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23/Sep/2014

Orthopedists tend to advise against overly sedentary lifestyles.  Although overzealous exercise can lead to profound knee pain and possibly to knee osteoarthritis, most orthopedists advise patients to simply ‘stay active’.  Two recent studies provide further evidence that a lack of physical activity, characterized by many hours of sitting every day, has disastrous health consequences.

Researchers reported that spending less time in a seated position prevents premature aging and promotes good health, according to a “Well” blog by Gretchen Reynolds published Sept. 17 in the New York Times.

She pointed out that the typical American sits for eight hours or longer daily. This is true even for many people who engage in regular exercise. Whether at work or at home, most activities involve sitting in a chair.

Previous studies have shown that sedentary behavior leaves people more vulnerable to cardiovascular disease, Type 2 diabetes and obesity. Years of inactivity also may result in osteoarthritis and other orthopedic conditions, which can cause debilitating pain in the hips and knees. Some patients require knee or hip replacement surgery to regain strength and range of motion in their joints. Sedentary adults are likely to die at a younger age than active people.

The British Journal of Sports Medicine this month published one of the studies cited by Reynolds. Swedish scientists recruited 68-year-old male and female participants. Half of the volunteers engaged in regular exercise programs, and made an effort to spend less time sitting. The other participants were told to carry on with their usual routines.

The scientists monitored the physiological effects. They especially wanted to know the impact of sedentary behavior on telomeres, compound structures attached to the tips of individual strands of DNA. When telomeres begin to decay and become shorter, it is evidence of premature aging in the cells. Illnesses, obesity and other conditions speed this degenerative process. Reynolds noted that “some evidence suggests healthy lifestyles may preserve telomere length, delaying cell aging.”

When the researchers analyzed participants’ blood after six months, they learned that telomeres had lengthened in the active volunteers and become shorter in the control group. The cells of the active group appeared younger.

The study suggested that avoiding the seated position is more important than exercising. Those in the active group who spent the most time standing, rather than sitting, had healthier telemores than the volunteers who worked out the most strenuously.

“Reducing sedentary time had lengthened telomeres, the scientists concluded, while exercising had played little role,” Reynolds reported.

The May issue of the American College of Sports Medicine’s journal contained the other recent study regarding the effects of excessive sitting. The lead researcher was Peter Katzmarzyk, a public-health professor at the Pennington Biomedical Research Center in Baton Rouge, La.

He analyzed survey results regarding the physical activity of Canadians, and compared the data with death records. He wrote that “mortality rates declined at higher levels of standing (rather than sitting).”

It appears that rigorous exercise is not necessarily required to fend off illnesses, diseases and early death. The two studies indicate that simply getting out of the chair, and spending more time erect than in a seated position, produces significant results.

If you have been told that you have knee arthritis or have pain that has persisted, contact Dr Robert Afra, award winning orthopedist.

 


22/Sep/2014

What causes heel pain?

Heel pain is an extremely common complaint and there are several common causes. Before any treatment can commence, it is important to get an accurate diagnosis of the cause of your symptoms. One of the most common symptoms of  is plantar fasciitis, which results in pain from walking or prolonged standing.

heel pain

What is plantar fasciitis and how is it caused?

Plantar fasciitis is heel pain as a result of irritation and inflammation of the connective tissue that reaches from the heel to the toes, supporting the muscles and arch of the foot. When this tight band of tissue (plantar fascia) is overly stretched, small tears can occur in the surface causing inflammation and pain.

Plantar fasciitis, sometimes known as jogger’s heel, is mostly caused by an injury to the plantar fascia from overuse due to running, increase in exercise routines, overweight and age-related issues.

Research has shown that the key words are overuse and wear-and-tear.

 Is there any treatment that will help to relieve this condition?

Successful treatment for heel pain depends on the cause of the problem. Before you embark on any treatment program, seek medical advice for a diagnosis of your symptoms and the severity of your condition.

Not all treatments are suitable for every circumstance, but listed below are some treatments which may be helpful in your situation, especially if diagnosed with plantar fasciitis.

