Category Archives: Conditions

Dr. Anz specializes in numerous sports injury, traumatic and degenerative-related conditions associated with the shoulder, knee, and hip. He is dedicated to each patient and strives to make the proper diagnosis and treatment recommendation so that a full recovery can be achieved. Dr. Anz is dedicated to research and applies the latest research standards and techniques during his assessments and treatments. Every injury will be treated based on each patient’s unique circumstance; when surgery is recommended, you can depend on Dr. Anz to offer the best surgical approach, performed with the highest levels of skill and with the least invasive methods that are currently available.

Save the Menisci: Meniscal Root Tears

The menisci are c-shaped, rubber-like cartilage discs that reside inside the knee joint.  There are two menisci in every knee, one on the inner side (medial meniscus) and one on the outer side (lateral meniscus). Their function is to increase surface area for weight transmission between the cartilage on the ends of the bone, which decreases pressure between the ends of the bone and adds to stability of the joint.  Both the medial and lateral menisci have stout attachments at the front and back of the tibia, these attachments are often called “roots”. These meniscal roots are important because they hold the meniscus in place to provide stability to the entire meniscus. The stability is obtained by a functional circumferential hoop which the C-shape obtains with attaching at the roots. This functional hoop stability prevents the meniscus from extruding out when pressure is exerted across the joint, effectively keeping the meniscus in place between the two bones.

Meniscus tears can occur in a number of different shapes and scenarios. They can occur as a result of accumulative wear and tear of the joint or as the result of an injury. Sometimes, wear and tear changes in the meniscus can be subtle until an injury event occurs and the scenario is worsened drastically. Tears of the meniscus root are especially concerning because they compromise the functional hoop property of the meniscus, rendering the meniscus non-functional. When there is a tear of the meniscal root the studies have suggested that pressure upon the cartilage is increased to levels similar to having no meniscus at all. This can subsequently cause early degeneration of the joint.

Meniscus root tears are often seen in two groups of patients:

  • The first group consists of young adults and athletes who sustain a root tear with a severe knee injury. This may include injury to the ACL, PCL or other ligaments of the knee. Failure to repair the meniscal root in these circumstances can lead to the development of early osteoarthritis, failure of a ligament reconstruction graft and other potential problems with age.
  • The second group of patients are middle-aged adults. In this population, the injury is “acute on chronic”. There are degenerative changes at the root and then the meniscal root becomes non-functional with an injury event. A sudden knee bending event accompanied by a “pop” in the back of the knee, is often described by patients who have had a root tear. A sudden deep squat or twist are also sometimes described. In this group of patients, rapid development of osteoarthritis can occur.

Symptoms

The primary symptoms of a meniscus root tear include pain on the inside or outside of the knee with mechanical symptoms.  Certain activities such as pivoting, running, climbing, or even getting up from a chair may produce symptoms including popping and catching.  Patients may hear or feel a clicking sound with movement, and the knee may be tender to the touch for some in specific locations.

Figure 1, Coronal view of normal meniscal root

Diagnosis

While an X-ray will not show meniscal damage, it is necessary to evaluate the overall health of the knee joint, as subtle changes on X-rays are common and help to guide treatment. Although a history, physical exam and x-ray are important in diagnosis, an MRI is important to visualize the meniscal root (Figure 1). These root tears can be very difficult to identify on MRI but is most often diagnosed when a “ghost sign” is seen. Meniscal root tears can be seen on coronal, axial and sagittal MRI views. On the sagittal view, as seen in figure 3, there is a ghost sign which is indicative of a meniscal root tear. A normal, healthy meniscus should look like a dark black triangle. On the coronal view, as seen in figure 2, there is a tear of the meniscal root.

Figure 2, Coronal View with “Ghost Sign”

 

Figure 3, Sagittal View with “Ghost Sign”

Surgical Treatment

Treatment of meniscal root tears can be very difficult, especially in older patients. In older patients, repair can be difficult as tears are not commonly diagnosed until progression of arthritis is more severe. In younger patients, repair is much easier due to decreased prevalence of joint degeneration.

