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.

To Cut or Not to Cut: Biceps Tenodesis vs Biceps Tenotomy

Recently, we discussed injuries and anatomy of the biceps muscle and tendons. If surgery is needed when an injury occurs to the biceps tendon, two procedures are commonly performed: biceps tenodesis and biceps tenotomy. In this post, we will review each and discuss the positives and negatives to each.

Biceps Tenodesis

With biceps tenodesis, the biceps is first released and then re-attached to the bone in a minimally invasive arthroscopic procedure. To do this, anchors or biotenodesis screws are drilled into the bone and the tendon is reattached. 

This procedure can also be used for labral injuries. The labrum is attached to the biceps tendon and can pull the labrum off and place the labrum under constant tension. Here, the tension is released by cutting the biceps tendon and allowing the labrum to return to its normal position, relieving the pain. The biceps tendon is then reattached to another anatomic position, where it will function properly and not cause pain. Patients that benefit most from tenodesis are younger and more active.

Biceps Tenotomy

In a biceps tenotomy, the biceps muscle is cut from the shoulder. By doing this, the pain is relieved. A tenotomy is performed arthroscopically and is a relatively simple procedure. A tenotomy is normally performed in less active individuals who lead a more sedentary life. Side effects with a tenotomy are weakness in the biceps muscle and a deformity referred to as ‘popeye arm’ sometimes occurs. 

To cut or repair?

The decision to perform a tenodesis or tenotomy is based on many factors. Each individual must be evaluated by a qualified orthopedic surgeon. Factors such as age, activity level, overall health, other injuries and occupation are considered. In younger and more active patients, a tenodesis is preferred. Also, people returning to physical labor often do better with a tenodesis.

Tenodesis restores the arm to a more anatomic state, therefore allowing the arm to heal and continue to function the way nature intended. Tenotomy is often the best option for older patients who lead more sedentary lives. The main goal with a tenotomy is to relieve pain and discomfort. Each option has advantages and disadvantages. If you feel you have a biceps injury, John Vitolo, MD is available to help. Contact our office, Advocare Orthopedic and Sports Medicine Center at 973-300-1553 or find us on facebook.com/johnvitolomd.

Case Study: Shoulder Injury - Old and New

As an orthopedic surgeon it is my goal to treat injuries by restoring the normal anatomy that has been disrupted. In this case study we will discuss an unusual combination of shoulder injuries which required a unique treatment plan.

In this case, a patient came into the office with a dislocated shoulder. Upon examination, we found remnants of an old injury that left his shoulder anatomy compromised and a new injury that was severely hindering his shoulder function. Many doctors may have opted to only address the new injury, but we knew that the first objective was to restore the patient’s anatomy to normal (fix the old injury) and then address the new injury. 

After thorough evaluation, we discovered scapular dyskinesis (abnormal movement) with winging, a prominent AC joint (the AC joint is the joint where the collarbone and shoulder blade meet) and unstable left shoulder. An MRI further revealed an anterior labral tear and bankart lesion.  The scapular dyskinesis and prominent AC joint were due to the old injury that had not healed properly and likely led to the anterior labral tear and bankart lesion.  In order to give the patient the best chance of full recovery and normal shoulder function, we had to address both injuries. 

We opted for staged surgical procedures.  First, we would need to reconstruct the AC Joint, then 2 months later we would perform a second arthroscopic surgery to repair the bankart lesion and anterior labral tear.  Reconstructing the AC Joint was the first priority.  By performing the reconstruction, we would be restoring the shoulder to its natural anatomy. Restoration of the natural anatomy gives the patient the best chances for a full recovery from the second injury.  By ignoring the old injury (which led to the abnormality of the AC Joint), the chances of a full recovery from the labral tear and bankart lesion would be slim and leave the shoulder more prone to future injury.

Following the surgeries and postoperative physical therapy, we could not be more pleased with the results.  Four months after the second procedure: the scapular winging disappeared, the patient was pain-free, the instability of the shoulder was gone and the patient was able to return to full work duty without any restrictions.  The patient is thrilled with the results.  Following his first injury, he had never returned to “normal”, but now he reports that he is better than ever.  He has complete range of motion in the shoulder and is living pain free. A complete success in our book!