Don’t Shoulder The Pain – Health & Life Magazine

CHECK OUT A RECENT ARTICLE IN MORRIS/ESSEX MAGAZINE WHERE I AM A FEATURED CONTRIBUTOR ON ROTATOR CUFF DISORDERS

Don’t Shoulder the pain – Health and Life Magazine

Read on – https://www.healthandlifemags.com/dont-shoulder-the-pain/


Don’t Shoulder The Pain – Health & Life Magazine
— Read on www.healthandlifemags.com/dont-shoulder-the-pain/

ACL (Anterior Cruciate Ligament) Repair

ACL tears are increasing in frequency secondary to increased levels of participation, frequency of games and practice.

ACL tears are a common injury and being seen with greater frequency and at younger ages. Tears lead to loss of time from sport and activities and can lead to further joint deterioration without prompt recognition and treatment. The standard treatment is a reconstruction with autograft (patients tissue) or allograft (donor, cadaveric tissue). The choice of graft depends on several factors including age of patient and sports activity level. Currently, the time to return to sport has been shown to effect re-injury rates. Historically, 6 months after surgical reconstruction was considered an appropriate time to return to sports without restrictions. This notion has been challenged by recent studies noting lower re-injury rates by waiting 9 months or more to return to sports.

ACL graft (hamstrings)

Newer surgical instruments and a retrospective look at studies from decades ago regarding primary repair have lead to resurgence in interest in primary repair instead of reconstruction. Failure rates have been high with this technique in previous studies that lead to the abandonment of this procedure. However, when evaluating the results or success of repair in specific tears, the results can approach that of a reconstruction. Specifically, proximal tears (from the femur) have better success when repaired. The advantage of a repair is that the ACL can be saved, less invasiveness and potentially faster return to sports. If the repair were to fail the standard options for reconstruction still exist. This is particularly attractive in pediatric patients where reconstruction techniques can injure growth plates.

Not every patient is a candidate but the option should be available for those patients inclined to have a repair over a reconstruction. I offer this to my patients who are appropriate candidates based on MRI appearance and surgical evaluation. Below is a short video demonstrating a repair I performed and the technique utilized.

Video of ACL Repair

Clavicle (collarbone) Fractures

Breaking the clavicle or “collarbone” occurs from a fall or direct blow to the area. Contact sports like football, rugby and ice hockey are common high risk sports. Falls while cycling, skiing and motor vehicle accidents are other common ways to fracture the clavicle. Immediately following the injury patients experience pain, swelling and limited use of the arm. X-rays are usually sufficient to make the diagnosis and initial treatment involves immobilization in a sling and use of ice and over the counter pain medications.

X-ray showing a clavicle fracture that is displaced and in multiple pieces

Treatment can be surgical or non- surgical. Non-surgical management simply lets the fracture heal in the position it is in and includes a period of immobilization. The immobilization period is typically 3-4 weeks until sufficient healing occurs so therapy can begin and pain is decreased. Non-surgical management has been the norm for a long time, however, surgical fixation or repair is gaining popularity for certain injuries.

X-ray showing clavicle plate

Surgical repair can be accomplished with a variety of devices, but usually a plate and screws has some advantages. Repair can align very displaced fractures. When the fracture is very displaced and when fragments shorten or ride over each other patients who are active tend to complain of shoulder pain and sometimes weakness or dysfunction. This can be alleviated with surgical repair. In addition, fracture healing time is shortened with surgical repair and risk of fracture not healing is lessened by surgical fixation. Use of the upper extremity is allowed much sooner following surgical repair.

In summary, clavicle fractures can be managed with or without surgery. Treatment decision is made based on fracture type, displacement and shortening. Patients activity level, age and other risk factors are taken into consideration as well. Below is a short presentation on a clavicle fracture I treated utilizing sutures and a plate to restore the anatomy and fix the fracture anatomically.

Presentation of clavicle fracture treated surgically

Tennis Elbow – Minimally invasive micro debridement

Tennis elbow is a common problem for patients who play tennis or not. The #Tenex device offers a minimally invasive solution for patients not improving with typical treatments and those who do not want to wait any longer to return to activity. I combine this with PRP at time of the procedure.

Shoulder Pain – Calcific Tendonitis

Shoulder pain is one of the most common complaints that patients come to my office for on a daily basis. There are many causes of shoulder pain including: bursitis, rotator cuff tendonitis, rotator cuff tears, labral tears, fractures of the shoulder, adhesive capsulitis ( frozen shoulder ) and many others. In this post I am going to focus on calcific tendinitis of the shoulder.

