Though shoulder pain is quite common, it is usually not normal. Many shoulders become stiff or inflamed for no apparent reason. However, with a shoulder injury, persistent shoulder pain is often a sign that there might be a structural abnormality about the shoulder.

The most common shoulder tear involves the Rotator cuff, but it takes a thorough clinical exam along with an MRI to properly diagnose.Many rotator cuff disorders can be treated without surgery, but if the injury is severe or does not respond to conventional treatment measures, surgery may be considered. Most of the time our orthopedic specialists recommend surgery if your shoulder doesn’t get better after 3 to 6 months of nonsurgical treatment such as rest, ice or heat, and physical therapy.

The procedure to repair a torn rotator cuff involves reattaching the tendon to the head of the upper arm bone (the humerus). Those patients with a partial tear may need surgery in order to trim or smooth the tendon, or often repair the tendon back to the bone to prevent the tear from propigating. With a complete tear, the surgeon repairs the tendon by stitching the two sides back together.

When is Rotator Cuff Surgery Recommended?

Rotator cuff surgery is a safe and effective way to regain full range of motion to your arm. Our orthopedic specialists perform this type of surgery often, and most patients who are active and use their arms for overhead work or sporting activities greatly benefit from this procedure.  Our doctors may recommend surgery if your pain does not improve, as continued pain is the main indication for surgical repair of the rotator cuff. Other signs that this procedure is a good option for you include:

• You have a large tear of more than three centimeters.
• Your symptoms have persisted for greater than six months.
• Your tear was the result of a recent acute injury.
• You have major weakness and loss of function of your shoulder area.

What are the Types of Surgical Options?

There are several different options that the orthopedic specialist can do to repair your rotator cuff and alleviate your problems. This will all depend on the size of your tear, the quality of your tendon tissue and bone, and your personal anatomy. These repairs include:

Open Repair:  This is a traditional approach to rotator cuff repair. With this procedure, the surgeon makes an incision at the shoulder area and detaches the shoulder muscles to gain better access to the torn tendon. During open repair, the orthopedic specialist will remove bone spurs and repair the torn structure. This option is best when the tear is complex and large or if additional reconstruction is necessary. Usually most open repairs done in our office employ the Mini-open approach described below.

Arthroscopic Repair:  Arthroscopy involves the use of a tiny camera (called an arthroscope) inserted into your shoulder joint. The camera will display images on a TV monitor so the surgeon can use these images to guide the scope and tiny instruments to make necessary repairs. Our orthopedic specialists makes several small incisions around the shoulder area to allow the arthroscope to be placed where the doctor needs it to be in order to see and repair the shoulder structures. The shoulder arthroscopic technique is minimally invasive and done on an outpatient basis. There is quicker recovery time and less pain with this procedure.

Mini-Open Repair:  Another option our orthopedic specialists utilize includes a mini-open repair technique. The orthopedic specialist makes an incision that is 3 to 5 centimeters long and uses an arthroscope to access and treat the torn rotator cuff and shoulder structures. This procedure avoids the need to detach the deltoid muscle, allowing for quicker recovery time and minimal pain. This procedure is similar to the arthroscopic repair method and generally is quite successful in the correct circumstance.

Parents often hear the word fracture for the first time and think it is less severe than a broken bone. Fractures, however, are broken bones. The severity of a break depends on the force that caused the fracture, where the fracture is located, and if the break is complex or simple.

If a bone breaks and fragments of it stick out through the skin, this is called an open fracture. These are particularly serious because the skin is broken and the child is at risk for infection. … read more

Have you felt a pop in your arm and been concerned that you may have torn your biceps?  You are not alone – this common injury affects thousands of Americans every day, with the typical tear occurring in males 30-50 years old, often with a distinct tearing feeling or even an audible “pop”.

These tears often cause significant bruising and loss of function and tend to do poorly without surgical reattachment of the torn tendon. Fortunately, there have been significant advances in the understanding of the tear and proper repair within the last couple of years that not only allows for a significantly stronger repair, but also allows for earlier recovery through minimally invasive treatments.

What is a biceps tear?

It is important to understand a bit of anatomy before delving into the specifics of the biceps tear rupture specifics.  The biceps tendon has two attachments at the shoulder and one attachment at the elbow. The biceps tendon is not only important for elbow flexion, but also forearm supinaton –rotation of the forearm that allows us to open up a door or hold our hand out for change. Rupture of the biceps tendon at the shoulder or elbow will cause dysfunction in both functions.

Proximal Biceps Tendon Rupture

The typical injury to the upper end of the biceps is where the biceps tendon ruptures from its attachment at the shoulder joint, specifically at the superior labrum of the glenoid bone.  Typical symptoms include shoulder pain, bruising, and often a bulging, shortened biceps muscle known as a “Popeye muscle.”

Often patients who tear their biceps tendon describe preexisting pain at the front of the shoulder and pain with shoulder movement called biceps tendonitis.  Biceps tendonitis can often be prophylactically treated to prevent or minimize biceps rupture, often through physical therapy, steroid injections or shoulder arthroscopy to debride or repair the tendon.

With Proximal Biceps tendon rupture, many active patients notice a slight loss of strength and a significant cosmetic change in their arm with the bulging muscle and many benefit from repair. I perform the proximal biceps tendon repair as an outpatient procedure and is often quite successful, typically allowing for full return to previous activity.

