Shoulder Arthroscopy FAQ

What is arthroscopic surgery?

Arthroscopic surgery is a technique that orthopedic surgeons use to diagnose and repair structural damage within a joint.  The surgeon makes 3 or 4 small incisions around the joint, about ½ inch each. Here, a fiberoptic camera is used to see within the joint and miniature surgical tools are used to perform the repair.

Arthroscopic surgery of the shoulder is an outpatient surgery, which means that you will not have to be admitted to the hospital. You will return home shortly after the surgery is over.

Arthroscopy of the shoulder joint has been a major advancement in surgical technique. This procedure allows less cutting of intact tissue to perform repairs, allowing for faster recovery times than with open surgery.

What types of shoulder surgeries can be performed using arthroscopic technique?

Dr. Shapiro performs many types of shoulder arthroscopy. Among those are:

  • Rotator cuff repair
  • Subacromial decompression (removal of bone spurs)
  • Glenoid labrum repairs (SLAP tears)
  • Repair of shoulder instability (dislocation)
  • Biceps tendon repair
  • Bursitis
  • Debridement due to arthritis
  • Frozen shoulder release

How long will my surgery take?

Most surgeries will take 45 minutes to 1 hour. You will then be required to stay in the recovery room for about another hour. You will then be discharged home. Please be sure to make arrangements for a ride home, as you will not be able to drive the day of surgery.

How long is the rehabilitation process after shoulder arthroscopy?
This depends on the type of procedure you had performed. It is important to understand that physical therapy is an important piece of recovery. You must be committed to the post-operative rehab if you wish to achieve the best outcome.

General rehab guidelines for specific surgical procedures are as follows:

Rotator Cuff Repair, SLAP Repair, & Shoulder Dislocation Repair: Physical therapy is grouped into several phases, beginning with gentle mobility and progressing to strengthening through the full range of motion. The process generally takes 4-6 weeks. Dr. Shapiro will provide both you and your physical therapist with specific instructions following your surgery.

Bone Spur Removal: Because the shoulder is left structurally intact, the rehab process flows quicker, about 6-8 weeks.

How much pain will I have following my shoulder surgery?
This varies greatly from patient to patient. You will be prescribed pain medication following surgery, along with instructions for icing the shoulder, which will help control excessive swelling. During physical therapy sessions, you will be asked to move the shoulder joint in order to restore full arm motion.

This may cause an increase in your pain level, and for this reason it is recommended that you take your pain medication 45 minutes prior to the start of therapy sessions. In time, you will need to take less pain medication.

Will I have to wear a sling following surgery?
This depends on the type of surgery that you had performed. For rotator cuff repairs, SLAP repairs, and dislocation repairs, you will be required to wear the sling for 2 weeks after surgery. For subacromial decompression surgery, a sling may be worn for comfort measures following surgery, and discontinued as pain decreases.

Can I take a shower following surgery?
Showering is permitted 72 hours following surgery.

When do I follow up with Dr. Shapiro following my arthroscopic surgery?
Dr. Shapiro or his physician assistant will follow up with you 1 week following your surgery. The goal of this visit is to make sure that your pain is under control, and the incision is free of infection and healing well.

Physical therapy is also prescribed at this time. This visit is designed to give the patient an opportunity to ask any new questions that may have arisen following your surgery.

When can I return to work?
Of course, this is highly dependent upon your occupation. You will be unable to actively use your arm following rotator cuff repair, SLAP repair, or dislocation repair. This is important in order to allow for proper healing and to not disrupt the surgical area.

If you have a sedentary job or are able to secure restricted duty where use of the arm is not required, then you should anticipate being out of work for 5-7 days. If you are required to use your involved arm, then time away from work is greater. You should discuss your situation with Dr. Shapiro prior to surgery so that you can make appropriate arrangements with your employer.

Is it a Lump or Bump? Find out What You Should Do About Ganglion Cysts of the Wrist and Hand

Perhaps it starts as a very low grade aching in the wrist, barely enough to get your attention. Then the pain becomes more frequent and persistent. As you roll your wrist around in circles trying to figure out the cause, you notice a small bump on the back of the wrist. Of course, your next move is to do the same with the opposite wrist to see if it’s present on both sides. Nothing. No bump. Time to see the doctor.

Finding a lump on your body that you know was not there previously is generally concerning. Most bumps on the hand are not cancerous, but are important to have checked out promptly by a hand surgeon. In this case, a common cause is a ganglion cyst, a small mass that can develop around the joints of the wrist and hand. Ganglion cysts are benign, fluid filled sacs that may or may not cause pain in the affected area. They are the most common form of mass found in the hand and are generally found in younger individuals between the ages of 15-40.