  • Rest. Take a few days off jogging or exercising. It might help reduce the pain and allow the inflammation to begin to cool down.
  • Anti-inflammatory medication helps to reduce heel pain and decrease levels of inflammation.  Over-the-counter meds are efficient, but prescription options are also available from a doctor.
  • Specially made shoes or shoe inserts which provide arch support are useful to reduce pain and further injury.
  • Frequent ice pack treatment.

Are there any recommended exercises to help reduce plantar fasciitis pain?

New studies have shown that certain exercises offer remarkable benefits. They mainly involve exercising the muscles of your foot by gently stretching them as follows:

  • Towel stretch. Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward you, curling your toes upward but keeping the knee straight. Hold for 20 seconds then relax. Repeat 3 times and do several times a day.
  • Plantar fascia stretch. Stand with the ball of your injured foot on a stair. Reach for the bottom stair with the heel until you feel a stretch in the arch of your foot. Hold position for 30 seconds then relax. Repeat 3 times and do several times per day.
  • Curl your toes upward while in a seated position until the arch of your foot feels tight. Hold for 30 seconds, relax, repeat 3 times, and do several times per day.

Opt for whichever exercise is most suitable for you.

 Will surgery be necessary?

Surgery is usually not needed for plantar fasciitis as most people are able to relieve the heel pain without surgery.

Your doctor could consider surgery if all avenues of non-surgical treatment have not helped and the pain is having a serious negative impact by restricting your daily activities and mobility.


19/Sep/2014

Developing the knee pain and hip pain commonly seen while working behind a desk or typing away on the computer in a La Jolla office is avoidable.  If you have ever sat around for a long period of time, you probably felt some of the painful side effects. It tends to cause knee pain, joint pain and leg pain. You can also suffer from uncomfortable tingling sensations in your feet and legs. The answer to these problems is far simpler than anyone could imagine. It’s just a matter of understanding that there are new methods that work much better than the old ones.Joint Health

The Old Method of Dealing with Effects of Sitting Too Long

Many people were under the impression that you could counteract the negative effects of sitting for too long by exercising. It turns out, according to the Washington Post report, that exercise has no health benefits in regards to the damage caused by sitting for eight hours. This report was related to a study conducted by Indiana University published in Medicine & Science in Sports & Exercise researchers.

The study found that people who sat for long periods of time, ended up with joint pain, leg pain and discomfort, even if they exercised daily. This is the result of a sedentary lifestyle of the 9-5 office worker who works five days a week.

When you sit at a desk for eight hours per day, it can be harmful to your health. Your blood begins to pool up in your legs. That can make blood circulation difficult. This puts you at risk of cardiovascular problems. It also causes knee pain, leg pain, hip pain, etc.

A New Method for Sitting 8 Hours per Day without Negative Effects

Instead of exercising after spending eight hours on your bottom, be more active altogether. Every hour, stand up and walk around as much as you can. Just standing is not enough. Move your muscles and exercise your legs to prevent the blood from pooling in your feet and legs. A funny light job around the office.  Jumping jacks.  Burpees.  Simply be creative!  When I was in medical school I would run stairs during study breaks.  It gets the blood pumping so it does not pool in the legs and it is rejuvenating.

Performing some typical walking exercises every hour while stuck behind a desk can be a life saver. You will feel better. Your blood will flow better, and there will be less discomfort, leg pain, hip pain, and knee pain.

It can be a bit of an adjustment, but one worth making if you want to see results and avoid unnecessary knee pains and hip pains. As time goes on, more jobs are requiring employees to sit down. And, this is not good for you… period. Call our award winning sports medicine physicians who specialize in alleviating your pain at San Diego Orthopedic Surgery.

Treating Leg Pain, Knee Pain and Joint Pain

If you are still feeling discomfort and pains, you should consider seeing an orthopedic surgeon. Your local San Diego orthopedic surgeon can help you with your bad circulation and leg pain issues. Call Dr. Robert Afra, M.D. at (760) 994-2663, or visit his San Diego Orthopedic office today.


19/Sep/2014

Ankle pain in athlete’s

Ankle sprains can impede an athlete’s active life style.  This is seen commonly in athletes involved in cutting sports like soccer, foot ball, and lacrosse.

