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What to Expect During a Rotator Cuff Tendon Reconstruction Surgery

If you need a rotator cuff tendon reconstruction surgery that likely means that you have torn your tendon either entirely or partially and you need to have it repaired surgically. The arthroscopic surgical approach is the most minimally invasive option available to minimized down time, pain, Rotator Cuff Viewand complications.

The original consultation is the perfect time to review which medical options you have at your disposal. It is also during this time that the Beverly Hills orthopedic surgeon will discuss which surgical options you have at your disposal.

Arthroscopic surgery is a minimally invasive surgical procedure which is growing in popularity because of the reduced recovery time and the reduced pain associated with it. When you have an arthroscopic procedure the surgeon will make a preliminary incision through which a small tube is inserted. Attached the end of this to positional camera which is used to feed live stream video directly into the operating room so that the surgeon can look around inside of your joint and locate the problem.

The Los Angeles shoulder surgeon will insert fluid into your joint to spread open the area and provide a better view in and around all of the various tendons and bones. In some cases the orthopedic surgeon will be able to first utilize an arthroscopic procedure to find the source of the problem and immediately upon locating the problem complete any necessary surgeries through a secondary incision. With the state-of-the-art surgical instruments available to put through the scope now, most sizes of rotator cuff tears can be repaired without having to make a true incision.Shoulder Arthroscopy

Once you have completed your surgical process, your orthopedic surgeon will design a unique physical therapy rehabilitation program which is personalized for your recovery and designed to enhance your flexibility, your range of motion, and your strength after surgery.

It is imperative after your procedure you follow the instructions you were given for physical therapy exactly in order to improve upon your strength and to make sure that the surgery is effective.

Some of the biggest potential complications associated with such procedure include internal bleeding and infection. These potential complications are much the same as any surgical procedure. In addition to antibiotics you may be given a prescription for pain medication to help you manage any pain you have immediately after the procedure.

Dr. Raj at Beverly Hills Orthopedic Institute is a first rate shoulder specialist, accomplishing all types of procedures through a minimally invasive arthroscopic procedure. Most insurance is accepted, and his outcomes are amazing with everyone from athletes, grandparents, students, executives, manual laborers and celebrities as well.

Call (310) 247-0466 today!

June 26th, 2015|Shoulder Surgery|0 Comments

How to Prepare Yourself for Shoulder Arthroscopy

How to prepare yourself for shoulder arthroscopy with a Beverly Hills orthopedic surgeon

Shoulder painIf you have sustained damage to your shoulder joint there are many things that you can do to help treat the problem area. One of the best things you can do is to speak with a Beverly Hills orthopedic surgeon about arthroscopic surgical procedures. These are minimally invasive procedures designed for situations where nonsurgical methods have been tried with no results.

When you meet with the orthopedic surgeon in Los Angeles, he will discuss the options you have at your disposal for your particular medical situation. They will also verify whether or not you qualify for different surgical procedures based on your personal situation and your health. In many cases you will be asked to complete a checkup and blood work to make sure that you are healthy and a qualifying candidate for surgery. Your Los Angeles orthopedic doctor will then discuss with you which surgical options you have at your disposal and review with you the potential complications.

As with any surgical procedure arthroscopic surgery does bring with it the standard potential complications including a risk of infection and bleeding. For this reason you will be given antibiotics prior to your surgery and your doctor will need to know which medications you are on and which herbal supplements you are taking so that they can make sure none of them interfere with your surgical procedure or recovery.

For example, some herbal supplements act unkowingly as a blood thinner, something which can cause excess internal bleeding during your surgical procedure. Many Los Angeles orthopedic Shoulder Arthroscopysurgeons will recommend that all of these substances be ceased approximately two weeks prior to your surgical procedure.

As with almost all injuries, the sooner you seek treatment, the better off you will be. The most basic shoulder “scope” will entail shaving excess bone and debriding inflamed tissue for pain relief. If a labral tear exists, it may also need to be shaved or repaired. Even larger rotator cuff tears can be fixed through the “scope” these days.