Figure 4, Normal Meniscal Root

An arthroscopic approach is utilized to repair the meniscal root.  Once access is made into the knee, Dr. Anz will visualize the meniscal root (Figure 4). A device is used to pull on the root to confirm the presence of a tear. After a tear is confirmed, Dr. Anz will use a guide to drill a tunnel at the anatomic site of the original root. (Figure 5) This tunnel will become the new home for the torn meniscal root. Sutures will be passed through the torn portion (Figure 6) of the meniscus and shuttled down into the tunnel previously drilled. Once the sutures have been pulled into the tunnel, Dr. Anz will visualize the meniscus and tighten the sutures and secure them with a suture anchor.

Figure 5, Drill bit coming up from root attachment
Figure 6, Sutures passed through the root repair

Post-Operative

After surgery, the patient will be non-weight bearing for 6 weeks to allow for healing of the repair. Physical therapy may be initiated the day after surgery. Range of motion at the knee is limited to 90 degrees of flexion for the first weeks in order to prevent excess stress on the repair. Six weeks after surgery a partial protective weight bearing program is initiated to slowly wean from the crutches. Patients should avoid impact activities, deep squats, and lifting in a deep squat for a minimum of 4 months after surgery to protect the meniscus root repair.

For more information on meniscus injuries, or to learn more about the surgical treatments for meniscus tears offered by Dr. Adam Anz, Orthopedic Surgeon/Sports Medicine Specialist, please contact our office

The Biology of ACL Healing: The Wild Card of Recovery

Ligamentization – The Wild Card

One of the most critical steps in ACL reconstruction is grafting a tendon into the knee to replace the damaged ACL. Following surgery, the graft not only has to heal tightly in its new position but also transition structurally from a functioning tendon to a functioning ligament—a process known as ligamentization. Believe it or not, this process takes time! Microscopic studies, in which physicians have taken small samples of healing ligaments following ACL reconstruction to determine their rate of ligamentization, suggest that this process can take anywhere from 6 to 24 months.

Continue reading The Biology of ACL Healing: The Wild Card of Recovery

When is an athlete ready for contact sports after ACL surgery?

Returning to Sport Following ACL Reconstruction

After ACL reconstruction, the most common question is also the most difficult to answer: “When will I be ready to go back to ___?” In short, there is no blanket answer; there are many factors that determine when the time is right for a patient to return to sport. These factors are physical, biologic and psychological in nature and they affect each patient’s recovery in a unique way. At the end of the day, return to sport is a decision that needs to be made on a patient-to-patient basis, weighing the benefits of continued rest and rehabilitation with the risks and benefits of returning to sport.

Continue reading When is an athlete ready for contact sports after ACL surgery?

Hip Instability

In orthopedics, instability occurs when patients have pain or discomfort due to abnormal looseness of a joint.   When a joint completely comes out of place it is called a dislocation.  When a joint partially comes out of place it is called subluxation.  In almost all cases involving the hip, it takes a great force or special scenario to dislocate, such as a motor vehicle accident.  Hip subluxations may require less force such as in the setting of football or soccer injuries.  With these types of injury, normal stabilizing structures may be compromised, for example ligaments that normally hold the joint securely in place may become stretched or torn. Hip instability may result and in this scenario it is known as traumatic hip instability.  A second type of hip instability is called acquired hip instability.  This type arises from recurrent microtrauma to normal stabilizing structures.  This can occur through normal activities in patients with abnormal anatomy such as in the setting of femoroacetabular impingment or hip dysplasia, or it may also occur in patients who perform certain repetitive activities which involve repetitive extreme movements which may slowly stretch the joint capsule with time.

Symptoms

Hip instability may cause one or more of the following symptoms:

  • •          Pain or the feeling that the hip will dislocate with certain movements
  • •          Deep aching in the hip joint
  • •          A repetitive clicking with certain activities or movements

Diagnosis

Dr. Anz will begin with a detailed discussion regarding previous injuries, surgeries, or activities that may include repetitive motions.  He will then perform a thorough exam of the hip joint and will assess the stability by performing specific movements and a series of stability tests. X-rays will be obtained to evaluate the joint space at the hip and check for underlying bony abnormalities.  If a patient has dislocated or subluxed his/her hip, it is often important to obtain a more in-depth study such as an MRI scan or a CT scan.