Last week, Chicago Bears wide receiver Brandon Marshall was very questionable to play on Sunday night against the 49ers.  He was so questionable, that numerous sports analysts reported that he was very unlikely to play. The reason for the questionable tag was ankle pain. Marshall hurt the ankle the week previously and was forced to momentarily depart from the game. He later returned but re-aggravated it in the fourth quarter. The funny thing is, not only did Marshall surprise us all by starting the game on Sunday night; he went on to score three touchdowns and lift his team to victory. Let’s take a look at what nearly prevented him from the incredible performance.

The ankle joint consists of three bones. The ankle bone (talus), the shinbone (tibia), and the small bone of the lower leg (fibula). The tibia and fibula come together to form a socket for the top portion of the talus. The bottom of the talus rests on the heelbone (calcaneus). In addition to the bones of the ankle, there is a set of ligaments that work in tandem with these bones in order to support the lower leg and ankle. In addition to bones and ligaments there is a set of tendons that connect the lower leg muscles with the ankle and foot. Just like a machine with moving parts, if any of these parts is hindered or working incorrectly, there can be ankle pain.

 

Ankle Ligaments
Ankle Impegiments

While there was no specific diagnosis of Brandon Marshall’s ankle, let’s take a look at the potential causes of his ankle pain. There are many things that can cause ankle pain. Tendinitis, arthritis, gout, infection, fractures, sprains, and bruises are the most common causes of ankle pain.

We can probably rule out things such as tendinitis and arthritis. These can be very painful and occur when there is inflammation to the tendons and joints respectively. These issues typically are long lasting and take time to develop. Similarly issues like gout and infection can be ruled out because these would not be caused by an in-game injury. Gout is caused when there is a high build-up of uric acid, which leaves crystalline deposits in the joints.

That leaves us with fractures, sprains, and bruises. A fracture would require a break in one of the bones that make up the ankle. It is possible that a hairline fracture could go un-noticed if there is not a proper a battery of tests conducted. However, even a hairline fracture would probably cause a substantial amount of pain and a good bit of instability, making it hard to play.  Ankle sprains involve tears of the ligaments in the ankle. It is possible that Marhsall had a very minimally sprained ankle, perhaps, just a couple of microscopic tears within the lower ligaments of the ankle. Between supporting the ankle and pain-management, Marshall could in fact play with a minimally sprained ankle. Lastly there could be simple bruising of the ankle due to in-game contact. This would cause some pain and discomfort but could be played through if managed correctly. Even the most minimal of ankle sprains or fractures are very unlikely to slip past the NFL’s strict injury reporting policies, so for my money, I’d chalk this up to just a simple bruised ankle. Whatever you believe was the cause of Marshall’s ankle pain; he played through it and performed substantially better than expected. No reason to believe that this upcoming week will be any different.

If you have any questions about your ankle pain, contact our award winning sports medicine specialists at San Diego Orthopedic Surgery clinic to receive guidance.

Ankle Pain In Athletes


19/Sep/2014

Obesity is intricately linked with multiple medical problems, knee pain, and hip pain. With more than 74% of its population considered overweight or obese, the United States is the ninth-most corpulent nation on Earth, according to the World Health Organization.

A recent study by the Centers for Disease Control and Prevention suggested that the problem is getting worse. The researchers wrote that “the waists of men, women, blacks, whites and Mexican-Americans all grew significantly from 1999 to 2012.”

The average man’s waistline expanded from 38.9 inches to 39.7 inches, while the typical woman’s measurement grew from 36.3 inches to 37.8 inches, according to the study (published in the Journal of the American Medical Association).

USA Today reported that researchers detected an increase in “abdominal obesity” in 43 percent of men and 64 percent of women. In 1999, the statistics were 37 percent of men and 55 percent of women.

The study involved 32,816 adults, including African-American women in their 30s, Mexican-American women older than 70, Mexican-American men in their 20s, African-American men in their 30s and white women in their 40s.

The Washington Post noted that “obesity calculated from body mass index, which measures body fat based on height and weight, (has) remained relatively stable.” However, BMI does not measure the distribution of weight. Patients with normal BMIs can have large waistlines, which leave them more vulnerable to cardiovascular disease.