Arthroscopic surgery is a popular surgical procedure used today. It was grown in terms of its popularity due to the fact that it reduces the amount of recovery time necessary and it reduces the amount of pain that an individual patient feels after a surgical process has been completed.

The arthroscopic surgery is minimally invasive because it requires first a single incision through which a small camera is placed. This camera is attached to a small cube and it feeds directly to the logovideo screens or monitors located inside of the operating room.

These are designed to provide live feed to the orthopedic surgeon so that they cannot only locate the injury but perform the repair immediately. Shoulder arthroscopic surgery is performed on an outpatient basis, and you will be given sufficient pain medication afterwards along with specific wound care instructions.

For the top shoulder specialist in Los Angeles and Beverly Hills, Call Dr. Raj today at (310) 247-0466!

June 24th, 2015|Shoulder Surgery|0 Comments

Study Reviews Outcome and Safety of Total Shoulder Replacement

A study was conducted to review the outcome and safety of total shoulder replacements in patients who are over or about shoulder arthritis80 years old. Of the participants, 50 shoulder replacements were done on 44 patients ages 80 to 89, making their mean age 82 years. The researchers evaluated and analyzed shoulder status, patient health, post-operative course, patient satisfaction, surgical and medical complications, the need for revised surgery, radiographs, and improvement of pain and movement.

Medical abnormalities were common among study participants, with nine of the shoulders required grafting. These nine were out of the 13 which had a bony deficiency of the glenoid. No peri-operative deaths were reported, but prolonged hospital stay and blood transfusions were common. The mean follow-up time was 5.5 years, from a range of 2 to 12 years. There was a significant reduction of pain and improvement in movement both internal and external rotation and in active elevation. The Neer scale was used to assess outcome, and 40 shoulders had a satisfactory or excellent result, which accounts for 80% of the total shoulders.

The researchers concluded that the total shoulder replacement is a relatively effective treatment for elderly patients of this age group.

Total Shoulder Replacement Researchers Find Pain and Mobility Improvements

The aim of another recent study was to analyze the xray and clinical outcomes of a third generation total shoulder arthroplasty treated patients for a follow up period of 15-20 years. The method used was the application of 63 total shoulder replacement2shoulder arthroplasties on 58 patients. After exclusions, 45 total shoulder arthroplasties were done on 40 patients, who had a mean age of 64 years.

The duration of the follow-up examinations were periods of 6 months, 1 year, 2 years, 3-4 years, 5-8 years, 9-14 years, and 15 years or more. At each follow-up visit, and preoperatively as well, the constant score as well as the external rotation and the shoulder flexion were assessed. At all these time points, radiographs were checked to catch any migration or loosening of the components.

All clinical parameters showed a substantial improvement from the baseline to latest evaluation at the follow up. A plateau was reached with the clinical results after one year. This remained stable without any further worsening results for a period of 8 years. They then remained good enough as the 6 month results had been until the postoperative 15 years mark.


It is now possible to recreate a near anatomic native bony shoulder anatomy reproduction with total shoulder arthroplasty. Function held up well predominantly for a long term and pain relief was substantial as well.

The top shoulder surgeon in Beverly Hills and Los Angeles is Dr. Raj. He offers total shoulder replacement surgery along with minimally invasive arthroscopic procedures for rotator cuff tendon problems. As a Top orthopedic surgeon in Los Angeles, Dr. Raj accepts most insurance and is an extremely compassionate doctor.

Call the office today – (310) 247-0466!


May 13th, 2015|Shoulder Surgery, Uncategorized|0 Comments

Overview of Traditional and Reverse Shoulder Replacement

Total Shoulder Replacement (Traditional and Reverse)

Total shoulder replacement is a surgery for those who have a severe cuff care. This replacement can result in pain and limited motion but for some patients may be the only solution. total shoulder replacements is a process which utilizes a plastic cup fit into your shoulder socket joint and a metal ball to represent the ball, in the ball and socket joint. These two items replace your existing ball and socket joint to provide better functionality and movement.

Who qualifies for a total shoulder replacement?

