Previous ◁ | ▷ Next

Dr. Paul Protomastro

4/14/16

Dr. Protomastro began by pointing out the various bones, joints and tendons in the shoulder.  He pointed out that the shoulder functions normally and painlessly when the joint components are held in place by a wrapping of muscle, tendons and ligaments.

When problems related to the rotator cuff occur, they normally result from injury to the top most tendon in this complex.  The most common injury is Bursitis, which results in soreness and stiffness in the shoulder.  The magic bullet to relieve these symptoms is a cortisone shot.  This will generally relieve the symptoms for some period of time, but they will eventually reappear.  Again this may be fixed with another cortisone shot, but repeated shots have some possible bad side effects and may be dangerous.

Another possible causal factor for shoulder problems is the wearing of the tendon, which results in the bones impinging on each other.  This can result from repetitive movements from things like swimming, tennis and throwing over time, or some traumatic event.  There are non-invasive treatments that may relieve the general weakness and pain symptoms, but if these don’t prove effective and the symptoms persist over six months a surgical procedure is indicated as rotator cuff tendons do not heal naturally.

Surgery to repair a rotor cuff tendon tear consists of anchoring the tendon to the bone with a plastic screw and sewing up the tear.  Following surgery the shoulder must be rested with no high impact activity such as tennis for at least six months.  It will be 18-24 months before the shoulder is totally recovered.  The success of this surgery depends to a great degree on the size of the tear and the time duration that it existed.  

Shoulder arthritis results when the cartilage covering the joint bones wears away.  This results in the bones milling against each other causing wear and possible bone spurs, which rub against the tendon.  Again there are possible non-surgical treatments such as: 

  • Cortisone injections
  • Hyaluronic acid treatments
  • PRP injections 
  • Stem cell injections
  • Synthetic cushioning injections

33% of people over the age of 65 have some shoulder arthritis.  The solution to this should the condition become too debilitating is a shoulder replacement.  An alternative approach would be a cleaning out of the arthritic material, but this only lasts for 6-12 months.  Total replacement is the preferred option, but this requires a good or repairable rotator cuff to be viable.  The operation only takes about 90 minutes and requires a one night stay in the hospital.  It then requires two to three months for the shoulder to be functional with 12-18 months for total recovery.  The complication rate is a low 2% and 87% still had no problems 15 years after the operation.

For rotator cuff arthropathy the approach is a reverse total shoulder replacement.  This is the most complicated shoulder operation and is only used on patients 65 and older. It suffers from a 40%-90% complication rate and after nine years only 67% of patients that have undergone the procedure are still comfortable. 

Q&A

Q.  Can you replace tendons?

A.  No.  Nothing works to replace a tendon.

Q.  Do successive cortisone shots become more effective in relieving arthritis symptoms?

A.  No.  It’s just the opposite.  They become less effective.

Q.  Do partial tendon tears heal completely?

A.  40% heal completely, 40% stay the same and 20% get worse.

Q.  Is the reverse shoulder replacement really only good for nine years?

A.  Take good care of your shoulder.

Q.  Why don’t the replacement components use metal on metal rather than metal on plastic?

A.  Metal on metal eventually causes metal debris from wear, which is toxic.  Plastic has proven better even though it is subject to quicker wear.

Q.  What kind of exercise can prevent these problems?

A.  High load lifting destroys joints.  Pulling against resistance is good.

Q.  Are gym machines like cross-trainers helpful for prevention?

A.  They are great and exercise is important.  You just have to be smart about the type you do.

Q.  Do dietary supplements have any merit? 

A. I don’t know.