Patients with abdominal obesity also are more likely to experience hip pain or knee pain. They have an elevated risk of osteoarthritis developing in their hips and knees, which sometimes requires joint replacement.

In a story by The Associated Press, Dr. William Dietz (an obesity expert formerly with the CDC) said: “Even though the obesity rate may be stable, fat distribution may be changing. The seemingly contradictory trends are puzzling. It could be that Americans are exercising less and getting flabby. But because fat weighs less than muscle, they are not necessarily getting heavier.”

To prevent abdominal obesity, it is necessary to adopt a healthy diet and engage in regular exercise. The body stores carbohydrates as fat, often in the lower part of the torso. Reducing carb intake is key to staying in shape.

A balanced diet consists primarily of vegetables, fruits, whole grains and lean protein. These foods contain few calories, but provide the vitamins, minerals and fiber essential to fitness. Spinach and other green, leafy veggies are the best because they deliver nutrients while burning fat.

Studies have linked sedentary behaviors, like spending too much time sitting, with a number of illnesses and diseases. Couch potatoes also are more susceptible to hip or knee osteoarthritis, which causes pain and limits mobility.

The solution is to stay active and adopt a regimen of daily exercise. Effective workouts can be as simple as walking or running in place, or on a treadmill, while watching television.

Other popular options include walking or running outside, swimming in a pool, and playing sports like tennis or golf. Cardio exercises, those that sustain an elevated heart rate for 20 minutes, burn the most fat.  If you need help addressing your knee pain or need help developing a proper exercise regimen, contact our renowned sports medicine team at San Diego Orthopedic Surgery today.

 


19/Sep/2014

A fall onto an outstretched hand can lead to hand injury, most commonly a wrist or finger fracture.  Hand injury is extraordinarily common in sports.  Other common considerations include wrist sprain, or the subtle and sometimes missed ‘scaphoid fracture’.

gerald-mccoy-hand-injury

Tampa Bay Buccaneers defensive tackle Gerald McCoy is one of the best defensive tackles in the game. In Sunday’s game against the Rams, Gerald McCoy left the game in the second quarter with a hand injury. Team doctor’s quickly diagnosed the injury as a broken hand and declared him out for the rest of the game. He was seen on the sidelines with the hand heavily wrapped and held in position with a sling.

The hand is one of the most intricate and complex structures in the human skeletal system. Including the wrist, the hand consists of 27 bones. These bones include the carpals, metacarpals, and phalanges. The carpals are the bones that make up the wrists. The metacarpals are the bones that make up the palm of the hand. The phalanges are the bones that make up the thumb and fingers. Many of these bones are small and thin and can break quite easily if there is forceful and direct contact to the hand. A broken hand can also occur from an abnormal twisting motion or from the hand being crushed in a fall. If any of these 27 bones are broken then the general diagnosis is a broken hand. However, this diagnosis can be further elaborated by stating both the type of fracture and the bone in which the fracture has occurred.

hand-injury-san-diego

The symptoms of a broken hand include tenderness, swelling, decreased range of motion of hand or finger, and deformity. A broken hand can put a large amount of burden on the injured because the hands are such an important part of our everyday life. Simple tasks like driving, typing, and writing can become very difficult with a broken hand. However, it is important that you do not continue to utilize this hand to complete these activities if you fear your hand is broken. Visit your family doctor and an osteopathic physician to determine the proper treatment of for your hand.  The doctor will first examine the condition of the skin, the position of the fingers, and the range of motion. The doctor will then schedule an X-ray to identify the location of the fracture and the extent of the fracture.  Contact our award winning sports medicine doctors to evaluate you today.

Once the location and the extent of the fracture are determined, the bones can typically be realigned without surgery. Typically, a splint or brace is used to hold the bone in the proper position to heal. Follow up X-rays are needed to determine that the bone is healing in the proper position. The healing process requires about three to six weeks of proper immobilization. Occasionally, surgery is required to align bones properly. The cases that require surgery are typically the ones where the bone has pierced through the skin. The surgery involves using screws, plates or wires to hold the bones in place. The healing process from surgical repair is usually eight to twelve weeks but can take longer depending on the fracture and the patient.