Treatment

Non-surgical treatment is almost always the best first step. After an initial traumatic event, a period of rest  to allow the capsule and/or surrounding soft tissue to heal is followed by a period of strengthening with physical therapy.  In patients with acquired instability, activity modification, strengthening methods with physical therapy focusing on pelvic girdle strengthening, and anti-inflammatory medications are the initial treatments. These treatments seek to reduce hip irritation and improve dynamic stabilization (stabilization provided by muscles) for the hip joint.  If these non-surgical treatments are not successful and symptoms continue, Dr. Anz may discuss surgery as an option.

Surgical Treatment

If surgery is necessary, Dr. Anz prefers an arthroscopic approach to treat hip instability.  Arthroscopic hip surgery uses several keyhole incisions, a tiny camera, and special instruments to allow Dr. Anz a complete view of the inside of the hip joint. The exact type of surgery will depend on the condition and/or the nature of the injury. Thus, each surgical treatment will vary from patient to patient. In some cases, Dr. Anz will tighten the hip capsule (inner lining of the hip joint).  The acetabular labrum is a structure important for hip stability. If it has been injured, it sometimes requires repair.  These procedures may occur in isolation, or together, in order to stabilize the hip and improve/maintain hip motion.

Post-Operative

Dr. Anz will prescribe a progressive, thorough physical therapy program following arthroscopic surgery.  Working diligently with a therapist after a hip surgery is important to regain motion, strength, and function.  Dr. Anz and his staff will outline a customized therapy regimen to guide patients toward the best recovery possible after their surgery.

If you have any questions relating to hip instability or any other hip related injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Subacromial Impingement

In many individuals, repetitive use of the shoulder can result in painful symptoms that make everyday activities difficult to perform. Subacromial impingement is one specific condition that affects adults, most commonly over the age of 30, and refers to the pinching (impingement) of the tendons of the rotator cuff between the humeral head and the acromion process of the shoulder blade. Irritation of the surrounding tendons leads to inflammation of the bursa which results in shoulder pain, and the inability to move the arm above the shoulder.  As the inflammation progresses, the symptoms become more severe and will occur more frequently.

In some cases, subacromial impingement may be associated with biceps tendonitis and/or rotator cuff tearing. Another factor that may cause shoulder impingement is weakness of the muscles around the shoulder blade, which cause it to sit in an inappropriate position and may predispose patients to the condition.  In addition, some patients have an abnormal shape to their bone, or have had a previous shoulder injury, both of which may be predisposed an individual to developing subacromial impingement.

Symptoms

The primary symptom associated with subacromial impingement is a sharp, piercing pain felt on the front of the shoulder with any type of overhead activity.  If the arm is resting, pain may not necessarily be felt, however, the arm will experience overall weakness making it difficult to use the affected arm for chores or activities.

Diagnosis

Dr. Anz will conduct a thorough physical examination that will include tests to check for pain level and mobility of the shoulder. Physical exam tests to assess for impingement include the impingement tests of Neer and Hawkins.  While shoulder impingement is relatively easy to diagnose based on the physical exam, Dr. Anz will require an X-ray and potentially a MRI to rule out if any other condition that may cause or contribute to the shoulder pain.

Treatment

In cases of subacromial impingement Dr. Anz will first recommend conservative treatment measures which consist of anti-inflammatories, rest, and physical therapy.  In many cases, these treatments are effective and surgery will not be needed. In cases with continued pain, an injection of corticosteroids to the subacromial bursa may help alleviate pain and allow the patient to make progress with physical therapy and accomplish longstanding relief.

Surgical Treatment

In more serious cases of subacromial impingement, Dr. Anz may recommend a surgical treatment. Arthroscopic shoulder surgery is often used to correct this condition. This surgery is performed through several very small keyhole incisions through which a camera and special surgical instruments are inserted. During this operation, Dr. Anz will assess the rotator cuff to make sure there is no injury. The area of inflammation in the subacromial bursa is then removed. The bone spurs causing the pinching are also removed and the entire area is smoothed down to allow normal, pain-free motion. In complex cases of impingement, Dr. Anz may also treat other conditions that will present themselves once he is inside the shoulder joint.  These can also be addressed during the surgery, and may include arthritis between the clavicle and the acromion, as well as inflammation of the biceps tendon.

