Best Practice Health TV
Not all pain in the shoulder is shoulder pain. Most people are really surprised to learn that pain in the shoulder can come from anything from breast cancer to an ectopic pregnancy. The problem is that a rotator cuff tear, when present, may need a surgical repair to get better. And to make matters worse, [...]
read moreRotator cuff tears are common after falls onto an outstretched arm or lifting something too heavy. But not all tears are due to injuries; degenerative tears happen when a tendon is worn down over time, often by repetitive motions or bone spurs. Today one hundred percent of rotator cuff surgeries are done with an arthroscopic approach. The traditional rotator cuff surgery is done without the arthroscope slows and limits your recovery. If a traditional surgeon tells you that surgery is needed but it can’t be done using a minimally invasive arthroscopic approach, then it’s a good idea to get a second opinion.
If you think you have a rotator cuff tear you should put your arm in a sling and make an appointment to see your chiropractor, physical therapist, or primary care physician. If your pain is so severe you can’t sleep, your shoulder is swollen, stuck in the wrong position then you should see an orthopedic surgeon directly. There’s generally not much sense in going to the Emergency Department or urgent care for shoulder pain.
Surgery is recommended for complete rotator cuff tear, and for incomplete tears that fail to heal adequately without surgery. Continuing to use your shoulder after a rotator cuff tear can make the tear worse, further damaging your shoulder.
If surgery is needed be reassured that major surgery is not required. Arthroscopic rotator cuff repair can be done in an ambulatory surgery center, so hospitalization is not required. The surgery takes 90 – 120 minutes and is usually done under a general or regional anesthetic. Your arm is placed in a sling in the recovery area.
Be sure to wear your sling after your arthroscopic rotator cuff tear surgery. The rotator cuff muscles were sewn back together during the surgery, and they need to heal back. The healing process takes months to be complete. There are several do’s and don’ts after rotator cuff repair surgery.
Arthroscopic rotator cuff tear repair restores range of motion in your shoulder and eliminates the pain after rotator cuff tear. The procedure is minimally invasive, and can be done in an Ambulatory Surgery Center, so risky hospitalization is not needed. You do need to wear a brace for 4-8 weeks after the procedure, and rehabilitation is required. But once it’s all done, you can’ count on getting back to a full night’s sleep without shoulder pain.
The first clue you have a rotator cuff tear is shoulder pain at night that makes it hard to sleep. The muscles of the rotator cuff primarily move the shoulder to raise your hand like you are asking a question in class, and put your hand behind your back https://youtu.be/iGctIedO29w. If these movements reproduce your usual shoulder pain, then there’s a good chance you have a rotator cuff tear.
The best test to determine if you have a rotator cuff tear is magnetic resonance imaging (MRI) (https://youtu.be/62t-5V6Qj94). The physical examination is suggestive, but not definitive. Traditional x-ray doesn’t show the muscles of the rotator cuff and therefore can’t be used to visualize a tear. CT scan is not as sensitive as the MRI, but it’s a reasonable alternative test if you can’t have an MRI.
Rotator cuff tears can be partial or full thickness. A partial tear may be able to heal by itself over 4-6 weeks. If you have pain in the front of your shoulder at rest at night that keeps you from sleeping and is reproduced by raising your hand or putting your hand behind your back, then you should suspect a rotator cuff tear. If the pain is severe, you have swelling, and you can’t sleep then see an orthopedic surgeon right away. It the pain is not that bad then you can try non-steroidal anti-inflammatory drugs (NSAIDS like Aleve or ibuprofen) with Prilosec to protect your stomach, and schedule to see your chiropractor or primary care doctor within a week or two. Your doctor will obtain x-rays. If the x-ray does not indicate advanced arthritis, then you should see an orthopedic surgeon in consideration for arthroscopic rotator cuff repair.
If you think you have a rotator cuff tear you should put your arm in a sling and make an appointment to see your chiropractor, physical therapist, or primary care physician. If your pain is so severe you can’t sleep, your shoulder is swollen, stuck in the wrong position then you should see an orthopedic surgeon directly. There’s generally not much sense in going to the Emergency Department or urgent care for shoulder pain.
Surgery is recommended for complete rotator cuff tear, and for incomplete tears that fail to heal adequately without surgery. Continuing to use your shoulder after a rotator cuff tear can make the tear worse, further damaging your shoulder.
If surgery is needed be reassured that major surgery is not required. Arthroscopic rotator cuff repair can be done in an ambulatory surgery center, so hospitalization is not required. The surgery takes 90 – 120 minutes and is usually done under a general or regional anesthetic. Your arm is placed in a sling in the recovery area.
Be sure to wear your sling after your arthroscopic rotator cuff tear surgery. The rotator cuff muscles were sewn back together during the surgery, and they need to heal back. The healing process takes months to be complete. There are several do’s and don’ts after rotator cuff repair surgery.
Be sure to wear your sling after your arthroscopic rotator cuff tear surgery. The rotator cuff muscles were sewn back together during the surgery, and they need to heal back. The healing process takes months to be complete. There are several do’s and don’ts after rotator cuff repair surgery.
In order to keep your repair safe after arthroscopic rotator cuff repair surgery the exercises are all passive in nature. Here are the exercises you should do.
The pendulum | External rotation with a cane | Shoulder rolls | Active stretches for your elbow wrist and hand.
The goal for weeks 6-12 after arthroscopic rotator cuff repair is to return normal range of motion to you shoulder. This is done with several exercises. Repeat each movement (exercise) 10-15 times, rest, then do the repetitions again 2 more times for a total of 3 sets of 10-15 movements for a total of 30-45 movements.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.
You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.
They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.
You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.
You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.
Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.
This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.
First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.
If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.
Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is
In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.
At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.
If you have any of the following red flags you need to see a doctor NOW!
Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.
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Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.
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Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.
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