The most common location is on the back of the wrist, but they may also be found on the palm side of the wrist or at the base of the fingers. The cause is not known, but often times there is a correlation between their development and chronic, mechanical stress in the wrist or hand. Athletes that have repetitive stress on the wrist and hand such as gymnasts have been found to have a higher incidence of these cysts developing.

These cysts may also develop at the most distal joint of the finger. This type of cyst, called a mucous cyst, is associated with wear and tear in the finger joints and is more common with age.

In my practice, ganglion cysts are a relatively common occurrence. The diagnosis is generally straightforward, usually requiring only a physical exam and occasionally an X-ray. The size and shape of the lump, along with its location, are generally sufficient to make an accurate diagnosis, but I sometimes will order an MRI if there is any uncertainty.

In most cases, these cysts are harmless and the treatment can be as simple as periodic observation for any changes that impact movement or function of the wrist or hand. Sometimes, the ganglion can disappear by itself. In cases where the cyst causes pain or becomes an impediment to movement and function, there are more aggressive treatments available. Often, the cysts are simply persistent and unsightly, requiring removal.

First of all, if you have been surfing the internet you may have read that ganglion cysts used to be called “Bible cysts” because in times past, a treatment was to slam a bible or other heavy book over the cyst, causing it to burst. DON’T DO IT. It is not effective and you could end up with a broken bone in your hand. It is just not worth trying.

Aspiration is usually the first treatment method used to reduce a ganglion. A small needle is inserted into the cyst and the fluid is drained. This produces an immediate reduction in the size of the lump. This is performed in the office setting, and there are no significant restrictions following the procedure. The downside is that the ganglion cyst may return in at least 50% of patients. This is because the root and capsule of the cyst is left intact. An analogy would be to think of deflating a balloon. With fluid production, the balloon can simply re-inflate. Even though the permanent success of aspiration is relatively low, given the ease and simplicity of the aspiration procedure, it is still often worth a try.

Should the cyst return following needle aspiration, surgery may be required that removes the capsule and root completely. This is an outpatient surgical procedure performed under a light anesthesia – usually a combination of a local anesthetic and a sedating medicine administered by the anesthesiologist. The ganglion plus a small amount of the joint capsule or tendon sheath from which the cyst stems is removed. Following surgery, the hand will be splinted for a short duration, and the patient will be able to return to normal activities within 2-4 weeks. Physical or occupational therapy is usually not needed, but a referral may be made in instances where a patient has significant stiffness in the hand or wrist joints. Although there is a small risk of the cyst returning, my patients enjoy a high success rate, with over 90% of all excisions being permanent.

It is important to have any persistent mass checked out by a physician. He or she can perform the appropriate physical exam and testing to confirm the diagnosis and refer you to the appropriate specialist if necessary. If you should have any questions regarding this or any other conditions of the hand, wrist or elbow, please feel free to contact our office at (206) 633-8100, ext. 18133 to schedule a consultation.

Baseball Injuries of the Wrist & Hand

The Tommy John Surgery and Little Leaguer’s Elbow

With a 13-3 record during the spring and summer of 1974, Los Angeles Dodgers pitcher Tommy John was having an incredible year. Then, mid way through the season, the left-handed sinkerball thrower significantly tore through the ulnar collateral ligament (UCL) on his throwing arm. The UCL, located on the inside aspect of the elbow, comes under extreme stress during the throwing motions and it is impossible to pitch at the major league level without it intact.

The season was over for Tommy John. In fact, up until that point it could have been assumed that his entire career was over. But on September 25, 1974, Tommy became the first person to undergo reconstructive surgery that would allow him to return to the playing field for the 1976 season.

The surgery, now commonly known as Tommy John surgery, replaced the damaged ligament with a tendon from his non-throwing forearm. These days, orthopedic surgeons can take a tendon from a variety of locations, including the hamstring or Achilles tendons. Although the rehabilitation process is lengthy at about one year, athletes have a good chance of recovery. Close to 85% of throwers will be able to achieve the same level of competitiveness once the process is complete.

Tommy John surgery is performed mainly on high level throwing athletes; however, injuries to the same area can plague the younger players as well. On the other end of the spectrum is little leaguer’s elbow. This is also an injury caused by repeated stress to the ulnar collateral ligament, but the difference here is that the force of a child or adolescent pitching a baseball does not cause the ligament to break. Here, the stress leads to an uneven growth between the inside and outside aspects of the elbow. This abnormal bone development may result in cubital tunnel syndrome, which is a compression of the ulnar nerve (funny bone) as it passes through the elbow. This can in turn cause numbness, tingling, or weakness in the elbow or hand.