Post-Operative

Following surgery, Dr. Anz may request that the arm be kept in a shoulder sling for a period of time to allow healing.  Soon after, he will prescribe a thorough rehabilitation program. This program is a combined effort between the patient, Dr. Anz, and the physical therapist and will introduce exercises, strengthening moves, and active range of motion in time. It typically takes 2 to 4 months to achieve complete relief of pain, but in patients who presented complex cases, full recovery may take up to a full year.

For more information on subacromial impingement, or to discuss your shoulder pain and shoulder injury with Dr. Adam Anz, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Sternoclavicular Joint Injuries

The sternoclavicular (SC) joint is a major joint of the upper body that is formed by the articulation of the collarbone (clavicle) and the center of the chest (manubrium). Most of the SC joint’s strength and stability originates from the joint capsule and supporting ligaments. SC joint injuries are often due to a direct blow or blunt force trauma that occurs to the collarbone. These injuries can also result from a traumatic landing to the shoulder area (such as in football). SC joint injuries are typically associated with a disruption of the supporting ligaments.

A sternoclavicular (SC) joint injury is relatively uncommon, but when it occurs, the affected ligaments are stretched or torn (partially or completely) causing the joint to become disrupted. Sternoclavicular joint injuries are graded into 3 types ranging from a first-degree injury that involves a simple sprain or stretching of the ligaments, to a second-degree injury where a portion of the clavicle becomes subluxated. In the most severe cases (a third degree SC joint injury), a complete rupture typically occurs between the sternoclavicular and costoclavicular ligaments, which permits the clavicle to completely dislocate from the manubrium.

Symptoms

The most common symptoms from an SC joint injury include:

  • Severe pain at or around the SC joint at the time of injury and afterwards
  • Bruising in the area
  • Difficulty swallowing, difficulty breathing, a sense of fullness around the neck or a feeling of choking sensation due to posterior displacement of the medial clavicle
  • Cracking noises, popping sounds
  • A feeling of instability where the clavicle feels like it “moves” during activities

Diagnostic Testing

Dr. Anz will conduct a thorough examination of the shoulder blade and collarbone. He will test for tenderness and pain, and evaluate the overall range of motion of the arm and shoulder. In some cases, he will be able to see if a dislocation or other major disruption has occurred, but an X-ray will usually confirm his diagnosis. Because ligaments and other soft tissue structures are typically involved with these injuries, he may also order an MRI to take a more in-depth look at this area.

Treatment

Non-Surgical

Surgery is not necessary for most SC joint injuries. Initial treatment consists of ice, pain medication and sling immobilization. Return to activity is based on type of sport and the position played, the arm injured (dominant versus non-dominant), and the severity of the sprain. In more acute cases, a reduction (or relocation) of the SC joint can be attempted by sedating the patient and pulling gently on the arm, manipulating it back into its normal position. This may allow the SC joint to ‘pop’ back into position.

Surgical

Operative treatment is reserved for patients who experience major trauma to the bones and ligaments of the SC joint. Dr. Anz will choose the type of surgery based on the exact injury, but in many cases will opt for a stabilization procedure that will allow him to reattach or repair any loose or torn ligaments of the SC joint. Without this stabilization procedure, a patient is a risk for future dislocations and/or subluxations, as well as the onset of arthritis.

Post-Op Recovery

Following surgery for an SC joint injury, it is critical that patients follow the prescribed post-op rehabilitation program as set forth by Dr. Anz. These guidelines will be broken down into phases and will be conducted with a therapist, and at home. Most patients are able to resume normal activities within 3-6 months; sports and other high impact activities may take longer.

For more information on sternoclavicular joint injuries or for additional resources on the other shoulder related injuries and conditions, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Shoulder Fractures

Fractures that occur within the structure of the shoulder joint can appear as a break or a crack in the bone on an X-ray. A shoulder fracture is generally classified based on which bone (clavicle, humerus, or scapula) is involved. A shoulder fracture can occur when sudden force, impact, or trauma has been sustained to the shoulder joint. Hard falls during sporting events or motor vehicle trauma are examples of possible causes of fractures in the shoulder.

There are 3 distinct bones within the shoulder that could sustain a fracture: The collarbone (clavicle) is the most common place where a fracture may exist; the upper arm bone (proximal humerus) can be fractured and is often related to poor bone density; a fracture of the shoulder blade (scapula) is less common, but usually occurs during a high-energy impact.