Total shoulder replacement is only recommended if you have endstage shoulder arthritis that cannot be repaired through any other means. It can also be recommended for people who have a cuff tear arthropathy, or those who have had a previous shoulder replacement surgery that was unsuccessful. People who experienced severe shoulder pain and have tried all other nonsurgical treatments but found no relief may also be candidates for the surgical procedure.

What happens during surgery?

This procedure replaces your ball and socket joint with the artificial ball and socket joint. It takes about two hours to complete. During the procedure your surgeon will make an incision on the front of your shoulder or the top of your shoulder. Through this incision they will remove the damaged phone and position your new components inside in order to restore function to your shoulder.

Surgical complications

This is a highly technical procedure and your surgeon will evaluate your situation carefully before you are approved. There can be a loosening or dislocation of the replacement components as well. If this occurs, the new shoulder joint may need to be re-operated.


After your surgical procedure your medical team will give you antibiotics in order to prevent an infection as well as pain medication. Many patients can get out of bed today after their surgery and eat solid food. Typically you will be discharged from the hospital and able to go home on the third day. When you leave you will have to keep your arm in a sling and follow the instructions of your surgeon diligently.

You will also have to craft a formal physical therapy program with your surgeon in order to improve the flexibility and strength in your new shoulder. You may need somebody with you for the first few weeks following your surgery, but after two weeks you should be able to eat on your own and dress on your own. You may also be asked to return to your surgeon’s office for x-rays in order to monitor the success rate of your new shoulder.

What can I do after surgery and what can’t I do?

You have to follow the exercise program prescribed by your Los Angeles shoulder surgeon. You should avoid any extreme arm positions for at least six weeks. You should not lift anything heavier than 5 pounds for the first six weeks. You should not push yourself out of a chair or out of bed. And you should not participate in any repetitive heavy lifting movements after this surgery.




April 20th, 2015|Shoulder Surgery|Comments Off on Overview of Traditional and Reverse Shoulder Replacement

Overview of Rotator Cuff Repair from a Los Angeles Orthopedic Surgeon

Rotator Cuff Repair

The shoulder has four muscles that comprise the rotator cuff.  These are the supraspinatus, infraspinatus, teres minor and the subscapularis. A rotator cuff tear is the injury that results when one or more of the tendons of the muscles forming the cuff are damaged. It may be partial or complete. The tears are common among athletes whose sport require overhead activity such as baseball and cricket players resulting in a great deal of headache for the players. The disease is also common with advancShoulder paining age but can also occur after trauma.

Affected individuals complain of night pain and difficulty sleeping on the affected side. The shoulder pain worsens with activity and there may be tenderness over the affected region. The patient may also complain of weakness and loss of motion especially when performing overhead activities. However, the condition may be asymptomatic. Unfortunately, rotator cuff tears do not have the ability to heal themselves and intervention is mandatory.

The diagnosis is made through history and physical exam coupled with appropriate investigations. A plain radiograph, an MRI and an arthrogram are common investigations that are ordered.

Traditionally, rotator cuff tears can be managed conservatively or through surgery. In partial tears, the treatment is non operative. The patient goes through six weeks of physical therapy and receives 2 steroid injections into the affected joint. Surgery is only an option once rigorous conservative management has failed. Surgery is the only treatment option for acute and complete tears occurring in healthy individuals. If comorbidities preclude a patient from surgery, the tears are managed conservatively.

The surgery can either be an open rotator cuff surgery, a mini open repair or an arthroscopic rotator cuff repair. General anesthesia or local anesthesia is given before the surgery.

Rotator cuff tear can be repaired using the three techniques:

Shoulder ArthroscopyOpen repair: Usually done in patients who have complex or large tears a large surgical incision is made to remove a large muscle and then the surgery is performed.

Arthroscopy: A small incision is made to insert an arthroscope that is connected on one end to a video monitor. The surgeon is able to see the inside of the shoulder and do the surgery.

Mini-open repair: An arthroscope is used to remove or repair any bone spur or damaged tissue and then a small incision is made and the rotator cuff is repaired.

