now one of a few specialized orthopedic surgeons trained in this new surgical technique, called the “Anatomic ACL Reconstruction Method”.  

Since adopting this new procedure, Dr. Vitolo has noticed that his patients experience less post-operative pain, improved range of motion and better overall results.  Dr. Vitolo stated, “Anatomic method takes each patient’s individual anatomy into consideration and attempts to restore that natural anatomy.  By using a medial portal approach, you are able to put the new graft where the original ligament existed.  The results have been phenomenal.  Post-operative pain has decreased and my patients are recovering more quickly and returning to activities faster.”

The anatomy of every patient is different.  The “Anatomic Technique for ACL Reconstruction” looks at each patient individually and anchors the ACL to its original anatomical position by using the medial portal approach; therefore keeping the natural anatomy of the knee.  By doing this, the patient is less likely to suffer a repeat tear and is able to return to activities in less time.  It is also believed that using this new method can decrease  the risk of developing arthritis later in life. 

When the ACL is injured it cannot be repaired by fixing the original ligament.  A “new” ACL must be constructed by grafting tissue from the patient’s body (autograph) or by using tissue from a cadaver (allograft).  It has been shown that anatomic graft placement is critical to the success and clinical outcome of ACL reconstruction.

The main benefit to the new procedure is that it helps prevent a re-tear of the ACL because the graft is placed lower and mimics the body’s natural anatomy.  Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction.  

For more information or to schedule an appointment, please visit our website:  www.skyvieworthopedic.com or call 973.300.1553.   

Dodging ACL Injury on the Slopes

Here’s the scenario: twilight, it’s the last run of the day, you are tired and wobbly and as you get off the lift you veer to the right to avoid the two snowboarders fastening their bindings in front of you. Your leg goes one way, your knee the other; you hear an unsettling pop and a sudden sharp pain on the inside of your knee. Congratulations, you just tore your ACL.  For skiers, the dreaded ACL injury, the most common ski injury, can mean missing out on an entire ski season and a trip to the hospital, rather than tomorrow’s corduroy.    

You may be wondering what the ACL is and why is it such a common ski injury?  The Anterior Crutiate Ligament (ACL) is one of the four ligaments of the knee that connect the femur and tibia.  The ACL runs diagonally across the middle of the knee and prevents the tibia from sliding out in front of the femur.  It also provides the knee with the ability to rotate.  

For skiers there are 2 main ways an ACL tear occurs.  The first is a sudden stop or acceleration of the leg, resulting in a tear.  The other more common cause of a tear is when the leg (or ski) stays in place, while the rest of the body stays in motion.  Symptoms of an ACL tear may include a popping sound, swelling of the knee, pain and instability. 

ACL injuries happen suddenly and often without warning, but according to Vermont Ski Safety (www.vermontskisafety.com), there are precautions that can be taken to help prevent them.   Resorts using the training & techniques offered by Vermont Ski Safety have seen a 50% drop in ACL injuries.  Also, according to Ski Magazine, new bindings are now available that can release directly at the heel and are expected to reduce knee injuries. 

Tips for on the Slopes:

1.       Overall follow the responsibility code and maintain balance and control.

2.       When you fall, keep your knees bent with skis parallel and together.  Also allow yourself to finish the fall -- don’t try to stop sliding with your ski edge.

3.       If you jump, know how and where to land – land on BOTH skis and keep knees flexed

4.       Use newer ski bindings that were designed to reduce knee injury.

5.       Stay hydrated and well nourished – this will increase your awareness on the slopes and help you avoid potentially dangerous situations.

Off the slopes:

1.       Strengthen hamstring muscles and muscles around the hips. 

2.       Keep your equipment in good shape and have bindings checked regularly.

3.       Work your upper body – knee injuries often are a result of the upper body becoming tired and letting poles drop behind.

4.       Work your core muscles.

5.       Cross-train, stay fit and eat a balanced diet. 

For more information and videos from Vermont Safety Research, please visit their website.  If you do suspect an ACL injury see a doctor.  Skyview Orthopedic, the office of John Vitolo, M.D., has locations in Sparta and Randolph.  Dr. Vitolo holds dual board certification in Orthopedic Surgery and Sports Medicine.  He specializes in arthroscopic surgery of the shoulder and knee.  Visit the website:  www.skyvieworthopedic.com or call 973.300.1553 for more information or to schedule an appointment.  Find us on Facebook at www.facebook.com/skyvieworthopedic.

References:  1..www.vermontskisafety.com  2.www.livestrong.com  3.  www.skinet.com/ski



John Vitolo, M.D.