Early Rotator Cuff Shoulder Repairs Lead to Promising Results #Health #rotatorcuff #Seattle

Rotator cuff tears are a very common condition, causing pain and reduced movement of the shoulder. While these injuries may not demonstrate symptoms at first, gradual degeneration may cause shoulder pain and other symptoms to develop within a few years

 "Repairs of isolated supraspinatus tears maintained considerable improvement in clinical and radiographic outcomes at 10 years," according to the report by a French orthopedic surgery research group. The lead author was Philippe Collin, MD, of CHP Saint Gregoire Vivalto Sante. The study provides new evidence that early surgery for supraspinatus tears can improve long-term outcomes by preventing later rotator cuff muscle degeneration.

 The researchers, in a French multi-site clinical setting, identified 511 patients at 15 hospitals who underwent complete rotator cuff tear surgery.  These same patients were had a clinical longitudinal research follow-up ten years later, where 288 patients returned for follow-up evaluation, including MRI scans in 210 patients.

 The results of these patients saw substantial improvement of quality of life as well as general range of motion and use of the affected shoulder. The average Constant score -- a standard assessment accounting for shoulder motion, strength, daily activities, and pain -- improved from about 52 (out of a possible 100) before surgery to 78 at ten years' follow-up. The MRI scans showed similar results with a marked improvement in the quality of the tendon strength.

 Journal Reference

 Philippe Collin, Jean-François Kempf, Daniel Mole[Combining Acute Accent], Nicolas Meyer, Charles Agout, Mo Saffarini, Arnaud Godene [Combining Grave Accent] che. Ten-Year Multicenter Clinical and MRI Evaluation of Isolated Supraspinatus Repairs. The Journal of Bone and Joint Surgery, 2017; 99 (16): 1355 DOI: 10.2106/JBJS.16.01267

Recovery After Shoulder Surgery #ASES #AAOS #Seattle #Health

The group of muscles and tendons that surround, stabilize and allow movement at the shoulder joint are the rotator cuff muscles. Because of this, any surgical procedure on the shoulder will likely have some involvement with your rotator cuff muscles.   No matter the reason for your shoulder surgery, here are some general tips to help maximize your recovery.

 Support your Rotator Cuff

It is important to insure that the muscles that have recently been operated on are supported and allowed to heal with minimal strain.  Wearing a sling or some sort of standing support will allow for this throughout the day and sleeping with a pillow to support the affected side at night will help.   

 Develop your Rotator Cuff

The rotator cuff muscles will take time to heal.  Initially you should avoid putting any strain at all on your shoulder.  After some time however, it’s important to stick to the physical therapists recommended exercises to slowly and gradually re-build the muscles. 

 Manage your Shoulder Pain

Of course pain will be more significant immediately after the operation as compared to a few weeks out.  To manage this, you can rely on prescription or over-the-counter medications as well as inflammation management practices like cold compresses.   In addition, wearing your sling should help reduce shoulder pain and reduce the likelihood of unnecessary strain or damage to the muscles and tendons during the recovery period.

 Gradually get back to normal

Consult with your physical therapist or physician as to when you can begin to resume normal activities with your post-operative shoulder. For example, from about 6 weeks you usually will be able to start using your shoulder for gentle tasks such as washing and dressing while at 12 weeks you will be thinking about using your arm for other moderate activities, such as swimming.

Is this exercise bad for my shoulder? #Fitness #Health #Seattle

The deltoid

Shoulder injuries are very common with sports and exercise.    2 out of 3 people will experience a shoulder injury or problem at some point in their lives.  Deltoid exercises are very common with many who lift weights, however, the anterior deltoid normally gets most of the attention.  The deltoid actually consists of 3 main heads: the anterior, middle, and posterior.  Imbalance in the 3 heads of the deltoid can lead to injuries.  A study conducted by the University of Wisconsin LaCrosse evaluated proper deltoid exercises to see which were most effective.

To determine which exercises are most beneficial for activating shoulder muscles, researchers compiled a list of the 10 exercises most often performed by both recreational lifters and athletes and most commonly prescribed by trainers.

• Barbell upright row

• Battling ropes

• Bent-arm lateral raise, great for the medial deltoids

• Cable diagonal raises

• Dips

• Dumbbell front raise

• Dumbbell shoulder press, tops in training for the anterior deltoids

• Push-ups

• Seated rear lateral raise, excellent for the posterior deltoids

• 45-degree incline row, excellent for the medial and posterior deltoids

Following the testing these exercises on 16 athletes, researchers compiled and evaluated the data.  The conclusions were:

• For targeting the anterior deltoid, the dumbbell shoulder press elicited significantly higher muscle activation than any other exercise tested.

• For the medial deltoid, two exercises came out on top: the 45-degree incline row and the bent-arm lateral raise.

• For the posterior deltoid, researchers found that the seated rear lateral raise and the 45-degree incline row both provided the greatest muscle activation for the back of the shoulder. 

My Take

For the most high yield workout, you are best served starting with weakest rear deltoid with either the 45-degree incline row or the seated rear lateral raise followed by the dumbbell shoulder press to target the front of the shoulders.

Exercise is very important both physically and mentally, but always needs to be done the right way.  I hope that this info will add to your workouts.

Do non-surgical factors affect recovery after a rotator cuff repair? #AAOS #Health #Seattle

A recent paper - A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors set out to answer this question. 

Many shoulder surgeons like myself have noticed that patients can have a wide range of outcomes after the same rotator cuff repair surgery.  This paper gives further evidence that many psychosocial factors can affect the result of surgery and need to be addressed to maximize a patient's outcome.  Patients with preoperative narcotic use, higher preoperative pain scores, and lower scores on the WORC (rotator cuff questionnaire) index and emotion sections.

I am immensely interested in studying how we can use different technologies and treatments to best address the psychosocial factors that we all have our shoulder and elbow patients.  Check out more about my research in this field here.

If you have a rotator cuff tear and are considering rotator cuff surgery, please ask your shoulder surgeon if there is anything that you can do before surgery to improve your outcome.