The mini open repair technique utilizes an incision of two inches compared to five inches used in the open repair technique. Arthroscopy utilizes incisions of up to 0.5 inches. It has the best cosmetic outcome but is more difficult because of the limited view of the operating field and is not suitable for repair of all types of rotator cuff tears. Recent studies have demonstrated that arthroscopic repair are associated with a lower occurrences of post operative stiffness and patients exhibited a quicker return of overall function. Early repair of a tear is also a major determinant of the overall outcome. When left alone, a tear can progress and get to a point where it is irreparable, which is quite an expensive price to pay for the delay.

Incisions are put at the end of the procedure and a dressing is placed on the wound.

Risks of rotator cuff repair surgery

There are the usual risk of anesthesia including difficulty in breathing and allergy to the medicines. The other risks of rotator cuff repair surgery are infection of the wound, bleeding and injury to a nerve of blood vessel during the procedure.

The top shoulder specialist in Los Angeles and Beverly Hills is Dr. Raj at Beverly Hills Orthopedic Institute. Receive treatment from the best orthopedic doctor in Los Angeles, call today.

April 17th, 2015|Shoulder Surgery|Comments Off on Overview of Rotator Cuff Repair from a Los Angeles Orthopedic Surgeon

Shoulder Resurfacing (Arthrosurface) with a Beverly Hills Orthopedic Surgeon

One option to a total shoulder replacement is partial (hemi) shoulder resurfacing. Several orthopedic specialists use this alternative conservative procedure, which is less invasive approach to shoulder replacemcopeland_1ent. With the humerus (upper arm bone) resurfacing, a metal cap made of cobalt chromium resurfaces the head of the humerus bone.

This technique requires a smaller incision and less bone manipulation and removal, allowing the patient less pain as well as a quicker recovery period. The implant helps the patient avoid the need for a total shoulder replacement in the future. However, for those patients who do require the full replacement, the Beverly Hills orthopedic surgeon can utilize a less-invasive approach.

Ream and Run Procedure

One type of shoulder resurfacing procedure is called the “ream and run.” This surgery utilizes a tool called a reamer to restructure the damaged shoulder blade socket. After the reforming, the humeral head (upper arm ball) is replaced with a prosthesis, which fits into the socket to form the shoulder joint.

The ball of the upper arm prosthesis is connected to a metal stem that is inserted down the center of the humerus bone and cemented to secure placement. This replaced humeral head fits into the socket to create shoulder joint stability and restore full range of motion to the arm and shoulder.

Preparing for Surgery

To prepare for surgery, patients need to begin preoperative strengthening exercises. Also, to ensure optimal health, many orthopedic specialists in Los Angeles recommend a comprehensive nutrition plan. The Los Angeles orthopedic surgeon also goes over possible complications and obtains tests to minimize the potential for adverse reactions. To prevent falls, the orthopedic staff will discuss how to prepare your home appropriately.

After Surgery

smr_resurfacingFollowing the shoulder resurfacing procedure, you will be hospitalized for one to two days. After the surgery, the patient is taken to a recovery room for stabilization and then transferred to a regular patient room. The day following the procedure is when the bandages are removed. Physical therapy is ordered to restore motion and promote blood flow to the surgical site.

The patient has to wear a sling for approximately six to eight weeks in order to protect the soft tissues of the shoulder during the healing process. Once at home, the therapist teaches you various stretching exercises to assist with strengthening and range of motion. It is vital for the patient to continue these exercises as instructed by the physician and therapist.

Recovery and Rehabilitation

Recovering following shoulder resurfacing surgery is greatly reduced as compared to rehabilitation after a total shoulder replacement. Each patient’s recovery time will vary, but most individuals are able to drive in four weeks, and golfing and other sports can be resumed in three months.

The Los Angeles orthopedic specialist advises each patient on activities, as it depends on individual circumstances. The only things the patient cannot participate in are activities that lead to complications because they place extreme pressure on the shoulder joint.

Who is a Candidate for Shoulder Replacement?

