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!

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

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!

You’ve torn your ACL, now what?

By: Dr. Barry Kraushaar

The diagnosis of a torn ACL can be scary for any athlete. Fortunately, you can get back to your sport with proper evaluation and treatment. Here’s a better understanding of what you may be dealing with and your options.

Your knee is a hinge-type joint that is held together by ligaments. In the center of the knee are the Posterior (rear) and Anterior (front) Cruciate Ligaments (PCL and ACL). Together, these cables of collagen stabilize the knee when you pivot or perform sports. Unfortunately, the ACL is often vulnerable to tearing suddenly during a pivot/twist maneuver, making ACL tears a common sports injury. When an ACL tear occurs, a decision needs to be made about whether to live with a torn ligament, to repair it or to replace the ligament. It depends on patient function and future needs.

  • Living with a torn ACL: Some patients choose to live with a torn ACL. For younger people, it may not be advisable to live a lifetime with this ligament torn. Although in some cases the ACL ligament can scar onto the PCL and act stable, more often instability occurs and it should not be ignored. An unstable knee can develop secondary damage, such as meniscus cartilage tears, and over time this can result in early-onset arthritis.  For those who do not sense instability, an ACL-deficient knee may be treated with rehabilitation and a brace. A custom designed brace will fit more closely. When a knee already has arthritis, an ACL reconstruction may not only be unnecessary, but the surgery may actually “Capture” the knee and hasten the worsening of arthritis.
  • Repairing the ACL: Because the ACL ligament tends to spread into separate strands like a torn rope when it ruptures, a simple repair of this ligament is rarely possible. The torn remnant is usually rolled up or shortened and it is hard to make it attach to the place on the femur bone from where it usually detaches. On rare occasions, it may be possible to perform a micro-surgical repair of your own ligament and keep your own structure.
  • Reconstruction of the ACL:  The most common treatment for a torn ACL in an adult who has no arthritis is to replace the ligament. A replacement can be strong and long enough to bridge the area of ACL detachment. The ligament is routed through the center of the knee and fixed to the bones above and below so that it acts similar to the original. The success rate of this procedure is high, but not 100%.  
    • For older and less active patients, cadaver ligament graft can be used. It is less painful and has a quicker recovery, but there are reports that the failure rate is higher than using your own graft material.
    • For younger, active patients, the best success rates are achieved if you use your own Patellar tendon (in front of the knee), Hamstring or Quadricep tendons on the inner part of the knee. The outcomes of these graft types are similar, so your surgeon may have preferences based upon their experience.
  • Rehabilitation from ACL surgery is individual for every patient but most cases finish doctor-supervised acre after three months. Return to sports occurs as late as nine months, depending on the type of activity.

ACL reconstruction techniques and methods are still evolving. The fellowship-trained Sports Medicine specialists at Northeast Orthopedics and Sports Medicine keep up with current trends and bring the latest treatment to you. If you’ve experienced a ligament tear, contact us to meet with our physicians and discuss treatment options available for you. 

If you do encounter an ACL or other orthopedic injuries, contact us today to find out what’s wrong and how we can help.

Preventing Gardening Injuries

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year.

By: Dr. Doron Ilan

For most of us who enjoy gardening, it is a relaxing, safe hobby.  However, every year we see many people who are needlessly injured in their backyards. Nationally more than 400,000 gardening injuries are seen in the ER every year. Back injuries, hand lacerations/puncture wounds, infections, overuse tendinitis, bug bites, and heat exhaustion are some of the more common medical conditions seen in recreational gardeners. Here are a few tips to keep you safe this spring and summer.

  • Warm up: One of the most common mistakes is to head straight to the shed and start lifting heavy bags of mulch, soil, and equipment. This can lead to back sprains and muscle strains.  Instead, first, take a 5-10 brisk walk to warm up the muscles, loosen the joints and get the heart rate up a bit.
  • Wear gloves: This will prevent most thorn punctures, blisters, lacerations, and bug bites. It will also protect your skin from pesticides, bacteria, and fungus (often live in soil). A small cut can lead to a major infection. A light long sleeve shirt and long socks or pants can’t hurt either.  Don’t forget the sunscreen and a hat.
  • Hydrate: It is very easy to spend hours gardening without drinking. Bring a bottle of water outside with you and sip regularly
  • Rotate your tasks: Avoid overuse repetitive stress injuries by not spending more than 10-15 minutes in a row doing the same motion. Make sure your gardening activities are varied so that the same muscles are not used repetitively.
  • Use proper equipment
  • Check your skin for ticks after you finish gardening for the day. Lyme disease and other tick-borne infections are very common in our area.

Following these tips can help minimize your risk, but of course, if you do sustain an injury make sure to get medical attention as soon as possible.  Have a great spring and summer — and enjoy your gardening!

If you do encounter an orthopedic injury while gardening, contact us today to find out what’s wrong and how we can help.