Golf
Doctor
(orthopaedics)
The Real Deal on Rotator Cuff
Repairs
Michael Leighton, M.D.
Dear Golf Doctor:
My golfing partner Gino, is getting surgery done on his rotary
cuff tear. He says he'll be back with the regular group in 6 weeks.
Is that true? Gino says he's got the BEST surgeon; he's fellowship
trained, board certified and even says he'll try to do the surgery
microscopically. I heard that recovery from shoulder surgery takes a
long time and you might need therapy. What's the real scoop?
&endash;Bobby Thomas, WPB
Dear Bobby:
I wish Gino the best of luck; if he's got a sportsmedicine
fellowship trained, board certified orthopaedic surgeon doing the
work, he's probably in good hands. I think, however, that like some
of my patients ( on rare occasions) he did not listen to all of his
preoperative instructions. Gino's perception of his surgery and what
he really faces are two very different things. Rotator (not "rotary")
cuff repair is a significant surgery&endash;even if done
arthroscopically&endash; assisted (not "microscopically"). This is
not like taking off a small skin cancer or even arthroscopic knee
surgery; recovery is a long road.
Some of the basics: the golfer's shoulder is controlled by many
muscles. One important group is a set of four muscles which end in a
thick tendon (that attaches to the humerus bone) called the rotator
cuff. As people age and continue to do aggravating overhead or
across-the-body type activities, the rotator cuff can become inflamed
(tendinitis) or chronically weakened and eventually tear. Another
cause of a tear is a single, forceful contraction of the muscle that
causes failure of the tendon where it attaches to the bone. (Can you
say, "Chunk a 3-iron?") when you've got a tear, the main symptom is
night pain. Those of you who have it know .exactly what it
is&endash;you roll over and POW! wide awake. Your sharp orthopaedist
will evaluate you with a history, physical exam and x-rays to
evaluate the shoulder. The x-rays don't actually show the rotator
cuff, but can give some significant clues toward diagnosing the
problem. Arthritis, which is a distinct entity entirely, bony spurs
within a ligament that irritate the tendon, calcific tendinitis, and
a long-standing irreparable rotator cuff (Milwaukee shoulder) can be
visualized on x-ray. Sometimes an MRI is recommended. This is the
"white glove test" of the exam. Anything short of perfectly normal
will show up. So, if you're over 65, the chance of you having a
"normal MRI" even if you have no pain is quite remote&endash;don't
get an MRI if you have no intention of going forward with surgery if
the MRI shows a tear. Tears don't heal themselves. Physical therapy
can alleviate the symptoms, and strengthening of the other muscles
can help compensate for a small tear, but if you've got pain and
weakness and therapy is not doing it for you, GET IT FIXED. If you
wait, surgery only gets more difficult, rehab becomes more prolonged,
results aren't as good.
The surgery can be done open or with the arthroscope. Even if
the arthroscope is used, a "mini" open technique will be required
except for all but the smallest of tears. Use of the arthroscope
really provides no advantage over a muscle splitting approach (my
preferred technique). This comment comes from a guy who has special
training in arthroscopic techniques&endash;there is such a thing as
technology over reason. I won't go into the technical details of a
repair, but there are three components to successful rotator cuff
surgery&endash;the surgeon, the patient and the physical therapist.
This is a team effort, and unfortunately, my work is virtually
completed in the operating room. I just have to guide the patient and
therapist carefully through the long recovery process. Passive motion
is begun right after surgery. This means no active exercises of the
arm&endash;no raising overhead, no reaching for the milk in the
fridge, no trying to catch the falling glass off the table! After
about 4 to 6 weeks, the tendon is healed to bone and active exercises
begin. Strength is really not there at this time and the fairways are
really looking sweet by now. It takes about 3 months to regain 50% of
rotator cuff strength, 85% at 6 months, and improvement continues for
about one year after surgery. It takes motivation, timing and a good
team approach to make rotator cuff surgery work well, and if things
are going right, Gino can probably be out there about 3 to 4 months
after surgery, but don't be surprised if you're still a threesome at
Thanksgiving!
Michael Leighton, M.D. is an avid golfer who specializes in
orthopaedic surgery and sports medicine. He can be reached at
Atlantis Orthopaedics, 561-967-4400 or by e-mail at
KNEESURG@aol.comMichael Leighton, M.D. is an avid golfer who
specializes in orthopaedic surgery and sports medicine. He can be
reached at Atlantis Orthopaedics, 561-967-4400 or by e-mail at
KNEESURG@aol.com
