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4 posts from May 2007

May 16, 2007

Rotator Cuff Injury Cycle

There is a frequent pattern of injury amongst those who suffer from rotator cuff inflammation. The shoulder goes through a cycle of injury followed by healing and then the patient will have a certain period of pain-free time only to re-injure it. Soon enough, the periods of pain-free times are less and the movements that cause pain are more and the threshold for re-injuring the rotator cuff lessens.

What is going on is that the rotator cuff will become injured as it is impinged under the coracoacromial arch. The rotator cuff has a very sensitive area on its superior muscle called the supraspinatus. The rotator cuff is made up of four different muscles. 90% of the injuries originate at the supraspinatus muscle. As a person goes through years of this cycling, the rotator cuff becomes scarred; becomes less flexible; it becomes more easily torn; it becomes less subtle. In affect, this rotator cuff prematurely ages and in this cycle of injury, inflammation, healing, scar tissue, the rotator cuff at some point becomes torn. The key to treatment is to break that cycle of repeated injury to allow the rotator cuff to restore some of its flexibility to reduce some of its scar tissue. Constant re-injury needs to be avoided at all cost. It delays the healing process and contributes to scare tissue and overall decreases the range of motion.

If you have a shoulder injury, it is critical to heal it quickly and completely.

Shoulder Replacement Surgery

Shoulder arthritis is an affliction affecting millions of Americans. Frequently we hear about knee replacement, hip replacement. More rarely is it suggested that patients undergo shoulder replacement. Primarily there is a lack of expertise that causes this. Also it has been cited that shoulder surgery has more risk. A recent study by the Johns Hopkins Department of Orthopedics led by Doctor Edward McFarland, MD, director of the division of adult orthopedics at Johns Hopkins Hospital analyzed a series of hip replacement versus knee replacement versus shoulder replacement procedure. After looking at how the patients fair, researchers concluded that comparatively total shoulder replacement was just as safe and effective as other types of joint replacement.

According to a nationwide 2003 Medicare figure, 6700 people had shoulder joints replaced that year compared with 107,000 hip replacements and nearly 200,000 knee replacements. It is interesting that patients in the study who had shoulder surgery, had far fewer in hospital post-surgical complications compared to those who had their hips and knees replaced. This includes a risk of death. Additionally, despite the fewer numbers, the shoulder replacement surgery also called arthroplasty was also less expensive according to the researcher. Shoulder replacements total cost on average were just over $10,000 where hip replacement was $15,000 and knee replacement was nearly $15,000.

The conclusion of this article is that shoulder replacement surgery should be performed more frequently noting that 99% of people who have had shoulder replacement for arthritis get pain relief and say they wish they had done it sooner. The study indicates there may be little reason to wait.

May 07, 2007

Rotator Cuff and Baseball

When you hear rotator cuff injury, what comes to mind? Typically a pitcher for your local team will have been recently placed on the disabled list. Most recently Orlando Hernandez and Jaret Wright are two of the big names on their respective team’s disabled list. This is not a problem restricted to baseball players, but they are particularly susceptible to it, given the throwing motion and how that impacts the upper part of the shoulder.

Essentially, they have something called impingement syndrome and this leads to rotator cuff tendonitis. It is also called the weekend warrior syndrome. This can be exasperated by playing basketball, by serving a tennis ball, by throwing a football. It is routine to feel somewhat sore after increased activity; particularly as one ages, but if routine movements such as turning off the alarm clock or reaching on the top shelf become painful, you need attention. Most of the time rotator cuff tendonitis can be healed and managed with physical therapy and full activity can be restored.

Occasionally, steroid injections are needed and more rarely than that , surgery is recommended. The critical aspect is to treat this problem early before there is major scarring or rotator cuff tears. Keep in mind that 90% of all rotator cuff tears are the original result of chronic inflammation. It is essentially something that starts small and gets progressively more difficult. If the shoulder is hurting, medical attention should be sought more quickly rather than less.

New Shoulder Therapy

Given that 90 + percent of shoulder pain is due to rotator cuff tendonitis it is worthwhile to consider those therapies set focusing on rotator cuff tendonitis. A recent study presented at The American College of Sports Medicine showed impressive results with using a nighttime brace to treat rotator cuff and tendonitis.

The study started with all patients receiving traditional care, which included hands on anti-inflammatory medications and physical therapy. However, half the patients then received an additional treatment of a nighttime brace that they wore for one month. The study was blinded. The results showed remarkable 100% improvement in those people who used the brace on a regular basis.

The patients did not need to wear the brace for more than three weeks. Only 50% of those in the group not using the brace got better over a one month period. This small but powerful study did reach statistical significance. This brace does represent new and exciting therapy to deal with this incredibly common problem of rotator cuff tendonitis.