Calcific tendinitis is a common painful condition of the shoulder that results from calcium deposits within the rotator cuff. The calcific material is actually calcium hydroxyapatite. The calcium hydroxyapatite can be present in as many as 10% of people that her asymptomatic, although approximately half of these people will become symptomatic or painful from the calcium deposit. This is a more common condition in women. It commonly occurs in patients between 30 and 60 years of age and can be in both shoulders. There is no known definite cause calcific tendinitis, but the res include degeneration of the rotator cuff, repetitive trauma and injury. Patients with diabetes and hypothyroidism may be at higher risk for the development of calcium deposits in the rotator cuff.

The symptoms can include pain which is often severe and constant, limited motion and difficulty with lifting and reaching away from the body or behind the back. Almost all patients have no history of injury to the shoulder. The symptoms often come on abruptly and the pain seems out of proportion to the lack of trauma. The pain is often on the outside part of the shoulder and can radiate down to the mid arm or lower. However, pain can be more diffuse and poorly localized. An x-ray is usually diagnostic and rarely is an MRI, CT scan or other imaging modality necessary to make the diagnosis. An MRI may be indicated when symptoms are not resolving with proper treatment to look for additional pathology such as a rotator cuff tear.

The symptoms can include pain which is often severe and constant, limited motion and difficulty with lifting and reaching away from the body or behind the back. Almost all patients have no history of injury to the shoulder. The symptoms often come on abruptly and the pain seems out of proportion to the lack of trauma. The pain is often on the outside part of the shoulder and can radiate down to the mid arm or lower. However, pain can be more diffuse and poorly localized. An x-ray is usually diagnostic and rarely is an MRI, CT scan or other imaging modality necessary to make the diagnosis. An MRI may be indicated when symptoms are not resolving with proper treatment to look for additional pathology such as a rotator cuff tear.

Treatment of calcific tendinitis includes rest from painful activities, anti-inflammatory medications such as Aleve or Advil or could be a prescribed anti-inflammatory. In addition, ice or and physical therapy/home exercises are often helpful. A cortisone or steroid injection into the shoulder can also be performed to ease pain and improve function. On occasion, more than one injection may be necessary over a several week period to alleviate symptoms. When these methods fail to resolve symptoms there are other methods to try and break up or dissolve the calcium deposit. The methods vary in invasiveness and include ultrasound-guided needle decompression/debridement, shockwave therapy, ultrasound-guided percutaneous micro debridement with a TENEX device and arthroscopic debridement of the calcium deposit. Most patients recover with the need for surgery, below is a video of a calcium deposit removal I performed arthroscopically.

Anterior Cruciate Ligament (ACL): Graft Choices

Anterior cruciate ligament tears are one the most common serious sports knee injuries that lead to prolonged time out from sports participation. It is estimated that approximately 100-200,000 ACL tears occur per year. The incidence of ACL tears has risen over the years due to increasing sports participation, training and the number of games athlete’s are playing. A concerning statistic is that the rate of tears in pediatric age athletes has increased over the last 20 years.

The ACL is an important ligament that provide stability to the knee particularly with pivoting and cutting movements that are common in sports. It is the primary restraint to anterior translation of the tibia on the femur, but also provides significant rotational stability to the knee. Most injuries to the ACL are non contact and occur with rapid direction changes, deceleration and landing from a jump. It is common for the athlete to feel a pop, immediate pain and develop swelling over the first 24 hours.

ACL reconstruction is the usual recommendation to treat an active person with an ACL tear. This is generally performed through an arthroscopic assisted procedure. One of the major considerations is which type of graft to use. In general, graft options include autograft ( the patient’s own tissue) and allograft ( a cadaveric donor tissue). Common autograft options include the patellar tendon, hamstring tendons and quadriceps tendon. Allograft options include the same plus different soft tissue grafts from other areas. Choosing the best graft for each patient depends upon the age of the patient, activity level and a variety of anatomical factors. I utilize all types of graft options in my practice and base the choice of the graft on multiple factors and discussions with my patients.

Arthroscopic photo of quadrupled hamstring autograft reconstruction

Within the autograft choices, each has its pro and cons. The patellar tendon graft is considered the gold standard, but the other graft choices may be a better option in select patients. Patient size, type of sport, age (growth plates still open) and history of other knee complaints in the past are important considerations when choosing a graft.

Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction
Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort

The American Journal of Sports Medicine, Vol. 43, No. 7

It is generally accepted that autografts have a lower re-tear rate than allograft in younger patients, highly active patients and patients participating in competitive sports. Allograft reconstructions have a similar success rate in patients that are older (generally 35 year-old and up) and do not participate in highly competitive sports on a frequent basis. The research continues to define which grafts have the best success in different patients and new information continues to guide our decision making.