  • People with rheumatoid arthritis, osteoarthritis, or avascular necrosis of the shoulder
  • Anyone with arthritic damage or a humeral head fracture
  • Young people with arthritis that is confined to the humeral head

Benefits of Shoulder Resurfacing

Shoulder resurfacing is an alternative to a total shoulder replacement. The orthopedic specialist determines who is a candidate for this procedure. The benefits to having the shoulder resurfacing done include:smr_prodottoBasso

  • A less traumatic procedure
  • Restoration of the normal shoulder anatomy
  • Quicker recovery with less pain
  • No risk of fracture to the prosthesis
  • No risk of embolus from the trauma of surgery
  • Easy revision of the surgery if necessary


October 26th, 2014|Shoulder Surgery|Comments Off on Shoulder Resurfacing (Arthrosurface) with a Beverly Hills Orthopedic Surgeon

Total Shoulder Replacement with a Los Angeles Orthopedic

Total shoulder replacement is a beneficial procedure for treatment of severe stiffness, pain, and immobility that occurs as a result of end-stage degenerative shoulder joint arthritis. The goals of this surgery are to give the patient relief from pain, restore motion, function, and strength of the joint, and to aid in the return to normal activities. Following a total shoulder replacement procedure, most people return to sports they enjoy, such as golf, tennis, swimming, and rackeShoulder instabilityt ball.

When shoulder arthritis occurs, the normally smooth cartilage surfaces of the shoulder joint erode away, denying the ball and socket smooth gliding against one another. When cartilage disappears, the result is a “bone on bone” joint, which leads to debilitating pain and loss of mobility.

Types of Shoulder Replacement

  • Open surgery: The total shoulder replacement open surgery involves removal of the damaged humeral head, called the joint ball, and replacement of that with a metal ball. Incisions are made at the upper arm and the front of the shoulder. Also, a new smooth plastic surface is placed on the upper arm bone, which is referred to as the socket. The metal-on-plastic allows for a full functioning joint.
  • Hemi-replacement: With a partial shoulder replacement (called a hemi-replacement), the ball is the only component replaced.
  • Minimally invasive arthroplasty: For patients who have shoulder conditions with diseased ligaments, tendons, and/or muscles, a minimally invasive shoulder arthroplasty is done. This works well when the patient has a torn rotator cuff or labral tear.
  • Reverse shoulder replacement: A new type of surgery to replace the shoulder joint is the reverse shoulder replacement. This surgery allows the ball of the joint to be positioned on the patient’s own socket, and the plastic socket is placed on the humerus bone. This reverse design allows the ball to rest against the socket rather than be positioned deep into the socket. The surrounding tendons hold the ball in place and allow for movement. The reverse shoulder replacement gives the shoulder more stability, allowing the shoulder to be moved by the deltoid muscle rather than the rotator cuff, which is perfect for patients who have damage to this structure.

The Open Procedure

During the open procedure, the orthopedic surgeon separates the deltoid and pectoral muscles to visualize the sur007(1)gical area. Also, the rotator cuff is opened by cutting the front muscles so the surgeon can see to manipulate the ball and socket of the shoulder joint. Once the arthritic regions are removed, the surgeon then inserts the implant ball, socket, and stem components. Once positioned, the area is closed by suturing up the rotator cuff muscle. A bandage is applied over the surgical incisions, and it must be kept clean and dry.

Either regional or general anesthesia (or both) is used for the total shoulder replacement procedure. Most patients are operated on in the beach-chair position. The implant materials are a metal ball and a plastic polyethylene socket.

Candidates for Shoulder Replacement Surgery

A shoulder replacement procedure is indicated for patients who have severe shoulder pain due to arthritis that is not controlled with conservative measures, such as injections and medications. Also, loss of range of motion and stiffness are reasons for shoulder surgery. These problems occur when the ball and socket rub against each other when there is not enough cartilage for smooth gliding.

To determine if the patient is a candidate for shoulder joint replacement, the doctor will order a magnetic resonance imaging (MRI) scan, x-rays, and possibly, a computed tomography (CT) scan. If nerve damage is suspected, a nerve conduction test (EMG) is done. For patients with ankylosing spondylitis of the shoulder, replacement alleviates the stiffness and improves overall joint function and mobility.