Fractures are classified as being displaced or non-displaced. In a non-displaced fracture, the broken pieces line up on each side of the break. Displaced fractures, in which the pieces on either side of the break are out of line, may require some type of manipulation to restore normal anatomy. Occasionally the rotator cuff muscles are injured or torn at the same time as the fracture, which can further complicate the treatment.

Symptoms

Shoulder fractures are usually characterized by pain with motion or palpation of the shoulder. Other symptoms include swelling or bruising of the shoulder area, a bump or bulge at the site of the break, or an inability to move the arm without pain.

Diagnostic Testing

A physical examination reveals pain over the bone, and often swelling or bruising is present. X-rays typically show the fracture. However, in more serious cases, 3-D imaging, such as CT scans or MRIs are often ordered to get a better picture of the fracture pattern.

Treatment

Non-Surgical

Many fractures can be treated without surgery, and heal in about 4 months. Many shoulder fractures can be treated with a simple sling and limited use of the shoulder until the pain and inflammation has subsided. By immobilizing the shoulder, the bone is allowed to heal, and once it has healed enough, physical therapy is typically ordered to regain motion and strength.

Surgical

The need to surgically repair a shoulder fracture depends upon your age, activity level, and the severity of your injury. Some fractures are better treated with surgery because they may carry a high risk of arthritis if left alone. There are many different types of surgery for different types of fractures including percutaneous pinning (placing pins in the bone to secure them back in place); open reduction internal fixation (ORIF—which involves opening up the fracture, realigning the bones, and putting a plate and screws in place to hold them together); and shoulder hemiarthroplasty – replacing the shoulder if the fractures are in too many pieces.

Post-Op

After any fracture surgery, proper rest and rehabilitation is critical to good success and improvement of pain and function. Dr. Anz will prescribe a very detailed physical therapy program that, if performed consistently and successfully, will help rehabilitate the injured arm. Most patients can resume normal activities within six months following surgery.

For additional information on shoulder fractures or to learn more about treatment for this shoulder condition, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Scapulothoracic Bursitis (Snapping Scapula)

The scapulothoracic joint is located in an area where the shoulder blade (scapula) meets and moves along the chest wall. The motion of the scapula is normally smooth because of the underlying scapulothoracic bursa, a fluid filled sac that aids in the movement of the scapula against the ribcage. If the bursa becomes inflamed from injury or overuse, a condition known as scapulothoracic bursitis may develop.

Scapulothoracic bursitis, also referred to as snapping scapula syndrome, is most often seen in young athletes who participate in repetitive overhead activities. However, the condition may develop in patients of any age. This syndrome is fairly rare and can also occur in individuals who sit or stand in a abnormal position for long periods of time and/or in patients whose shoulder movement was altered for long periods of time, such as in the setting of a shoulder injury.

Symptoms

Symptoms associated with a snapping scapula include pain located near the middle of the upper back (the top inside border of the shoulder blade) with movement of the shoulder. During shoulder movement, snapping, grating, and/or grinding noise is present. This is often accompanied by a dull ache in the shoulder blade and ribcage area. These symptoms may steadily progress with time.

Diagnosis

The most common physical exam finding in patients with this problem includes a grinding or snapping sensation over the inner aspect of the shoulder blade when the arm is moved. Dr. Anz will perform movement tests involving the shoulder joint to assess these symptoms. If he suspects that scapulothoracic bursitis is the condition causing the symptoms, he will most likely require an X-ray and MRI to confirm his diagnosis and to rule out any alternative abnormality. Once snapping scapula has been diagnosed, Dr. Anz will begin discussing treatments options according to the severity of the injury.

Treatment

Dr. Anz will prescribe a course of physical therapy to improve shoulder kinetics as the first line treatment for this condition. To manage pain during this recovery process, he may use a corticosteroid injection to the scapulothoracic bursa to relieve pain and allow further progress with physical therapy. Rehabilitation will focus on restoring normal scapular motion, eliminating positions which cause symptoms, and strengthening the musculature around the shoulder blade.

