The Rotator Cuff

By: Dr. Patrick Murray

The rotator cuff is a group of 4 muscles and tendons around the shoulder joint. The shoulder joint, like the hip joint, is a ball-and-socket joint. But unlike the hip joint, the ball is not constrained by the shape of the socket. The result is that the shoulder joint is capable of a greater degree and freedom of motion. The rotator cuff acts as a dynamic stabilizer of the shoulder joint, keeping the ball relatively centered in the socket as the shoulder “rotates.”

The 4 rotator cuff muscles are:

  1. Supraspinatus
  2. Infraspinatus
  3. Teres Minor
  4. Subscapularis.

The rotator cuff is subject to stress and injury from a variety of sources, ranging from shoulder dislocation to degeneration that occurs over time from use.

Symptoms and Diagnosis of Rotator Cuff Problems

There are many different ways that the rotator cuff can cause problems. These problems may also involve other associated structures, like the biceps tendon. Neck disorders, such as herniated discs, may also cause symptoms of shoulder pain. Symptoms that patients experience related to rotator cuff problems include pain, stiffness, weakness, and clicking or popping when moving the shoulder. Rotator cuff problems may or may not be caused by an injury. In some cases there is pain and inflammation, but no structural damage. In other cases, there may be structural damage to the rotator cuff. Making an accurate diagnosis requires obtaining an accurate history, performing a physical examination, and usually obtaining some imaging studies. Plain X-rays are very useful initially. Advanced imaging, such as ultrasound or MRI, may also be recommended. Once an accurate diagnosis is made, an individualized treatment plan can be constructed.

Impingement Syndrome

The supraspinatus tendon of the rotator cuff lies at the top of the shoulder joint, directly below a projection of the shoulder blade, or scapula, called the acromion.  When the arm is elevated overhead, the space between the acromion and the ball decreases, thereby putting more pressure on the supraspinatus tendon and the bursa that overlies it. This can frequently cause inflammation that is painful. This problem is called “Impingement Syndrome,” and is one of the most common causes of shoulder pain. Pain caused by inflammation of the rotator cuff is generally treated with therapeutic exercise, which may be done at home and/or under the direction of a physical therapist, and some form of anti-inflammatory medication. Cortisone injection may be required to alleviate pain, and in some cases, surgery may ultimately be necessary.

Image credit: rehabmypatient.com

Rotator Cuff Tears

In addition to causing pain from inflammation, the rotator cuff may also be damaged, or torn. Small, partial thickness tears of the rotator cuff are generally treated in a similar way to inflammation. A full-thickness tear, in which the tendon is detached completely from the bone, can range in size from small to massive, and is more likely to require surgery to repair. Rotator cuff repair surgery requires that the tendon be reattached to the bone. It can be performed with traditional open surgery, or with minimally invasive arthroscopic surgery. Recovery time varies, but usually requires at least 3 months, and physical therapy.

Full Thickness Rotator Cuff Tears

Full thickness rotator cuff tears increase in size over time, and patients do not always have symptoms as this occurs. When a rotator cuff tears gets larger, the mechanics of how the shoulder joint moves changes, putting more stress on the cartilage surfaces in the joint. This may eventually cause the development of arthritis in the joint, which can itself be painful and disabling. If a patient has a large chronic rotator cuff tear that has caused arthritis in the joint, several treatment options exist. Physical therapy may help restore range of motion and strength. Medications can alleviate pain when needed. There are several types of injections that can be performed, including cortisone, for relief of symptoms. Hyaluronic acid, or “gel” injections, can also be used for symptomatic relief. These are more commonly used for the treatment of osteoarthritis of the knee. Other injections, such as platelet-rich-plasma (“PRP”) and stem cell injections are currently considered experimental for treatment of rotator cuff disorders and arthritis. The last resort for treatment of this problem is a type of shoulder replacement called a reverse total shoulder replacement.

Image credit:  https://orthoinfo.aaos.org/

At Northeast Orthopedics and Sports Medicine, our physicians have the knowledge and experience to diagnose and treat the full spectrum of rotator cuff disorders, using the most advanced and minimally invasive techniques, including an array of non-surgical treatments. If you think you have a rotator cuff problem, schedule a consultation with one of our talented physicians for an evaluation and treatment plan today

NEOSM Gives Back for the Holidays

With generous contributions from our staff and physicians, Northeast Orthopedics and Sports Medicine is proud to have donated an incredible amount toys and pantry items in support of the East Ramapo Central School District (ERCSD) Family Center. Donations will be distributed to those in our community in need this holiday season. A big THANK YOU to all for making this season a bit brighter for our neighbors!