Gerald McCoy’s broken hand does not require surgery and will be looked at on a week-to-week basis. It is highly unlikely to play this week and is probably questionable for the next week as well, but there is a chance he could return as soon as week 5.


18/Sep/2014

Jamaal_Charles_ankle-sprainIf you are wondering why your fantasy-football playing coworkers are spending their lunch breaks hitting their heads against the lunchroom table, your answer lies ahead. Kansas City Chiefs running back Jamaal Charles left Sunday’s game early in the first quarter. Jamaal Charles is arguably the best running back in the NFL and he was a top 5 fantasy football pick in virtually every draft this year. The good news is Jamaal Charles season is not in doubt; the bad news is that he will likely miss a few weeks. It turns out Jamaal Charles suffered a high ankle sprain.

jamaal-charles-nfl-ankle-injury

Ankle sprain is very common injury and can happen during athletics, but can also happen during simple, everyday tasks. You could be walking the dog and step on an uneven surface. You could be heading home from a night at the theater and your heel could collapse underneath you. Literally, there are about a thousand different ways you could sprain your ankle. The cause of an ankle sprain is typically due to a twisting, rolling, or turning of the foot. These movements are by no means abnormal and usually the ankle ligaments naturally stretch and then revert back to normal position. However, if the motion causes the ligament to stretch beyond their normal range, than an ankle sprain can occur.lateral-ankle-sprain-injury

Ankle sprains is diagnosed by severity of the sprain. Grade I ankle sprains are very minimal and consist of only microscopic tearing of ligament fibers. There may be some pain, swelling and tenderness, but range of motion is minimally affected and ankle can typically still bear full weight. Grade II ankle sprains are moderate and consist of complete tears of some of the ligament fibers.  There is likely pain, swelling, tenderness, bruising, decreased range of motion, and instability associated with a grade II ankle sprain. Grade III ankle sprains are severe and consist of a complete rupture of the ligament. A grade III sprain will cause severe pain, swelling, tenderness, bruising, decreased range of motion, and instability. In addition to the severity of the sprain, the location can also have an impact on the diagnosis and the prognosis. The high ankle sprain is the worst of the ligament sprains because it involves the set of ligaments that lie above the ankle. These ligaments act as a shock absorber between the tibia and fibula. Compared to the lower ankle ligaments, the higher ankle ligaments are placed under significantly more force while walking, running, jumping, and cutting.

ankle-injury

Ankle Sprain Recovery

Recovery from an ankle sprain does not typically require surgery and occurs in three phases: resting and protection, restoration and strengthening, and gradual return to normal activity. The recovery time is dependent upon the severity and the location of the ankle sprain. Grade I sprains typically take 1-3 weeks. Grade II sprains typically take 3-6 weeks. Grade III sprains can take anywhere from 6-12 weeks.  A high ankle sprain can typically take twice as long to return to form. There has yet to be a timeline released for Jamaal Charles’ return, but the initial diagnosis is a non-severe high ankle sprain; likely somewhere between a grade I and grade II ankle sprain. So while this is a pretty huge loss for Charles, the Chiefs, and all you fantasy football owners out there, there is a very good chance he returns by mid-season and if he recovers fully he should make a huge impact for the playoff push.

ankle-sprain-grades

If you need help recovering from an ankle injury, contact our award winning sports medicine doctors at San Diego Orthopedic Surgery today.

 


17/Sep/2014

Orthopedic surgeons commonly talk about knee osteoarthritis occurring after major trauma or ACL tears; we solve this problem by performing a total knee arthroplasty or knee replacement surgery.  However, there does not exist a similar replacement for the traumatic brain injuries or brain damage we see in athletes years after the stadium lights have dimmed.

One doesn’t need a medical degree, or data, or even a television to believe that players of a rough contact sport, such as football, will probably suffer long term brain damage and cognitive impairment from repeated head trauma.   In fact, locker room speak for the neurologic changes that boxers and gladiators such as UFC fighters undergo is commonly known as ‘punch drunk’.

brain traumatic injuries

The NFL, however, disagreed this to be the case and convinced its players the dangers were minimal.  However, after being recently sued by 5,000 former players, they were forced to rethink their stance. After hiring actuaries to compile the data, they came to the conclusion that approximately 33% of retired football players will develop long-term issues like degenerative brain disease at a much earlier age than those of us that do not play football.

