Category Archives: Shoulder Treatments

Dr. Anz is skilled in arthroscopic shoulder surgery, and other progressive techniques of the shoulder. After he has consulted with you and determined that shoulder surgery is the appropriate step to take, he will discuss which surgical procedure will offer you the most optimal outcome for your particular injury.  Each shoulder surgery and technique is different, and may require varying steps and/or stages depending on how complex your shoulder injury is. Therefore, each procedure is uniquely tailored to fit the situation. While some of the procedures might be handled arthroscopically, some will require an open approach.  Physical therapy will be prescribed, and as a team, you both will work towards the goal of a full recovery.

Shoulder Replacement Surgery

Osteoarthritis of the shoulder can be a debilitating condition among the older adult population.  Typically beginning as arthritis, it can take years of wear and tear to cause osteoarthritis and the symptoms that can at times almost be too much to take for some patients. For these patients, once conservative and joint preserving options have been exhausted, shoulder replacement surgery is often recommended.

Shoulder replacement surgery, also known as shoulder arthroplasty, has come a long way in recent years and many patients are able to sustain normal lives following the procedure. During replacement surgery, the natural degenerated cartilage and bone of the shoulder joint are replaced with metal and plastic components.  The metal and plastic components are kept in place with a combination of medical bone cement and tightly fitting the components in place.  These components allow a painless motion of the shoulder after surgery.

It’s important to note that replacement surgery, while it often brings similar, positive results for patients, may not have forever lasting effects.  Most patients are able to live pain-free and active for years following this surgery, however, it is a procedure that is not typically recommended for patients under the age of 65 because it often is considered a last resort procedure to treat osteoarthritis.

Shoulder replacement surgery will require physical therapy and rehabilitation so that the shoulder joint can regain strength, motion, and overall mobility. Initial therapy focuses on safe motion with certain restrictions for 6 weeks.  After a recovery period of 2-3 months, patients typically are painless and performing well with their normal activities.

For more information on the treatment of osteoarthritis of the shoulder, or to learn more about shoulder replacement surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Arthroscopic Revision Rotator Cuff Repair

The rotator cuff muscles are a very important part of the shoulder joint because they are responsible for all forms of rotation and provide the shoulder the strength it needs in order to perform certain activities.

The rotator cuff is a series of four muscles that make up, and surround the shoulder joint – each one responsible for centering the ball in the socket of the shoulder and providing strength to move the arm and participate in overhead activities.

The muscles that make up the rotator cuff are surrounded and connected by tendons.  Individuals who partake in constant shoulder rotations (such as swimmers), who are injured in sports, or those who experience a traumatic injury such as from a fall or accident, risk damaging these tendons.  This damage may be in the form of inflammation from overuse or bursitis, or from an impingement.   Degenerative wear and tear from chronic overuse can also be the cause for injury. There are a variety of conditions that can occur from damaged rotator cuff muscles-these conditions usually involve a tear in the muscle or tendon.  Depending on the exact injury, treatment can help alleviate the pain and restore function to the shoulder joint.

In the case of rotator cuff injuries where a partial tear, or complete tear, of the muscles or tendons exist, surgery is usually needed to correct this injury. Dr. Anz typically uses an arthroscopic approach to repair rotator cuff tears. In some circumstances a patient may have a re-tear of the rotator cuff after a previous repair. This is often do to some sort of traumatic occurrence which leads to re-injury (and in many cases, is a sign that the patient may have returned to activities too quickly after the initial surgery.)

In these cases, a revision rotator cuff repair is typically required to provide the patient with an optimal outcome. A revision repair is a more difficult procedure due to the complexity of dealing with a tendon that has now torn multiple times and the fact that a repair has already been completed previously.

Dr. Anz conducts revision rotator cuff repairs via an arthroscopic approach as well. During surgery, his primary focus is to use as much of the healthy tendon as he can and reattach it to its native footprint. Some cases may involve a graft or additional attachment to assist in this process. Dr. Anz may also use assisted techniques such as a marrow stimulation healing response or platelet rich plasma.

The revision surgery, and the intricate nature of how it is performed will determine on the exact type of tear or re-tear. In very severe cases involving large, traumatic and chronic re-tears, full repair may not be achievable. These cases are treated with partial repairs, augmentation, or debridement.

