Patient Story: Peter Gori

For patient Peter Gori, and others whose livelihood include physical activity, the occasional body aches and soreness are part of the job. Peter owns a landscaping business and therefore relies on his body to get the jobs done. But when that pain worsens, making movement difficult, it is time to seek professional help.

“I was never a ‘sit-down’ boss. My line of work causes me to rely on my body,” explained Peter, who was recently injured on the job. “I knew right away that I did something to my left shoulder, when I lifted a wheelbarrow filled with heavy debris.”

Peter is no stranger to shoulder or knee pain or Dr. Vitolo, who performed surgery on both Peter’s right shoulder and right knee in the past.

“When I tore the ACL in my right knee I met with Dr. Vitolo for a second opinion. After talking to him, I trusted him right away,” said Peter.

“Now after these surgeries, I wouldn’t trust anyone else. He is a phenomenal orthopedic surgeon who goes in and gets the job done.” 

 After an MRI showed significant injuries to his left shoulder, surgery was performed on May 10^th. However, the damage was worse than expected. He had three tendons that were damaged: two rotator cuff tendons and the biceps tendon. Peter continues to recover and is hoping for the best.

Q & A with Dr. Vitolo

Prognosis

“Due to the amount of damage his prognosis was guarded. But Pete could not do his job or resume his active lifestyle with the current injury he sustained.” 

 What pain can be expected following surgery?

“Initially it can be significant, but after the first few days it typically becomes manageable. 

 What after care is expected?

“Usually physical therapy for 8-12 weeks. However, because of the size of Pete’s tear, his physical therapy will be longer.”  

 Who is prone to a torn rotator cuff?

“Individuals who perform repetitive lifting like landscapers and laborers, or those who perform overhead jobs such as electricians and carpenters.  People active in weight lifting and other overhead sports such as, tennis and throwing may also experience such injuries.” 

 How common are rotator cuff tears?

“There is a one in twenty chance of rotator cuff tears in the general population. The incidences of rotator cuff tears is increasing in women.” 

 Can rotator cuff tears be prevented?

“There is no known preventive measures other than not doing the activity.  However, Pete’s surgery went well in part because he was in good physical condition to start and he has a positive attitude toward his recovery.”

 Importance of a positive attitude

“Pete was determined to get better. He owns his own business, which depends on his mobility so he was highly motivated. In addition, his desire to remain active and involved in sports and coaching also contributed to his determination to get better.  

 This is Peter Gori’s third operation performed by Dr. Vitolo. According to the doctor, with each surgery Peter has exceeded expectations from his surgery, namely a faster recovery as well as better –than- expected function after such a severe injury.

“Over 90% of the time the surgery is successful in restoring function and decreasing pain,” added Dr. Vitolo.

Peter’s right knee and right shoulder are now pain free. He hopes for the same outcome for his left shoulder. He expresses his gratitude for the surgeries Dr. Vitolo performed and believes the doctor’s skill is the reason for his successful surgery and recovery.

“I feel ahead of the game because of the work Dr. Vitolo does. He is a true professional, said Peter. “He put me back together and allowed me to resume my life. It has been life changing and I am very grateful.”

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.

Common Injuries of the Rotator Cuff

The rotator cuff is a group of muscles and tendons in the shoulder. The rotator cuff allows for stability and movement of the shoulder. This piece of the anatomy is commonly injured as a result of overuse or acute injury.

There are five main conditions that involve the rotator cuff:

1. Rotator cuff tear
2. Rotator cuff tendonitis
3. Rotator cuff impingement
4. Frozen Shoulder
5. Subacromial Bursitis

Rotator Cuff Tears

Rotator cuff tears cause pain and weakness in the shoulder, making everyday activities difficult. People most at risk for a rotator cuff tear are those over 40 and those athletes or workers who engage in repetitive overhead and lifting activities. Treatment varies depending on the size/severity of the tear and the age/activity level of the patient. 

Rotator Cuff Tendonitis

Rotator cuff tendonitis occurs when the rotator cuff tendons become aggravated or inflamed. This causes pain in the shoulder. The pain is typically located in the front of the shoulder and sometimes extends to the upper arm. Tendonitis often occurs in conjunction with bursitis. The pain may make sleeping uncomfortable and sometimes a ‘clicking’ sound is heard when raising the arm.

Rotator Cuff Impingement

Rotator cuff impingement occurs when the rotator cuff is being pinched by the bones of the shoulder causing pain. Symptoms of impingement may develop gradually, with the pain becoming worse over time. When diagnosed early, impingement can generally be treated conservatively with physical therapy, ice, activity modification and anti-inflammatories.

Subacromial Bursitis

Subacromial Bursitis occurs when the bursa (the fluid filled sac located between the acromion and rotator cuff) becomes inflamed. The bursa acts as a cushion between the bones and tendons. When inflamed, pain is felt. Bursitis can typically be treated conservatively. 

Frozen Shoulder

Frozen shoulder or adhesive capsulitis causes pain and stiffness in the shoulder that becomes worse over time. Individuals between 40 and 60 years of age are more prone to this condition. Frozen shoulder can be debilitating, but is treated non-surgically in 90% of cases. 

It is not uncommon for multiple conditions to be present at the same time. If you experience shoulder pain, it is important to see a physician as soon as possible. In many of these conditions, early treatment can prevent larger issues in the future. Left untreated, less serious conditions can develop into more complicated issues that require surgical intervention and longer recovery times.

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