Understanding Carpal Tunnel Syndrome

By: Alan Gotesman, MD

Are you experiencing pain in your hand waking you up at night?  Do you have tingling in the fingers when you are driving or holding your phone? Is it getting difficult for you to manipulate small objects like buttons or clasps? You may have carpal tunnel syndrome. 

Carpal tunnel syndrome occurs when the nerve crossing your wrist is compressed, usually due to swelling of the tendons, which can cause pain and diminished sensation in your hands, particularly the thumb, index, middle and half of the ring finger. Typical symptoms are pain that wakes people up at night that needs to be “shaken out”, numbness and tingling as well as weakness and difficulty performing activities requiring fine manipulation. The diagnosis can usually be made with a detailed history and physical examination but confirmation can be performed with a nerve test called EMG’s that can determine the severity of the nerve compression and rule out other causes.

In milder forms, carpal tunnel syndrome can be treated with bracing, anti-inflammatories and cortisone shots. Once the compression is more severe, releasing the pressure on the nerve can be crucial to relieve the symptoms and prevent permanent nerve damage which can occur with chronic compression of the nerve. Newer minimally invasive techniques are available that allow the procedure to be done through a quarter-inch incision with the assistance of a camera. This technique allows for a quicker recovery process as well as less postoperative discomfort.  Results of surgery are generally excellent with many patients going back to all of their activities within 6-8 weeks.

If you think you may be suffering from carpal tunnel syndrome, the first step is to have an evaluation so schedule your appointment with one of our board-certified specialists today for an evaluation. 

Hudson Valley Top Docs 2019

Northeast Orthopedics and Sports Medicine is beyond proud to announce that twelve of our physicians have been named Top Doctors by Hudson Valley magazine. Congratulations to our doctors for this recognition of their commitment to exceptional care!

Hudson Valley Magazine Top Doctors 2019

Orthopedic Surgery

  • Kenneth Austin
  • William Davis
  • Barry Kraushaar
  • Mark Medici
  • Patrick Murray
  • Steven Renzoni
  • Richard Semble
  • Jordan Simon

Physical Medicine & Rehabilitation

  • Michael Robinson

Rheumatology

  • Shivani Purohit Mehta

Sports Medicine

  • Mark Berezin
  • Richard Popowitz

Where Tech Meets Tech Can Help Your Knee

By: Dr. Barry Kraushaar

Total knee replacement is evolving in ways that will improve outcomes for our patients in the future. While around 95% of knee replacements are good or excellent at five years, there is still room to reduce problems with Total Knee cases in the future. Two areas where technology is guiding surgery outcomes are in the precision for positioning components and in eliminating the need for acrylic bone cement, which sometimes crumbles or loosens.

Component Positioning with Surgical Robot

One advancement over the past few years is the use of a surgical robot as a tool to optimize the precision in the process of putting the implant in the best position possible. We at NEOSM have been using this device with great success since 2017, and our results have been incredible. The surgeon can make real-time adjustments to their preoperative plans during the case, measuring each decision against the robotic feedback that technology gives us. This decreases the likelihood of the knee being too loose or too tight, and allows the surgeon to test stability before the end of the case.

Cementless Knee Replacements with Robotic Guidance

The precision of robotic surgery helps us meet another need for future knee replacement patients. In total knee replacements, acrylic bone cement is applied to the undersurface of the metallic components and acts as a cement to provide stability.  The downside is that bone cement is a brittle substance. It does not flex and deform with motion. Rather, it tends to crack and does not heal itself. Over time pieces can break off and act as particles to create debris in the joint which can be abrasive. If the use of cement can be avoided then there will only be a bone-metal connection with no debris. Robotic surgery provides a predictably precise surface upon which to rest a “press-Fit” total knee replacement, allowing for a cleaner match and better outcome. The immediate stability is achieved by the pegs and surface shapes of the total knee implant components, and, in the long term, the porous inner surfaces of the devices provide a way for bone to grow into the tiny spaces and form a long term bond.

Cementless knee replacements are not new. They have been around for decades, but recently the popularity of this technology has grown when used alongside robotic guidance. Currently only a small number of patients who have ideal circumstances receive cementless total knee replacements, but that number may grow if it becomes apparent in the long run, there are even better outcomes in the future. NEOSM surgeons remain attentive to emerging trends and we are applying these advances to our patients with careful consideration.