After revision rotator cuff surgery, Dr. Anz will prescribe a very detailed, thorough physical therapy and rehabilitation program. The patient’s arm will placed in a sling and therapy will start almost immediately after surgery. The specific progression of rehabilitation will depend on the injury, type of repair, nature of the surgery, age, and overall health of the patient.  Initially, the patient will need to remain in the sling for a period of 6-8 weeks. Therapy typically involves passive range of motion moves, followed by active motion, strengthening, and a slow, steady return to activities.

For additional information on rotator cuff repairs or revision rotator cuff repairs, or for additional resources on rotator cuff injuries and other shoulder conditions, please contact the office of Dr. Adam Anz, orthopedic shoulder surgeon in Gulf Breeze, Florida at the Andrews Institute.

 

Biceps Tenodesis

The biceps is a muscle (also referred to as the brachii muscle) that is located on the upper arm between the shoulder and the elbow.  It is the muscle that is responsible for elbow flexion as well as rotating the forearm.

Two muscle “bellies”, make up the biceps region, these include the long head of the biceps and the short head of the biceps (brachii is a Latin phrase which means two-headed muscle of the arm). The long head of the biceps attaches to the shoulder blade inside the shoulder joint through a tendon.  One common injury that can occur to this area is tendonitis.  Biceps tendonitis occurs when acute episodes of overuse takes places. It can also develop when chronic micro-damage from repetitive overhead activities take place, or through degenerative changes in the shoulder joint. Tendonitis occurs when the long head of the biceps muscle becomes irritated.  Symptoms associated with this condition include pain and tenderness in the front of the upper arm.

Dr. Anz will often try and treat biceps tendonitis through conservative measures first, which usually involves rest, ice, anti-inflammatory medications, and therapy. However, if biceps tendonitis causes extreme pain and disability without response to initial treatment, surgical intervention may be the next best step.

If surgery is required, Dr. Anz will most likely perform a biceps tenodesis which is performed arthroscopically.  During this operation, a release of the tendon from its attachment inside the shoulder joint takes place, and it is reattached to the upper arm. The actual release of the tendon is known as a tenotomy.  During the arthroscopic approach, Dr. Anz will make small incisions and use tiny instruments including an arthroscopic camera. The tenodesis is performed through a small incision near the front part of the armpit. Patients can have chronic pain in the front of their arm from biceps tendonitis.  After this tendon is reattached away from the area of previous pain through tenodesis, most patients will feel great relief.

Dr. Anz will prescribe a full rehabilitation program for each patient following surgery. Each case may be slightly different, but the ultimate goal is to regain strength and range of motion. Depending on the severity of the injury and surgical case, range of motion can usually begin shortly after surgery and a full recovery can be anticipated at approximately 3 months.

For additional resources on injuries associated with the biceps muscle, including biceps tendonitis, or to learn more about the surgical treatments for this injury including a biceps tenodesis, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Subacromial Decompression

Patients that experience shoulder pain and shoulder weakness due to bursitis are candidates for a treatment known as subacromial decompression. Bursitis and impingement can lead to pain, disability, and tears of the rotator cuff.  The rotator cuff is a group of four muscles that are integral for shoulder function.  These muscles arise from the shoulder blade and attach to the humerus.  As the muscles travel to attach onto the humerus, they travel underneath a portion of the scapula known as the acromium. In some instances, the bursal tissue located in this region can become irritated and inflamed, also known as bursitis.  Additionally, as changes occur with age and use of the shoulder, the acromium may impingement on the rotator cuff.

If conservative treatments fail to work, surgical intervention using an arthroscopic approach can be applied. The surgical procedure to remove the inflamed bursa from the acromium is known as a subacromial decompression.  Using arthroscopic instruments, Dr. Anz will make a small incision in the shoulder and the inflamed portion of the bursa and degenerative portions of the acromium, which are causing the impingement, are removed. Depending on the injury, if bone spurs exist, they will also be removed.

Following subacromial decompression shoulder surgery, patients will be prescribed a physical therapy program. Initially after surgery, they will wear a sling, but will begin active movement of the shoulder pretty quickly. If only a subacromial decompression is performed, range of motion can begin immediately after surgery and a full recovery can be anticipated at approximately 2 months.  Most patients are able to return to their previous activities without pain.