If knowing that 1 in 3 football players will be affected isn’t bad enough news, Chris Nowinski, from the Sports Legacy Institute states: “… that total does not even include former players who develop mood and behavior disorders and die prior to developing the cognitive symptoms associated with C.T.E.”

The lawyers for the NFL maintain that the findings were an overestimate and the number is likely to be smaller since it was based only on those involved in the lawsuit. Their sole purpose for the data, however, was to ensure there would be enough funds to pay any settlements to the players that were affected.  In the case there is a higher number of players with long term brain damage, there will be money to cover their settlements, too.

brain traumatic injury

The NFL originally agreed to around $1 billion in compensation, but amended that to an unlimited amount over 65 years. Most players who file claims to the NFL regarding this work-related injury, if it could simply be referred to as that, are those who are diagnosed with advanced dementia or Alzheimer’s disease. This amounts to around $800 million in compensation settlements. Those who are diagnosed with Parkinson’s disease, chronic traumatic encephalopathy, or amyotrophic lateral sclerosis will receive up to $5 million.

The NFL calculated that players younger than 50 have about a 0.8 chance of a diagnosis of dementia or Alzheimer’s (compared to less than 0.1 percent for the rest of us), and those ages 50-54 have a chance of 1.4 percent (compared with less than 0.1 percent for the rest of us). Chances increase with age.

While the amount of money sounds like fair compensation, it will take 20 years to receive the first half and 45 years to receive the rest. If a player is diagnosed at say, age 45 with Alzheimer’s disease, he will have his total compensation at age 110. That sounds fair.

Many will argue that the players knew the risks involved when they signed up to play and shouldn’t receive any more compensation than other professions. While this may be true to an extent, every job has risks, even innocuous ones. Librarians can develop carpal tunnel syndrome, preschool teachers can get bulging disks, or a mom finds herself with osteoarthritis. All painful, but some possibly more deserving of a larger compensation than others.


14/Sep/2014

Knee pain and hip pain can be a result of osteoarthritis.  Sometimes shedding a few of the extra pounds we carry around with us can provide substantial pain relief.  In fact, some patients who have been told they may be a candidate for joint replacement find that the weight loss improves their pain to such degree that they no longer feel the need to undergo the surgical procedure.

What is obesity?

Due to modern day fast-paced daily lifestyles, many people are eating on the run, mostly snack type take away foods, resulting in growing weight problems. When a person consumes more calories than they burn, this leads to overweight and eventually obesity. Recent studies have shown that almost two thirds of Americans are overweight to some extent, and at least one third of these are actually obese.

Which  foods contribute most to overweight issues?

Food loaded with sodium, fat and with a low nutritional value, is the main culprit. Unfortunately these foods which include TV dinners, fast food such as hot dogs, burgers, and sugary drinks, are cheap and convenient for busy folk.

Why do people overeat?

There is not a “one shoe fits all” reason, although you could have some things in common with someone else.

Here are some well known reasons for overeating:

  • Boredom.
  • Depression or anxiety.
  • A rushed lifestyle which results in eating too much junk food.
  • Nibbling snacks while on the phone, in the car, in front of the computer or watching TV.
  • Poor lifestyle habits.
  • Portions which are hopelessly too large for your needs.

The risks of obesity.

Obesity is a risk factor for several diseases such as type 2 diabetes, hypertension, heart problem  issues, stroke and osteoarthritis. Carrying too much body weight can do real damage to your knees and hips, setting you up for a lot of pain.

Research has shown that when you weigh more than you should, the extra force on the knee cartilage results in knee pain, which over time, can be linked to osteoarthritis.

The same applies to the hip, where pain which seriously limits mobility, is also associated with obesity. Studies show that cartilage damage causes hip pain which may also lead to osteoarthritis. If overweight and obesity is allowed to continue unchecked, a knee replacement as well as a hip replacement, is very much on the cards.

A smart way forward.