Distal Biceps Tendon Rupture

Injury to the distal biceps occurs when the biceps tendon is being flexed against a significant force. There is typically a “pop” or a tearing sensation followed by bruising and retraction of the biceps muscle. In a significant percentage of patients, this initial episode is followed by a reasonable return to activity over the next several weeks, delaying care.

Active patients often notice pain, weakness and difficulty in twisting activities such as opening a door. Elbow flexion is somewhat preserved due to the presence of the brachialis muscle, which is quite strong and rarely injured.

Treatment for distal biceps tendon rupture includes prompt early diagnosis as the retracted muscle and tendon quickly scars into its retracted position. For the vast majority of patients, surgical reattachment is recommended and can be done as an outpatient procedure.

New Repair Treatment Technique

I perform a newer technique of Biceps Tendon repair, which includes performing the surgery through a very small incision, typically 2 centimeters at the elbow. The smaller incision is utilized due to a newer biceps button technique that provides not only stronger fixation and proper tension, but also earlier recovery due to the strength of the repair and the limited nature of the incision and dissection.

Chronic biceps tendon ruptures (typically over 3 months old) might require larger dissection, due to the retracted scarred nature of the tear.  They can occasionally require the use of additional tendon graft, but still utilize newer more-reliable fixation techniques that allow for quicker rehabilitation.

All in all, advances in Biceps tendon tear repair allows for early return to activity and strength. The key to proper treatment includes early identification and diagnosis and is quite rewarding to help patients return to their pre-injury state of function.
Do not hesitate to contact us for further questions or for a prompt evaluation.

Have you felt a pop in your arm and been concerned that you may have torn your biceps?

You are not alone – this common injury affects thousands of Americans every day, with the typical tear occurring in males 30-50 years old, often with a distinct tearing feeling or even an audible “pop.”

These tears often cause significant bruising and loss of function and tend to do poorly without surgical reattachment of the torn tendon. Fortunately, there have been significant advances in the understanding of the tear and proper repair within the last couple of years that not only allows for a significantly stronger repair, but also allows for earlier recovery through minimally invasive treatments.

What is a biceps tear?

It is important to understand a bit of anatomy before delving into the specifics of the biceps tear rupture specifics. The biceps tendon has two attachments at the shoulder and one attachment at the elbow. The biceps tendon is not only important for elbow flexion, but also forearm supinaton –rotation of the forearm that allows us to open up a door or hold our hand out for change. Rupture of the biceps tendon at the shoulder or elbow will cause dysfunction in both functions.

Proximal Biceps Tendon Rupture

The typical injury to the upper end of the biceps is where the biceps tendon ruptures from its attachment at the shoulder joint, specifically at the superior labrum of the glenoid bone. Typical symptoms include shoulder pain, bruising, and often a bulging, shortened biceps muscle known as a “Popeye muscle.” Often patients who tear their biceps tendon describe preexisting pain at the front of the shoulder and pain with shoulder movement called biceps tendonitis. Biceps tendonitis can often be prophylactically treated to prevent or minimize biceps rupture, often through physical therapy, steroid injections or shoulder arthroscopy to debride or repair the tendon.

With Proximal Biceps tendon rupture, many active patients notice a slight loss of strength and a significant cosmetic change in their arm with the bulging muscle and many benefit from repair. I perform the proximal biceps tendon repair as an outpatient procedure and is often quite successful, typically allowing for full return to previous activity.

Distal Biceps Tendon Rupture

Injury to the distal biceps occurs when the biceps tendon is being flexed against a significant force. There is typically a “pop” or a tearing sensation followed by bruising and retraction of the biceps muscle. In a significant percentage of patients, this initial episode is followed by a reasonable return to activity over the next several weeks, delaying care. Active patients often notice pain, weakness and difficulty in twisting activities such as opening a door. Elbow flexion is somewhat preserved due to the presence of the brachialis muscle, which is quite strong and rarely injured.

Treatment for distal biceps tendon rupture includes prompt early diagnosis as the retracted muscle and tendon quickly scars into its retracted position. For the vast majority of patients, surgical reattachment is recommended and can be done as an outpatient procedure.

New Repair Treatment Technique

I perform a newer technique of Biceps Tendon repair, which includes performing the surgery through a very small incision, typically 2 centimeters at the elbow. The smaller incision is utilized due to a newer biceps button technique that provides not only stronger fixation and proper tension, but also earlier recovery due to the strength of the repair and the limited nature of the incision and dissection.

Chronic biceps tendon ruptures (typically over 3 months old) might require larger dissection, due to the retracted scarred nature of the tear. They can occasionally require the use of additional tendon graft, but still utilize newer more-reliable fixation techniques that allow for quicker rehabilitation.

All in all, advances in Biceps tendon tear repair allows for early return to activity and strength. The key to proper treatment includes early identification and diagnosis and is quite rewarding to help patients return to their pre-injury state of function.

Do not hesitate to contact us for further questions or for a prompt evaluation.

Read the original article on by our very own Dr. Scott Ruhlman. He performs the new surgical technique that allows for stronger repair and earlier recovery.

Many Americans suffer rotator cuff tears and they are a common cause of pain and disability. When you tear your rotator cuff, you weaken your entire shoulder making daily activities more difficult. Just raising your hand up to comb your hair could cause serious pain. Read on to find out what makes up the rotator cuff, who is at risk for this type of injury, what are the symptoms of a tear, and how a rotator cuff is treated. … read more