Patients who are not good candidates for a shoulder replacement procedure include those with:shoulder

  • Symptoms that are not severe.
  • Loss or paralysis of the deltoid muscles and rotator cuff.
  • Active infection.
  • Progressive nervous system disease.


Once the patient leaves the operating room, he or she is transferred to the recovery room, and the surgical arm is immobilized in a removal canvas sling. Usually, the patient wakes up from surgery in the recovery room, but pain will be minimal. Once stabilized, the patient is transferred to a hospital room. Based on stability of the implant and shoulder range of motion, physical therapy begins the following day (the first postoperative day).

During the early rehabilitation phase, the patient uses the sling to allow the tendons to heal without injury. The sling is only removed for showering and for therapeutic exercises. The physical therapist has the patient use the wrist and hand immediately following surgery, but use of the whole arm and shoulder doesn’t begin until approximately six to eight weeks following the procedure. Recovery landmarks include:

  • Three months post-surgery – Most people have around 50 percent of mobility but notice slight weakness of the shoulder.
  • Six months post-surgery – Most patients do not have pain. Strength and motion is about 66 percent of normal ability.
  • Twelve months post-surgery – Around 95 percent of patients are pain-free, and it is rate for someone to have significant strength or mobility issues.

Possible Complications

As with any surgery, a total shoulder replacement does have a few complications. These include:

  • Shoulder stiffnessBest Los Angeles Orthopedic Surgeons
  • Nerve damage
  • Instability (ball slips from socket)
  • Glenoid loosening
  • Infection


October 22nd, 2014|Shoulder Surgery|Comments Off on Total Shoulder Replacement with a Los Angeles Orthopedic

What are my Surgical Options for Shoulder Instability?

Shoulder doctor Los AngelesShoulder instability is a disorder that will lead to subluxation or dislocation of the shoulder joint (excessive mobility), and the ball may come out of the socket. There are two types of shoulder instability: traumatic instability and multidirectional instability. With the traumatic type of shoulder instability, the shoulder is forcefully dislocated during an injury, such as a fall or car accident. This results in torn tendons and/or ligaments. Multidirectional instability is when the shoulder joint becomes too lose and may dislocate or partially displace with simple movements. This type of shoulder instability is not related to injury or trauma.

When the orthopedic specialist diagnoses shoulder instability, non-surgical measures are often attempted first. However, when these treatments do not prevent further episodes of subluxation or dislocation, surgery is recommended.

Shoulder Capsule Surgery

The shoulder capsule is the compartment that surrounds the shoulder joint. This envelope contains several thick ligaments and other structures that stabilize the shoulder. Patients with multidirectional instability often have laxity of the ligaments and capsule looseness. Surgery to correct this instability is aimed at tightening the ligaments and decreasing the size of the capsule. The traditional shoulder capsule surgery involves an incision in the front aspect of the shoulder, which is called a capsular shift. The arthroscopic procedure is done by the aid of a tiny flexible tube that has a camera and is inserted into the shoulder for repairs.

Open Capsular Shift

An open capsular shift is a surgery performed to tighten the shoulder joint. With this technique, the orthopedic surgeon makes an incision at the front of the shoulder and detaches the subscapularis (area of the rotator cuff) to allow visualization inside the joint. The capsule is split, the bottom aspect pulled up, and the top pulled down to lessen volume.

The advantage of the open capsular shift is that it has been perfected and works well.  A top Los Angeles sports medicine orthopedic specialist can adequately visualize and tighten the joint to significantly reduce the shoulder capsule. However, the recovery is longer than other procedures due to the detachment of the subscapularis.

Capsular Plication

Capsular plication is a procedure performed arthroscopically. The Beverly Hills orthopedic surgeon will insert a tiny camera into the shoulder joint through a small incision and use sutures to grasp the areas of the shoulder capsule that need to be tightened. Some orthopedic specialists prefer this procedure because they can visualize the structures easily on the monitor and recovery time isn’t as long as with open surgery. Both bankart_repair_1techniques will work for shoulder instability, but the choice depends on the extent of the damage, the surgeon’s preference, and the patient’s health.

