May 2012 | Issue 02

Shoulder Replacement Surgery

Are you suffering from severe shoulder pain?

Has your shoulder pain from arthritis gotten so bad that you can no longer function well or tolerate pain with even simple daily activities?  Has the failure to respond to more conservative treatment measures left you wondering about the next step?  Suffering from shoulder pain can limit personal freedom and mobility. Though not as common as knee or hip replacement, shoulder replacement surgery is a common treatment for people suffering from painful shoulder conditions.  

Approximately 53,000 shoulder replacement surgeries are performed each year as treatment for injuries, broken bones, osteoarthritis, rheumatoid arthritis, and even tumors in or around the shoulder.  The procedure should be considered when less drastic, non-surgical treatments for shoulder pain have failed.  Total shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant.  

The ball and socket joint of the shoulder is comprised of two main components, the round end of the arm bone, or humerus, and the open end of the shoulder blade, known as the clavicle.

Total shoulder replacement surgery replaces the round end of the arm with an artificial round, metal head. The socket of the shoulder blade is replaced with a smooth, plastic shell held in place with cement.  In the instance that only one of the two bones needs to be replaced, the surgery is referred to as a partial replacement.  The primary goal of shoulder replacement is pain relief, with a secondary benefit of restoring motion, strength, and function.  

After surgery, patients are put on a regimen of pain management and rehabilitation.  Just like any joint replacement, the success of the surgery depends on many factors, including the advanced state of the arthritic joint at the time of surgery, the overall health of the patient, and most importantly the dedication to the physical therapy required after the surgery.  After full rehabilitation, most total shoulder replacement patients enjoy pain-free function, which enables them to return to their favorite activities, including golf, swimming and tennis.  

The ORA Orthopedic surgeons have extensive experience with the most innovative and trusted shoulder surgical techniques and implants.  We will help you in your decision making process and decide whether a total shoulder replacement is necessary and can provide the best possible outcome to your condition. 

Physician Feature:

Dr. Andrew Bries specializes in sports medicine with a specific interest in evaluating injuries and conditions of the shoulder and elbow.

As a fellowship-trained sports medicine physician, Bries’ clinical interests include diagnosing and treating sports and activity-related injuries and conditions.  He has extensive training and experience in advanced arthroscopic and minimally invasive surgical techniques which increase the efficiency and effectiveness of the procedures and reduce recovery time.  Arthroscopic procedures include rotator cuff repairs, shoulder instability repair, ACL and PCL reconstruction, meniscectomy and meniscal repair, and hip and elbow arthroscopy.  Bries performs complex reconstructive surgical procedures of the shoulder, including shoulder reconstruction and replacement

An Iowa native, Bries pursued a Bachelor of Science in Biomedical Engineering at the University of Iowa. Upon completion of his degree, Bries continued his education at the university, earning a Doctor of Medicine in 2005. Bries completed his residency in Orthopedic Surgery at Summa Health Systems in 2010, followed by a fellowship at Steadman Hawkins Clinic of the Carolinas, specializing in Sports Medicine and Knee and Shoulder Reconstruction in 2011.

Bries practices at clinics in Bettendorf and Davenport, Iowa. He is a member of the American Medical Association, the American Association of Orthopedic Surgeons, the American Association of Sports Medicine, and the Arthroscopy Association of North America.

Preventing Golf-Related Back Injuries

Each year, spring brings the return of warm weather, blooming foliage and golf.  Though many consider golf to be a low-impact sport, more than 55,000 hospital visits were attributed to golf-related injuries in 2009.

 Most injuries occur from the repetitive movements of the sport, focusing stress on the same muscles, tendons and joints over and over. The powerful rotation and extension motion of a golf swing can be especially brutal on the lower back.

As the season approaches, it is important to prepare your lower back for the increase in stress. Most often, injuries are caused by poor swing posture, however, poor flexibility and muscle strength also contribute to strains on the back.

Increase both by implementing a few simple exercises into
your routine:

• Rowing
   
• Pull Downs
   
• Yoga and Pilates

A Lesson in Runner’s Knee

Runner’s knee is a term used to refer to a number of medical conditions that cause pain around the front of the knee.  While classically associated with long-distance running, any activity that places significant stresses on the front of the knee joint can result in “runner’s knee”.   This includes repetitive jumping sports like basketball or volleyball, as well as skiing, cycling and soccer.  

Runner’s knee, or patellofemoral pain, is the result of irritation of the soft tissue around the front of the knee and an abnormal loading of the underlying bone.  Many factors contribute to the development of runner’s knee, including malalignment of the kneecap, dislocation of the kneecap, muscle imbalance, inadequate stretching, and overuse with running and jumping activities.

The most common sign of runner’s knee is a dull, aching pain under the front of the kneecap, where it connects with the lower end of the thighbone.  While the pain develops during activity, it can often be most pronounced afterwards during a period of rest.  Pain is also felt after sitting for a long period of time with the knees bent.

