Transforming patient information into patient understanding.

Last week I covered an awful lot about Rotator Cuff tears. I talked about how they happen, why and what symptoms you might have. I stopped short of treatment because it is such a large area.

If you missed last week and have no clue what I am talking about, you can catch up! Go to www.orthopodsurgeon.com Library and click on the Gratiot County Herald Archive of articles and bring up the most recent one.

Accurate Diagnosis First

I diagnose rotator cuff tears based on history, physical exam and plain x-rays. Often I also resort to additional imaging studies such as a shoulder arthrogram or MRI.

It should always be done in that order. In the shoulder exam I am checking for several other possible shoulder problems which might not require advanced x-ray studies.

Don’t forget that there is a big overlap between the neck and shoulder so I have to be aware of that possibility.

Non-surgical Menu

In many instances a rotator cuff problem can be treated without surgery depending on how complicated it is.
Options may include:

• Rest and limited overhead activity

• Over the counter anti-inflammatory medication

• Sometimes prescription medication

• Anti-inflammatory steroid injection

• Physical therapy at a PT place combined with good long term home exercise program

Surgical Treatment

I might recommend surgery if:

• Conservative treatment did not cause improvement

• The tear has just occurred and is very painful

• Tear is in the dominant arm of an active person

• If maximum strength is needed for work or sports

The type of surgery depends on the size and location of the tear.

Partial Tear

A partial tear of the rotator cuff tendons might require a smoothing or trimming procedure called a debridement.

Complete Tear

A complete tear of the rotator cuff is repaired either by suturing the two sides back together or if the tendons are torn away from the bone they must be sutured directly back to the bone.

The Repair

* Arthroscopic Surgery

Some tears of the rotator cuff lend themselves to repair by arthroscopic techniques. It really depends on how complicated the tear is.

* Limited Open Repair

An incision is required if the tear is determined to be larger or complicated. I am often amazed by how well patients do after they have extremely large complex tears repaired.

Rehabilitation

Rehab is the third part of getting better. The first two are the surgery and nature’s healing.

After surgery the arm is always immobilized in a special sling to allow the tear to begin to heal.

I find that well over half to two thirds of my patients can do all of the rehab program at home with my directions.

Some patients require Physical Therapy, which I determine at about the 4 – 6 week period.

Time Line

Recovery depends on many variables unique to each patient. Patients who do the best rehab usually get the best
results and are happiest with their outcome.

Factoid

A very recent report in the greatly respected Journal of the American Medical Association found no benefit in taking
Glucosamine/Chondroitin for lower back pain.

This has been my experience in my own practice also. I do not tell patients to take Glucosamine, but many have done so and report no benefit.

Conversely however, I do believe it can be a benefit to my patients with certain knee problems. I am very selective in who I tell to take it which is a big reason why I believe it works for my patients.

Office Website and Gratiot County Herald Archive

Please take the time to view the newly redesigned office website www.orthopodsurgeon.com and the amazing Archive of Articles (Orthopaedic Connection) in Gratiot County Herald. Every article title is listed from most recent back to the first. Click on any interesting title and the text of the entire article appears. The Archive and Website which takes you to Your Orthopaedic Connection is a huge resource of Orthopaedic information. I deal with all of this in my practice and want the information to be available to all patients and families.

Our goal is simple – To help people return to more pain free, functional lives. I specialize in you.

Good health. Good life. All the best to you.

Be well.

Dr. Haverbush