Bankart Repair

One of the most common structures involved with shoulder instability is the Bankart ligament, which causes the shoulder to be prone to anterior dislocations. Bankart repair involves stapling or sewing the ligaments and the labrum, on the front aspect of the joint, back into position. The orthopedic surgeon will clear away any torn or frayed edges and then drill holes for sutures into the scapula bone. The labrum and capsular ligaments are then attached to the bone. As they heal, scar tissue will anchor the ends to the bone.

Bankart repair surgery is usually done through an incision on the front region of the shoulder, but some surgeons use an arthroscopic technique. This technique means less time to heal and less time in the hospital.

Thermal Capsular Shrinkage

A newer procedure for shoulder instability is called thermal capsular shrinkage. The Los Angeles orthopedic surgeon uses an arthroscope to slide an electrode probe inside the shoulder joint. This electrode is heated and moved over the damaged ligament. The heat cause shrinkage of the capsule, as well as tightening. This surgery is still being perfected, and one complication is restricted shoulder mobility.

August 24th, 2014|Shoulder Surgery|Comments Off on What are my Surgical Options for Shoulder Instability?

Top 5 Things to Know About Rotator Cuff Repair

One of the feared injuries for pitchers, tennis players, and other athletes is a rotator cuff tear. When a tear of this muscular structure is severe, it can end the player’s career. The rotator cuff is a group of muscles and tendons that converge around the upper region of the humerus (upper arm bone). These structures form a cuff that holds the arm in place and permit movement in varying directions. Too much stress on the shoulder joint can lead to swelling and partial tears in the rotator cuff tendons. When one or more of these tendons pulls away from the bone or tears, it is considered a rotator cuff tear. Here are the top five things you should know about a rotator cuff repair.Shoulder doctor los angeles

1. Who is at Risk for a Rotator Cuff Tear?

Athletes are the most prone to getting rotator cuff tears. They include swimmers, baseball players (especially pitchers), tennis players, and football players. Other people are at risk for this type of injury also. A tear can occur from using your arm to break a fall, falling on the shoulder, lifting heavy weights, and degenerative tearing of the cuff.

Most rotator cuff tears are the result of wearing down of one or more of the tendons over time. This occurs with age and from heavy use of the shoulder. Repetitive stress on the shoulder occurs from throwing a baseball, pitching, playing tennis, rowing, and lifting weights. Also, bone spurs can put someone at risk for shoulder impingement, which over time, weakens the tendons and causes tearing.

2. What is involved in Rotator Cuff Surgery?

During the rotator cuff repair procedure, loose fragments of bursa, tendon, and other debris are removed from the shoulder space. This process is called debridement. Also, to make more room for the tendons, the surgeon may have to shave bone or remove bone spurs from the shoulder blade, which is called subacromial smoothing. Additionally, the torn edges of the supraspinatus tendon may need to be sewn together and attached to the humerus.

With the open surgery procedure, the surgeon makes a two to three inch incision in the shoulder. With the mini-open procedure, a smaller incision is made so the surgeon can reach the tendon by splitting the deltoid muscle. The mini-open surgery often requires a shorter stay in the hospital compared to the open procedure. Also, rotator cuff tears are repaired by arthroscopic surgery in some cases. General anesthesia or a nerve block must Shoulder painbe used for the procedure.

3. What occurs after a Rotator Cuff Repair Procedure?

You can expect mild discomfort after the rotator cuff repair, but the surgeon will prescribe analgesic medications for this. The arm will be placed in a sling to prevent risk of injury, and physical therapy is ordered for rehabilitation. When you awake from anesthesia, the therapist has you start doing flexion and extension exercises of the hand, wrist, and elbow. The day after surgery, the therapist begins passive exercises of the shoulder.

You are sent home and are expected to follow up with the physical therapist. He/she will teach you active exercises, where you move your shoulder and arm yourself, as well as stretches. This will start four to eight weeks after the procedure. The therapist will have you begin using light weights and progress to heavier ones to regain strength in the shoulder.