A history and physical examination by an ORA Orthopedics’ sports medicine specialist will help determine the cause of the pain. The examination will check the alignment of the lower leg, mobility, flexibility, and strength.  In some cases, the specialist may order diagnostic imaging such as an X-ray, MRI, or a CT scan to identify damage to the knee and tissue.

Treatment is usually non-surgical, consisting of a combination of rest and nonsteroidal anti-inflammatory medication such as aspirin.  In the case that surgery is necessary, treatments include arthroscopy and re-alignment surgery to improve the tracking of the kneecap (patella). The ORA Orthopedics’ sports medicine specialists will develop an individualized and customized treatment plan to fit your specific needs.

Preventing Runner’s Knee:

Runner’s knee can easily be prevented by taking the correct precautionary measures. To protect yourself from injury, follow the steps below:

• Stretch and warm up thoroughly before any running or jumping activities.  
   
• Stay in shape – keeping leg muscles strong and flexible will provide better support for the knee, making exercise less irritating.
   
• Wear proper shoes and orthotics – flat feet can predispose to maltracking problems and knee pain.  Orthotics to reconstitute the arch of the foot can help to alleviate these symptoms.  High heels can also worsen anterior knee pain and should be avoided if you have runner’s knee symptoms.  
   
• Quadriceps Strengthening – a strong quadriceps will improve the tracking of the kneecap and help minimize contact pressures between the kneecap and the thighbone.

Rotator Cuff Tears

Rotator cuff tears are a surprising common cause of shoulder pain and disability.

Last year, over two million people in the United States went to their doctors because of a rotator cuff problem.  Rotator cuff tears afflict a wide range of the population, from middle-aged weekend warriors to retirees.  A torn rotator cuff will weaken your shoulder. This means that many daily activities may become painful and difficult to do.

What is a rotator cuff?
The rotator cuff is a group of tendons that connects the four muscles of the upper shoulder to the bone.  The rotator cuff attaches the upper arm bone (humerus) to the shoulder blade (scapula) and helps to lift and rotate your arm.  This anatomy allows the shoulder more range of motion than any other joint in the body.

What is a rotator cuff tear?
A tear occurs when injuries cause one or more of the rotator cuff tendons to become torn.  In the case of a tear, the tendon no longer fully attaches to the head of the humerus.  Tears can be either partial, where damage occurs but the tendon is not completely severed, or full-thickness (complete tear).  In a full-thickness tear, the soft tissue is split into two pieces and in most cases the tear occurs at the head of the humerus.

What causes a rotator cuff tear?
Many factors can contribute to these rotator cuff tears, including falling, lifting, repetitive arm activities – especially those done overhead, such as throwing a baseball or placing items on overhead shelves, lack of blood supply, and shoulder impingement caused by bone spurs.

Rotator cuff tears are segmented into two main classifications:

• Acute Tear: Acute tears are caused by a traumatic event such as a fall or heavy lifting.

• Degenerative Tear: Long-term overuse resulting in a tear is known as a degenerative or chronic tear. These types of tear develop slowly over time.

What are the symptoms of a rotator cuff tear?
The most common sign of a tear is pain in the shoulder region - either when the arm is at rest, or when the arm is moved in a specific way.  Weakness when lifting or rotating the arm is also a sign there may be a tear.  For acute tears, the trauma usually results in a sudden, intense pain.  This can be accompanied by a snapping sensation and immediate weakness in the arm.
In degenerative tears, there may be a dull, aching pain that gradually increases or moves down the arm with time.  It may be difficult to lift the arm out to the side or over the head.

How is a tear diagnosed?
Our ORA Orthopedics’ shoulder specialists will perform a physical exam consisting of a series of tests designed to pinpoint the cause of the shoulder pain.  The tests include a variety of arm movements that may cause temporary discomfort, but will aid in identifying the source of the pain.  In some cases, imaging tests may be needed to confirm the diagnosis.

What are the treatment options?
Many of these injuries, especially small or partial-thickness tears, can be treated with anti-inflammatory injections and physical therapy – strengthening the remaining rotator cuff and compensating for the torn portion.  

Rotator cuff tears do not heal and in fact, they tend to get larger with time.  Surgery may be recommended if the pain does not improve with nonsurgical methods or there is a full-thickness tear.  Surgical options include minimally invasive arthroscopic repair or mini-open repair.  These techniques repair the torn tendons with minimal trauma and scarring to the overlying muscle.  

If the tendon is torn over a long period of time, the muscle may atrophy to the point that it will not move again.  In these scenarios, repair is not advisable as it will not improve function.  In this situation, anti-inflammatory injections or minimally invasive surgery can remove the inflammatory tissue and may allow the shoulder to move with less pain.  

The shoulder specialists at ORA Orthopedics employ a wide variety of options to treat rotator cuff tears.  Regardless of your age, size of tear, or even if you have had a failed rotator cuff tear in the past, we have the experience and training to help restore you to a pain-free and mobile shoulder.

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