For additional information on shoulder bursitis, impingement, and other conditions that cause shoulder pain, or for additional resources on subacromial decompression, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Arthroscopic Stabilization for Shoulder Instability

Shoulder dislocations are the result of the humeral head (ball) and glenoid area of the scapula (socket) to become pulled apart.  Athletes who perform powerful overhead motions, such as serving in tennis or pitching in baseball, put the shoulder joint at risk for dislocations. While the shoulder joint offers the greatest range of motion of any joint in the human body, it also offers an extreme mobility that comes at the expense of stability.

To allow for such great motion, the shoulder is stabilized by soft tissue restraints (such as ligaments and cartilage that surrounds the socket called the labrum). When a shoulder dislocation occurs, the ball comes out of the socket and in most cases, the soft tissue stabilizers are damaged as well.

While the initial treatment for a shoulder dislocation is to reduce the joint (put the ball back into the socket), ongoing instability most likely will occur if further assessment is not performed on the joint to ensure that additional damage doesn’t exist.  Once the shoulder is reduced, X-rays will then be utilized to assess any nearby damage to other bones. Dr. Anz will also determine if the patient should be treated surgically or non-surgically in order to stabilize the joint. If he feels a surgery needs to be performed, he will perform arthroscopic stabilization surgery for shoulder instability.

In the majority of patients, arthroscopic stabilization has been shown to be highly effective in eliminating shoulder instability. In certain situations such as longstanding instability, bone loss from the glenoid or humerus, and a dislocation that can’t be manually reduced, a specialized open procedure may be necessary.

During arthroscopic stabilization surgery, the shoulder is examined to confirm the direction and degree of instability. Next, the area of damage will be assessed and small surgical instruments used to place anchors into the bone on the glenoid that contain strong sutures. These sutures are then used to repair the torn labrum and ligaments, restore the anatomy of the joint to its natural position, and to effectively “tighten” the shoulder back to normal.

Dr. Anz will require all patients to become involved in a post-operative therapy program following arthroscopic stabilization shoulder surgery. This typically consists of gentle passive range of motion movements, followed by active motion, strengthening, and eventually, the return to activities. The patient will continue to wear a cling for about 6 weeks.  Dr. Anz will examine the joint to assess how the progression of therapy should continue.  This will depend on the configuration of the injury and type of repair.

For more information on arthroscopic stabilization shoulder surgery, or to learn more about your specific shoulder injury and shoulder pain, please contact the Gulf Breeze, Florida office of orthopedic shoulder surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Arthroscopic AC Repair

The collarbone (clavicle) attaches to the roof of the shoulder (acromion) in a joint referred to as the acromioclavicular joint. The collarbone is also stabilized in this area by ligaments called the coracoclavicular ligaments, which attach the collarbone to the front of the shoulder blade (scapula). Direct trauma to this area (such as a football hit or falling over handle bars on a bike) can disrupt these connections and lead to a scenario where the collarbone and roof of the shoulder are no longer sitting next to each other. This is often referred to as an AC separation and leads to elevation of the collarbone that can often be felt at the top of the shoulder.

Mild AC separations can often be treated by rest and sling use followed by a short physical therapy program. However, in cases of a severe separation, surgery is often warranted because chronic shoulder instability and frequent separations and dislocations can occur on a daily basis following the initial injury. Thus, the goal of surgery is to secure the collarbone back into its normal position by attaching very strong sutures to the collarbone and front of the shoulder blade. This is often accompanied by reconstruction of the coracoclavicular ligaments, which involves looping a donated graft from the front of the shoulder blade to the top of the collarbone. Dr. Anz performs this surgery with the use of the arthroscopic camera as well as a small incision at the top of the shoulder.

Following surgery, patients will start shoulder motion under the direction of a therapist. Patients will be asked to wear a sling for protection for many weeks following surgery. Eventually, after the ligaments heal, patients will be allowed to progressively strengthen the shoulder and discard the sling. Return to sporting activities usually occurs around 3 to 4 months after surgery.

For more information on AC joint injuries, or to learn more about arthroscopic AC repair, please contact the office of Dr. Adam Anz,  Gulf Breeze, Florida orthopedic shoulder surgeon. 

Reverse Total Shoulder Replacement Surgery

Arthritis of the shoulder is a common, degenerative condition that affects the adult population. Sometimes brought on from a previous shoulder injury, and other times developing due to the aging process and natural wear and tear of the shoulder joint, arthritis can cause pain, stiffness, and shoulder weakness that makes normal daily activities difficult to perform.