4. What are the Risks of Rotator Cuff Surgery?

Rotator cuff repair is done for tears that can occur from sudden injury or degeneration that occurs from stress and strain. The repairs for large repairs are not always successful, however. When the tissue is frayed or thin, the repair surgery is not as likely to work as when the tissue is healthy.

There are several risks associated with a rotator cuff repair procedure. These include infection of the surgical incision, blood loss, anesthesia complications, pain and stiffness that persists, damage to the deltoid muscle, injury to one or more of the tendons, nerve or blood vessel damage, and complex regional pain syndrome.

5. When is Rotator Cuff Surgery Deferred?

Rotator cuff repair is not always done when there is an injury or tear. Very large tears (greater than two inches) often cannot be repaired. Also, pRajLogoFeople who are not active and older than 60 years often do not improve with the procedure. In these cases, rotator cuff surgery can cause significant weakness and pain. For some patients, the orthopedic surgeon will do arthroscopic debridement to smooth the shoulder region so that surgery is not necessary.


August 5th, 2014|Shoulder Surgery|Comments Off on Top 5 Things to Know About Rotator Cuff Repair

FAQs on Shoulder Injury Treatment with a Los Angeles Sports Doctor

What is the anatomy of the shoulder?

The shoulder is one of the most mobile joints of the body, enjoying a wide range of motion. This is due to the ball and socket joint configuration that finds the humeral head centered within the glenoid fossa. The joint is stabilized by four rotator cuff muscles, namely the supraspinatus, infraspinatus, teres minor, and subscapularis. Aside from this, the shoulder also serves as an attachment for numerous muscles such as the deltoids, Shoulder doctor Los Angelesrhomboids, trapezius, among others.


How is the shoulder injured?

Due to its mobility and frequent use, the shoulder is at risk of injury. There are numerous conditions that can affect the shoulder, ranging from degenerative conditions to acute traumatic injuries. Athletes and people in professions involving frequent shoulder movements are at greater risk for shoulder injury.


How is a shoulder injury diagnosed?

While the specific presentation of symptoms will vary with each injury, most will manifest with pain and limited range of motion. The opinion of a top Beverly Hills or Los Angeles shoulder doctor is key to determining the proper diagnosis and treatment. The diagnosis is made after a complete medical history and physical examination. Additional imaging studies may be requested, such as X-rays, Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scans, when necessary.


What are some examples of shoulder injuries and how are they treated?

The following is a sample of shoulder injuries and a discussion of their treatment. Note that this should not replace consult with a physician.

  • Tendinitis – refers to the inflammation of the tendons, typically from repeated wear and tear, leading to progressive micro-trauma to the tendon. This manifests as progressive pain and limitaShoulder Arthroscopytion of movement. This is treated with rest and treatment with non-steroidal anti-inflammatory drugs (NSAIDs).
  • Sprains – refer to tears in the tendon. This may be partial or full-thickness. The preferred treatment option is immobilization and rest, followed by a program of physical therapy and rehabilitation. Surgery is reserved for the more severe cases that are unresponsive to conservative measures.
  • Impingement – tissues and nerves can be pinched against the bony tip of the shoulder blade (the acromion), leading to irritation and inflammation. This manifests as pain and limited movement, particularly when the shoulder is unstable. Physical therapy is the preferred option, although steroid injections may be used to reduce swelling and inflammation. Surgery is not typically done, although this may be warranted in some cases.
  • Dislocation –refers to the displacement of the humeral head from the glenoid socket. A condition of instability refers to the frequent dislocation of the shoulder, due to excessive laxity of the joint. Closed reduction will put the humeral head back in place. One of the biggest risk factors for dislocation is a history of previous dislocation, and it is recommended that patients undergo strengthening and conditioning of the rotator cuff muscles.
  • Fracture – refers to a break in the bones of the shoulder. This typically follows a history of acute trauma. Older patients are at greater risk for suffering fractures.
  • Separation – refers to the misalignment of the acromioclavicular joint, typically after tears to the ligament. This is normally treated with immobilization and rest, followed by a program of physical therapy and rehabilitation.



July 14th, 2014|Shoulder Surgery|Comments Off on FAQs on Shoulder Injury Treatment with a Los Angeles Sports Doctor