Each case is different, so we encourage you to schedule your consultation with one of our orthopedic surgeons today to discuss options available to you.

NEOSM Staff Go ‘Pink for Hope’

October is Breast Cancer Awareness Month and NEOSM is proud to celebrate survivors, bring awareness to early detection and support research efforts to find a cure.

On October 18th, our staff participated in our ‘Pink for Hope’ day by proudly wearing pink and contributing to the American Cancer Society.  We’re so thankful for their show of support!

Together, we stand behind all the mothers, daughters, sisters & friends who are survivors or soon-to-be survivors!

Is the sport you love causing you pain? Understanding Tennis/Golfer’s Elbow

By: Dr. Neal Shuren

Tennis and golf are two of the most popular sports, especially amongst adults. As enjoyable as they are to play, overuse can lead to pain of the elbow, commonly called Tennis or Golfer’s Elbow. Both tennis and golfer’s elbow are very common and affect both men and women, mostly between the ages of 40 to 50 but can occur at any age. It can also arise from activities not related to sports, such as household chores or work that requires repetitive gripping, like painting, but can also occur form a traumatic injury, such as a blow to the elbow.

Symptoms 

Pain with activities such as lifting, gripping and grasping that starts in the elbow but often radiates down the forearm to the hand. 

Diagnosis and Treatment  

The diagnosis of tennis or golfer’s elbow is usually made clinically by a thorough history and physical examination by your doctor. Sometimes your doctor may order different images such as X-Rays or MRIs to rule out other conditions.

Prevention and Treatment

  • Activity Modification 

If the pain is from playing tennis or golf it is often recommended that you be evaluated by a tennis or golf professional to make sure you are using proper equipment and have proper technique. 

  • Rest & Ice

It may be necessary to stop the aggravating activity all together, for a period of time to allow the soft tissues to heal. Try to avoid heavy lifting, pushing, pulling or repeated hand shaking. Using two hands for heavier lifting can help protect the injured arm. Apply ice 2 to 3 times a day for 15 to 20 minutes at a time when the condition first starts or after actively using the arm to help diminish the inflammation.

  • Stretching 

Stretching can help with tendonitis by keeping muscles and tendons flexible and preventing stiffness. It can also help break down scar tissue that may have formed.

  • Physical/Occupational Therapy

Therapy can help in many ways. Initial treatment is aimed at diminishing inflammation and stiffness while subsequent treatment helps strengthen forearm muscles, which can help prevent future episodes from occurring.

  • Medications 

If there are no medical contra-indications, over-the-counter pain medication, like Advil, Aleve or aspirin, can be taken to help reduce inflammation and pain.

  • Bracing

The counter-force brace is a padded strap that can be worn on the forearm, just below the elbow. By putting gentle pressure on the muscles, tension is released on the tendon. Bracing can be used for treatment and can be used to prevent recurrence in the future by wearing for all activities that put a lot of stress on the arm.

  • Cortisone Injections

Cortisone injections usually reduce the pain in the arm for an extended period of time but do not always diminish the time it takes for the elbow to fully heal. 

  • Platelet Rich Plasma (PRP)

PRP is a procedure where blood is withdrawn and then is processed to concentrate the platelets so they can be re-injected into the area of tendonitis. This procedure can usually be done in the office. This is a newer technique and research on this treatment modality continues.

  • Surgery

Surgery is the last resort. If conservative treatment fails and symptoms have been present for at least a year then surgery can relieve the pain. The aim of surgery is to remove degenerated or worn out tissue from the tendon and release tension on the tendon. Symptoms can take several months to fully resolve and a small percentage of people may still have some symptoms, even after surgery.

Prognosis 

Most cases of tennis and golfer’s elbow will resolve with conservative care but can take a long time to fully resolve.

If you have been suffering from symptoms of golf or tennis elbow, schedule a consultation with one of our talented physicians for an evaluation and treatment plan. 

NEOSM Annual Backpack Drive

Once again, NEOSM has had the honor to support the amazing team at the East Ramapo Central School District Family Resource Center by providing school supplies and backpacks for the children of our community. Our physicians and employees contributed a countless number of back-to-school basics that are necessary for the students in our area to succeed. We wish all of them a wonderful year full of learning! 

A special THANK YOU to the ERCSD Family Resource Center for all that they do throughout the year!