Surgical Treatments

If conservative treatments fail to ease the symptoms of snapping scapula syndrome and restore shoulder function, Dr. Anz may recommend surgery. In most cases, a minimally invasive arthroscopic approach can be used. This involves tiny keyhole incisions, a miniature camera, and surgical tools to assess and treat the bursitis. During the surgery, Dr. Anz will remove the inflamed scapulothoracic bursa, as well as areas of bone which may be attributing to the bursitis. These procedures are typically successful in relieving pain, eradicating symptoms of rubbing and snapping, and removing the areas of inflammation to restore shoulder motion.

Post-Operative

Dr. Anz will require patients to adhere to a strict rehabilitation program following arthroscopic surgery. Detailed guidelines, rehabilitation progression, and expectations for each of his patients will be outlined so that a full recovery can be achieved. Therapy is a vital part of the recovery process following a shoulder injury and is a partnership between the patient, Dr. Anz, and the physical therapy team.

For more information on snapping scapula syndrome or for additional resources on shoulder pain or scapulothoracic bursitis symptoms, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Rotator Cuff Injuries

Rotator cuff injuries are a very common cause of shoulder dysfunction in both young and old patients. The rotator cuff is comprised of a group of four muscle-tendon units that surround the shoulder joint and allow for overhead motion of the arm. The muscles and tendons that make up the rotator cuff also help stabilize the shoulder joint. A rotator cuff injury can occur when any of these muscle-tendon units become damaged. This is typically characterized by a separation or “tearing” of the tendon attachment off of the humerus. This can occur due to a number of factors, including:

  • Acute injury – Such as a hard hit or traumatic fall sustained in a sport or car accident
  • Chronic overuse – Continuous, repetitive movement that occurs with athletic training in activities such as baseball (pitching) or performing overhead movements like in tennis or swimming. On the job lifting of heavy objects can also lead to overuse.
  • Gradual aging – the degeneration of the muscles or tendons over time and normal wear and tear can cause a breakdown of collagen, thus making the tendons and muscles more prone to degeneration and injury.

When any of these risk factors are present, the rotator cuff may be at risk for a tear. Certain other conditions, such as impingement and tendonitis, can also contribute to tearing of the rotator cuff. These tears result in a significant amount of shoulder pain, weakness, and limited range of motion. The severity of the injury may range from a mild strain with associated inflammation to a partial or complete tear that might require surgery.

Symptoms

The symptoms of a rotator cuff injury arise from the inflammation that accompanies the structural damage. The most common symptom is pain over the top of the shoulder and arm. In some patients, the pain can descend down the arm towards the elbow. This pain is evident at rest and may interfere with sleep at night, especially when lying on the affected shoulder.

Another common symptom typically associated with a rotator cuff injury includes weakness of the shoulder in combination with pain, causing difficulty in lifting the arm up in overhead motions or performing seemingly simple tasks such as getting dressed or reaching up to grasp an object.

 Diagnostic Testing

Dr. Anz will conduct a thorough examination and will observe the shoulder joint to look for deformities, muscle wasting, or weakness of the affected rotator cuff muscles. He will touch and manipulate the bones and muscles that make up the shoulder joint to find areas of tenderness or pain. He will carefully check overall mobility and strength. In addition, a variety of tests may be utilized to determine which of the muscles or tendons of the rotator cuff is damaged including X-rays (to look at the joint) or an MRI (to assess the soft tissue and cartilage).

Treatment

Most rotator cuff injuries can initially be treated without surgery. The success of non-surgical treatment options depends on the type of rotator cuff injury (acute versus more established), the size of the tear as determined by the diagnostic tests, and the activities of the patient.

Non-surgical

The goal of treatment is to reduce inflammation and strengthen the uninjured muscles around the shoulder to compensate for the torn or injured muscles or tendons. Some conditions may be easily treated with a combination of ice and heat, rest and diminished use of the shoulder for a determined amount of time. Anti-inflammatory medications (NSAIDs) can also help.

Some patients may require the assistance of a physical therapist to help strengthen the muscle and increase flexibility through a special exercise program. Dr. Anz may inject a steroid, such as cortisone, into the area of inflammation if the pain persists. The cortisone shot is designed to act only in the area where it is injected and has a potent anti-inflammatory effect.