Losing weight will cut your risk of obesity-related diseases, and definitely ease the pressure on your joints which causes knee and hip pain. Note that you may not be overweight, but still have knee pain and hip pain. If that is the case, keeping your weight down is just as important to prevent the pain from getting worse.

Embarking on a weight loss program is the smartest way forward to improve your health and take some of the stress off painful knee and hip joints.

A good dietician can help you plan healthy meals so that you consume fewer calories, and show you how to adjust your portions so that you steadily begin to lose weight (phentermine).

Make the right decision to put yourself back on the road to pain free, optimal good health.

If you have been told you would benefit from a hip replacement or knee replacement, call us to schedule an appointment to discuss your options.  Our award winning surgeons at Orthopedic Surgery San Diego will provide you individualized treatment to get you back in the game!

 


14/Sep/2014

Although the goal of performing rotator cuff repair surgery is to alleviate the pain and weakness, there is no guarantee that the rotator cuff will heal.  If it does heal, there is no guarantee that it won’t retear.  Patients specifically at risk of failure to heal/retear are: older than 65 years, larger size tears, the tissue has undergone muscle atrophy and/or fatty infiltration, diabetic, smoker, and noncompliant with rehabilitation restrictions.

rotator-cuff-illustration-san-diego

Nine times out of 10, patients experience significantly less shoulder pain after undergoing arthroscopic surgery to repair rotator cuff tears. The procedure also, in nearly all cases, improves the range of motion of the arm and shoulder. Patients generally recover full use of their shoulders.

However, some report continued pain, stiffness and weakness. The degree to which they can rotate their shoulders and move their arms may not be not any better than it was before the operation. When this happens, doctors identify the problem as failed rotator cuff syndrome. Elderly patients, those with diabetes and people who smoke are particularly vulnerable to the condition. Careful diagnosis is required to ensure that a patient does not have superior labral anterior-posterior lesions, rather than a rotator cuff tear. Each condition produces similar shoulder pain.

rotator-cuff-tear-anatomy

The syndrome is characterized by an “incompetent” rotator cuff. That typically means the tendons did not heal adequately after surgery. The term also can refer to new tears in the rotator cuff sustained during patients’ recovery. People who have had large tears repaired are more vulnerable to subsequent tears.

Other ways that rotator cuffs are rendered incompetent include cervical spine disease and a nerve condition called suprascapular neuropathy. Athletes and workers who repeatedly and strenuously extend their arms overhead are susceptible to subacromial impingement, which compromises the rotator cuff. Another cause of ongoing discomfort is a type of arthritis.

The best treatment for failed rotator cuff syndrome depends upon the cause. The primary options are revision repair, non-anatomic repair, tendon transfer and arthroplasty. Synthetic materials, or tendon tissues from other parts of the body, are used to create a bridge reconnecting the cuff’s torn segments. This method is known as a “tension-free” repair because tissues do not have to be pulled together, as when they are reattached with stitches. Another technique entails implanting scaffolds (natural or artificial supports) to hold tissues in place.

Tendonesis, which can be performed arthroscopically or as open surgery, enables some patients to regain shoulder function. For seniors, surgeons tend to suggest biceps tenotomy, which takes less time than tendonesis and requires shorter rehabilitation.

visible-rotator-cuff-tear

Tendon transfers are not recommended for the elderly, for patients experiencing post-surgical stiffness or for those with nerve injuries. However, the procedure can help young, physically active patients with weakness and limited range of motion but little pain. Patients diagnosed with degenerative glenohumeral arthritis, as well as older people who have had repeated cuff tears, sometimes undergo total shoulder replacement (arthroplasty). Hemiarthroplasty is the replacement of just the humerus portion of the shoulder joint.

In one study, researchers spent eight years following 20 people with repaired rotator cuffs who had sustained re-tears. In most cases, the new tears stopped growing. The patients did not report increased shoulder pain or additional loss of movement. These results suggest that surgery is not always required when a re-tear occurs. For patients who do need further treatment to find relief for their symptoms, surgeons can suggest a variety of possible solutions.

If you have been told you have a rotator cuff problem, call to schedule an appointment with our expert sports medicine surgeons at Orthopedic Surgery San Diego.


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