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Wednesday, December 7

Awake In-Office Shoulder Arthroscopy

In the past, diagnosis of shoulder problems such as rotator cuff tears required an imaging study such as an MRI. Recently technological advances have allowed for miniaturization of cameras to the point where a camera can be put at the end of a needle. These super-small cameras can be painlessly inserted into the shoulder, allowing the surgeon to evaluate the inside of the joint by directly looking. This tool is extremely useful, safe, and more accurate than MRI. This short video demonstrates the procedure. The shoulder is numbed with anesthetic and the camera is inserted. At the end of the procedure, a cortisone injection is given.

Sunday, November 6

Biceps tendon repair in the elbow

A tear of the distal biceps usually occurs in a man in his 50's or 60's.  The patient might feel a pop or tear.  Usually the injury occurs while lifting or lowering a heavy object.  A "popeye" deformity of the biceps muscle can sometimes be obvious, where the muscle "balls up" in the arm.  If a biceps tear has occurred, surgery is one option to regain strength and restore the normal contour of the biceps muscle.  Repair of the tendon should be considered in active patients.  The technique demonstrated here has the advantage of early motion, which begins the day after surgery.  Early motion allows for early healing and a faster, more complete recovery.

Thursday, April 21

An alternative to shoulder replacement? A new technique shows promise: Superior Capsular Reconstruction

The rotator cuff is a series of four tendons that stabilize and move the shoulder.  Rotator cuff tears are a common problem and can sometimes be treated without surgery.  Surgical repair of the torn tendon or tendons is sometimes required.

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Superior capsular reconstruction (source: Arthrex)
Occasionally, a tear is so severe that a repair cannot be performed.  Sometimes this is the result of a failed attempt to repair the tendon, and sometimes it is just the process of aging that makes it impossible to repair.  These tears are called "irreparable".  In a patient with this problem, options are very limited.  In general, the patient must either live with the problem or have the shoulder replaced with a special replacement called a "reverse" shoulder replacement.  The reverse shoulder replacement takes the place of the torn rotator cuff, but it is a big surgery and sometimes does not work.

Superior capsular reconstruction was developed in Japan as an alternative to shoulder replacement for patients with massive irreparable rotator cuff tears.  The technique involves taking a tendon or skin graft and reconstructing the top of the shoulder.  This technique reproduces the normal function of the rotator cuff.  Early results have been promising.  One study showed a significant increase in motion and strength in 23 patients treated with the technique.  Pain was also significantly improved. 

Who might benefit from this new procedure?  Ideally, a younger patient (50's or 60's) who has an irreparable rotator cuff tear but doesn't want a shoulder replacement. 

In my practice, I have begun to offer this procedure to selected patients.  Early results have been good, but the technique is still new and the results very early.  Time will tell if this procedure works well for everyone.  The good news, though, is that it is minimally invasive, safe, and still allows for a shoulder replacement to be placed later.