In some cases of little leaguer’s elbow, there may even be a stress fracture where the UCL attaches.3 The young athlete will have pain with throwing a baseball, and may be tender to the touch over the inside of the elbow. Little league baseball mitigates the risk of this condition developing by setting rest requirements and pitch count limits. All coaches and league officials should follow these regulations. If your child is a little league pitcher, you should make sure that he does not exceed the recommended limits for his age group.

Year round baseball play may also increase the risk of little leaguer’s elbow. In Seattle of course, weather does not permit youth baseball to continue year round, but some pitchers aspiring to improve their skills may seek indoor facilities to continue their practice. In this case, players should follow the guidance of the USA Baseball Medical and Safety Advisory Committee, which states that pitchers should not play for more than nine months total per year.

Pitchers certainly are at risk for arm and hand injuries, but the rest of the team is not immune from getting hurt either. Fractures to the hand may result from getting struck by a pitch while gripping a bat or sliding into a base. Diagnosing a fracture in the hand is usually done with X-ray. Treatment for simple fractures is casting for 6-8 weeks, although surgical fixation may be required for more complex breaks.

One final injury worth discussing is mallet finger, also called baseball finger. This injury is a tearing of the tendon that straightens the most distal joint of the finger. The injury mechanism is usually a “jammed finger”, either from sliding into a base or being struck on the top of the finger with a ball. The inability to fully straighten the finger will usually send the player to a physician, who can make the diagnosis through clinical presentation.

Treatment for this injury usually involves splinting the finger for several weeks. If adequate function has not been restored after splinting or if there was a bone fracture or joint misalignment during the original injury, then surgical repair may be necessary. This could consist of tendon grafting to the damaged finger, or using small pins or screws to fix bone fragments.

Wayne Mitchell Weil, MD, specializes in the surgical and non-surgical treatment of hand and elbow disorders. Dr. Weil uses the latest surgical techniques, including minimally invasive carpal and cubital tunnel releases. Those suffering from pain or reduced functional use of their hand or elbow should contact Dr. Weil for a consultation.

What to Do to Prevent Adventure and High-Risk Sports Injuries

The Summer Season is Here

Staying Safe During Summer Activities | Seattle Sports Medicine Summers in the great Pacific Northwest brings out the adventurous side in all of us.

Sports activities like kayaking and kiteboarding on the Puget Sound as well as hiking, cycling, running, sky diving, and mountain biking all things we like to take advantage of while the weather cooperates with us. Physical activity is a great way to keep the mind and body healthy and fit.

Preventing sports injuries so you can enjoy the summer takes some preparation, including assessing your current fitness level and any risk factors or pre-existing conditions. Ways to prevent summer sports injuries include:

  • Annual physical exam – The healthier you are, the better you are at participating in a sports activity.

  • Proper equipment and sports activity training – Check your equipment and get some simulated practice time in so that you get a feel for the sports activity as well as building up your aerobic endurance on the off season.

  • Hydrating properly before and after a sports activity.

  • Proper understanding of your playing field – “Lay of the land” for all sports activities can be tricky if you have never been to an area before and are attempting your first adventure sports activity like kiteboarding.

If it’s paddling down Columbia Gorge, kiteboarding on the Puget Sound or mountain biking on Tiger Mountain, remember, good preparation before attempting an adventure or high risk sport will help in preventing future injuries.

If you believe you are suffering from a sports injury and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.

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Mariners’ Montero Undergoing Knee Surgery for Torn Meniscus

Montero Knee Surgery | Seattle Torn Meniscus Repair The Seattle Times reported from the Mariners Clubhouse that, “Montero has a tear of the meniscus in his left knee and will undergo surgery next week. He is expected to miss four to six weeks.” It is unclear at this point what caused this specific injury.

Although a meniscus tear is painful and will require surgery in this case, there is hope for a great outcome.

Dr. Charles Peterson II commented on this specific case saying, “While Jesus Montero has been having his challenges this year at (and behind) the plate, his meniscus-tear surgery should go fairly smoothly. In most cases of isolated meniscus tears, we can have athletes back to full sports about 6 weeks after surgery. Now, whether this will improve his OBP remains to be seen!”

Below are some symptoms and treatment that may come with a torn meniscus from our Meniscal Tear Article: … read more