Surgical

The need to surgically repair a rotator cuff injury depends upon your age, activity level, and the severity of your injury. Dr. Anz strives to achieve maximum recovery with minimal surgery and often prefers an arthroscopic treatment approach:

Arthroscopic Rotator Cuff Repair

An arthroscopic rotator cuff repair is done through a series of small incisions. Dr. Anz utilizes a small camera to view the damaged tissue on a large television screen. He is then able to insert small instruments into the joint to achieve the repair. The advantage of arthroscopic surgery is that there is usually less pain and a faster return to normal activities.

Post-Op

A rehabilitation program will be prescribed at your first post-operative visit with Dr. Anz. This will usually entail a period of rest and minimal rehab to allow the repair to heal. After healing is achieved, a more aggressive regimen is prescribed with the goal of regaining motion and strength.

Rehabilitation after surgery is as important as the surgical repair itself. Without proper rehab, the chance of full recovery is diminished. Patients are advised to be good to the shoulder as the rotator cuff heals by avoiding extra and unnecessary physical stress.

For more information on rotator cuff injuries, or for additional resources on shoulder injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Labral and SLAP Tears

The labrum is a type of cartilage found in the shoulder that surrounds the socket (glenoid) and has two primary functions: 1) to deepen the socket so that the ball of the shoulder stays in place; and 2) the Labrum acts as an attachment site for other structures, such as the biceps tendon or shoulder ligaments. When there is an injury to the shoulder, such as a dislocation, the labrum can be peeled off of the rim of the socket (glenoid).

Labral tears can occur for a variety of reasons and there is a number of ways that this injury can affect a patient. The most serious is when the labrum is torn completely away from the bone. This acute, traumatic injury is often associated with a dislocation or subluxation of the shoulder. Another labrum injury is associated with a tear within the substance of the labrum itself. When this degenerative condition occurs, the labrum is left with an unsmooth, rough edge. This condition is usually found in older patients. A tear can also occur in the area where the biceps tendon attaches to the upper end of the socket (SLAP tear).

A SLAP Tear (Superior Labrum Anterior Posterior) refers to a specific type of labral tear in the shoulder, which is located at the top of the shoulder socket (glenoid) and involves the attachment site of the biceps tendon. Acute trauma and overuse are often the causes of this specific type of labrum injury.

Symptoms

A SLAP tear is often accompanied by pain deep in the shoulder, stiffness, a popping or clicking sensation or feeling of instability. Decreased range of motion or strength can also be present.

Diagnostic Testing

Dr. Anz will conduct a thorough examination and perform a physical examination to help determine whether or not you have a SLAP tear. During the evaluation, Dr. Anz will determine if the tear is associated with any type of pre-existing instability to the shoulder or if it’s from a particular traumatic event. X-rays will rule out any fractures or bone-related issues. Typically, an MRI is most effective in diagnosing a tear.

Treatment

Several key factors play a role in the decision-making process regarding treatment of a tear, including age, type of tear, and athletic profile.

Non-surgical

Initially, patients are directed to rest and ice the area, along with taking anti-inflammatory medications followed by a course of physical therapy.

Surgical

When non-surgical treatments fail, arthroscopic surgery of the shoulder is typically recommended. Generally speaking, there are three surgical options for a SLAP tear

 

  • Debridement: During a debridement procedure, Dr. Padelecki will smooth out the torn labrum during an arthroscopic surgical approach. This option is only suitable for stable SLAP lesions that do not seem to involve the biceps tendon.
  •  SLAP Repair: A SLAP repair is an arthroscopic procedure that uses anchors with sutures attached to secure the torn labrum down to the shoulder socket. A SLAP repair is the most common procedure done for symptomatic SLAP lesions and is typically reserved for young patients with an otherwise healthy shoulder who want to remain athletically active.
  • Biceps tenodesis: A biceps tenodesis cuts the biceps tendon from where it attaches to the labrum, and reattaches it to another area. By decreasing the forces that pull on the SLAP region, the symptoms will be alleviated. A biceps tenodesis can either be performed arthroscopically, or through a small incision.

Post-Op

A rehabilitation program will be prescribed at your first post-operative visit with Dr. Anz. Rehabilitation after surgery is extremely important, especially in athletic individuals who are seeking to get back into regular activity. Without proper rehab, the chance of full recovery is diminished and shoulder stiffness can occur.

For additional information on labral and slap tears, or to learn more about arthroscopic shoulder surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.