Once all conservative treatment measures—both non-surgical and surgical—have been explored and/or tried, replacement surgery can be the next step in helping to alleviate some of the symptoms that occur with arthritis of the shoulder.

A reverse shoulder replacement surgery, like a standard shoulder replacement, involves replacing the natural degenerated cartilage and bone of the shoulder joint with metal and plastic components. These components allow patients to have a more mobile, painless, motion of the shoulder joint. The reverse total shoulder replacement technique is not for everyone.  In patients who have rotator cuff surgery/arthropathy, the rotator cuff muscles may no longer function as they should, therefore, the reverse total shoulder replacement surgery is a better fit because it relies on different muscles (the deltoids) in order to create shoulder movement.  A traditional replacement approach relies on the rotator cuff muscles to function.

The surgical approach for a reverse total shoulder replacement is similar in nature to the total shoulder replacement surgery.  In a standard shoulder replacement, the head of the humerus is replaced with a rounded metal component attached to a stem that is fitted into the humerus.  Additionally, the glenoid portion of the shoulder blade, or socket of the shoulder joint, is replaced with a plastic socket.  In a reverse shoulder replacement, the shape positions are reversed, so that the glenoid becomes a rounded partial sphere and the arm portion, humeral component, involves the socket.

Patients who have experienced rotator cuff problems and who have undergone reverse total shoulder replacement surgery have experienced good result in eliminating their shoulder pain, and regaining mobility and function.

After shoulder replacement surgery, patients are placed into a rehabilitation program.  It is important for patients to follow rehab closely as this therapeutic process is as important as the surgery itself in reaching a full recovery. Initial therapy focuses on safe motion with certain restrictions for 6 weeks.  After a recovery period of 2-3 months, patients typically are painless and performing well with their normal activities.  A return to sporting activities is patient and activity dependent.

For additional resources on treatment for shoulder pain and stiffness for injuries associated with osteoarthritis of the shoulder, or to learn more about the reverse total shoulder replacement surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Clavicle Fracture Fixation

The collarbone (clavicle) of the shoulder can become fractured from a direct hit or a fall onto the shoulder. This is a common injury for athletes and frequently occurs in football players.  Clavicle fractures can occur anywhere along the bone and in numerous configurations. They also can result in multiple bone fragments which is a scenario referred to as “comminution”.  Most clavicle fractures can heal over time with use of a sling and avoidance of activities for 6 to 10 weeks. In comminuted fractures or fractures in which the bones do not line up well, surgery is often recommended to restore the normal alignment and length of the bone.

Clavicle fracture surgery usually involves an incision over the top of the shoulder and placement of a plate and screws along the top of the clavicle. The goal of surgery is to stabilize the clavicle so that it can heal in the appropriate position. Surgery does not speed up the healing process but rather ensures that the bone heals correctly. Certain types of clavicle fractures can also be fixed with the use of a long pin placed within the bone (intramedullary nailing). Patients are usually allowed to go home the same day as their surgery.

Recovery from clavicle fracture surgery often takes a few months and involves sling use and guided physical therapy. This included range of motion training and strengthening. Some patients request to have their hardware removed from the collarbone but this is not allowed until after the fracture has fully healed.

For additional information on clavicle fracture fixation surgery, or to learn more about other injuries associated with the collarbone, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Rotator Cuff Repair with Augmentation (Graft Reinforcement)

The rotator cuff is made up of muscles and tendons that surround the shoulder joint. It is responsible for centering the ball in the socket of the shoulder and helps the shoulder to stay stable and move.  Injuries to the rotator cuff are quite common. Sports are among the most common reasons why rotator cuff injuries occur. In addition, a traumatic occurrence such as a hard fall, or injury that occurs from micro-damage that stems from overuse and impingement (pinching of the tendon against the acromion process of the scapula) can also be factors. Chronic degenerative changes of these tendons can also make them weak and prone to tears. Injury to the rotator cuff may involve one or more tendons. The spectrum of injury can range from mild tendonitis, inflammation, and bursitis, to partial tears and full thickness tears.

