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Wednesday, November 4

Pectoralis Major Tendon Rupture in a Football Player

Pectoralis major (pec tendon) tears occur in young, active, male patients.  A torn tendon is usually obvious, and surgery is usually necessary to repair the torn tendon to restore strength and function.  Here I repair a torn pec major tendon in a college football player.

Monday, October 12

Did I tear my pec tendon?

In a previous post, I described a pec major tendon tear.  The pectoralis major is the large muscle on the front of the chest.  The tendon attaching the muscle to the test can tear, and this almost always happens in an athletic male performing bench press.  A torn pec tendon is very obvious:  the weight drops, there is severe pain and a feeling of something tearing, and a bruise usually develops.  The pec muscle looks deformed or "caved in".
A right pec tendon tear.

A pec tendon tear is more common in someone who uses steroids, because the muscle grows so big that the tendon can no longer handle it's force.  The presence and severity of a pec tendon tear is confirmed on MRI.
MRI: Arrows show the separated tendon.
A pec tendon tear can be partial and may not need surgery.  If the tear is more serious, however, then surgery is necessary to repair the tendon in order to maintain strength and a normal appearance.  Here I demonstrate the latest technique for repair of the pec major tendon.  A strong initial repair allows for early return to gym activities.

Surgery is very successful and 90% of patients are able to get back in the gym and back to their pre-injury level of function.

Tuesday, August 25

Distal Biceps Repair with Achilles Allograft

A distal biceps tear usually happens to a man in their 50's or 60's.  The biceps tendon usually tears with a heavy lift, or when lowering something to the ground.  Some people describe the sensation as being hit in the arm, a "pop", or like being shot in the arm.  Often there is immediate deformity, but not always.

Most people choose to have surgery to repair their biceps, but if several months have passed, the tendon can become scarred and impossible to repair.  In these cases, a graft can be used.  A graft is a tendon from a cadaver that has been specially prepared.  Here I repair a tendon that was torn 12 weeks ago.  The tendon was shortened and retracted and scarred, and could not be repaired.  I used a graft to reconstruct the torn tendon.
The tendon is seen.  It is too short and scarred to repair.

Here a graft has been sewn to the stump of the tendon.  The graft provides the length needed to repair the tendon back to the bone.

A hole has been drilled in the bone to accept the tendon graft.

The new tendon can easily be brought to the hole without any tension.  This ensures the tendon graft will not tear when used.

Here the tendon repair has been completed.  The graft is "docked" into the hole in the bone.

Saturday, June 20

Rotator Cuff Presentation to Missouri Administrative Law Judges

I was honored to speak to the Administrative Law Judges at the Missouri Division of Workers' Compensation 2015 Annual Meeting.  Often, I am asked to give my expert opinion on causation in rotator cuff tears.  Rotator cuff tears can occur from an injury, but also occur from "wearing out" over time.   I had a very interesting discussion with the judges about their legal perspective on this question.

Sunday, February 1

Do I have carpal tunnel syndrome?

Carpal tunnel syndrome is caused by a pinched nerve in the wrist.  Since the nerve is being compressed, signals can't flow through the nerve.  This causes pain, tingling, and numbness in the hand.  The pinched nerve is sort of like stepping on a garden hose.  When you step on the hose, water can't flow out the end.  With a nerve, when normal signals can't get through, your body perceives that as tingling and numbness.

One of the most reliable ways to know if you have carpal tunnel is to ask:  "Do I wake up at night with my hands numb?"  Most people with carpal tunnel syndrome will wake up at night with numb fingers, and have to "shake it out" by shaking their hands.  Most people with carpal tunnel will also notice their fingers going numb when they drive or hold a phone.

If left untreated, carpal tunnel syndrome can cause permanent damage to the nerve in the wrist.  People with moderate or severe carpal tunnel syndrome might consider carpal tunnel release surgery.  Carpal tunnel release is an outpatient procedure designed to relieve pressure on the pinched nerve.

Carpal tunnel release is a common procedure.  In this video I perform a carpal tunnel release.  The skin is open and the surgical scalpel is used to release the ligament compressing the nerve underneath.