In the case of a rotator cuff tear, surgery is usually required. In instances when the tear is acute and the tendon/muscle is healthy, the rotator cuff can usually be primarily reattached to the anatomic footprint using strong sutures and anchors placed in the bone. In unusual tear patterns, chronic retracted tears, degenerative tears, and tears that have some atrophy (loss of bulk) of the muscle, repairing the damage isn’t as easy.

In these situations, a technique referred to as rotator cuff repair with augmentation of graft reinforcement is usually used.  This is a safe and effective technique used to augment the repair providing better strength and a healing environment for the tendon.

This procedure is typically performed with a combination of an arthroscopic and open approach to the shoulder. The torn tendon is identified and a primary repair is attempted. At this point a decision is made as to whether the tendon would benefit from an augmentation. If this is the case a graft (patch) is obtained (which is made from cadaveric dermis). The type of tear will dictate the exact configuration of the repair needed as well as the size of the patch. The patch is sewn into the rotator cuff tendon and a repair will involve using strong sutures and anchors into the bone to secure the graft and tendon. In specific situations, adjuncts may be used to assist in healing such as a marrow stimulation healing response technique or an injection of platelet rich plasma.

Following rotator cuff repair surgery with augmentation, physical therapy becomes a crucial component in the recovery process. The specific progression of physical therapy following a surgery of this nature will depend on the configuration of the tear, type of repair that was used, and the number of tendons involved.  In most cases where a graft was used to help repair the injury, the progression of therapy is often slower.  It is very important that patients follow the advice of their therapists and take their time with this type of therapy so that the delicate graft and surgical processes are not interrupted. Therapy will typically consist of passive range of motion, followed by active motion, strengthening, and eventually return to activities. A sling is worn for 6-8 weeks after the surgery. The procedure has been shown to be highly successful in alleviating pain and improving function of the shoulder.

To learn more about the treatment alternatives for rotator cuff injuries, or to learn more about rotator cuff repair with a graft reinforcement augmentation, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Arthroscopic Rotator Cuff Repair

Rotator cuff injuries are common injuries among athletes.  They occur when one of the four rotator cuff muscles are injured or damaged. The rotator cuff muscles involve four muscles that surround the shoulder and are responsible for stabilizing the ball in the socket of the shoulder. They work together to provide the shoulder with its powerful range of motion, strength, and the ability to perform overhead activities.

As the muscles get closer to their insertion on the humerus, they are called tendons. There are numerous activities that may cause damage to these tendons. Sometimes the damage is small and considered “micro” from overuse and impingement. Inflammation is very common condition as well. Other times, the injury may consist of a tear, or from chronic degenerative changes of the tendon. When injuries to the rotator cuff occur, a broad spectrum of symptoms can occur and treatment for the condition will depend on the type of injury or tear, and the number of tendons involved.

In mild cases that may consist of small or partial tears, or tendonitis, Dr. Anz will usually try and treat the condition conservatively using non-operative measures first. These consist of rest, ice, anti-inflammatory medications, physical therapy, and possibly, an injection to reduce the inflammation.

In patients with full thickness tears, large partial thickness tears, or smaller tears/tendonitis that have failed non-operative measures, surgery may be indicated. In the majority of cases, surgery to treat rotator cuff tears can be performed arthroscpically using small incisions, a camera, and tiny instruments to perform the procedure.

During surgery, Dr. Anz will enter the shoulder joint and examine the injury by identifying the torn tendon and reattaching it to its insertion site on the humerus—this is known as the footprint, or original site of attachment.  This process is completed using sutures placed through the tendon, and anchors that are attached to the bone to secure the normal anatomy of the tendon.

Dr. Anz will determine the exact type of repair once the configuration of the tear has been assessed.  New procedures are now helpful in repairing tendons with additional support.  In some cases, a double row repair will be performed if needed to provide compression of the tendon for healing.

Every patient will be given a strict rehabilitation protocol to follow once surgery is completed. Immediately following post-op, patients are placed into a sling and an individualized physical therapy program is started. Rehabilitation will include the work of a skilled therapist and will involve passive range of motion, followed by active motion, strengthening, and eventually return to activities. The specific progression of therapy will depend on the configuration of the tear, type of repair, and the number of tendons involved.

For additional resources on rotator cuff injuries, or to learn more about arthroscopic rotator cuff repair surgery, please contact the Gulf Breeze, Florida orthopedic shoulder practice of Dr. Adam Anz located at the Andrews Institute.