The practice of orthopedic surgery is an ever changing field. Fullerton Orthopaedic Medical Group is one that continues to incorporate new technology to treat their patients disorders. For the upper extremity surgeons, Dr. Michael Rubinstein and Dr. Eugen Williams, the use of ultrasound as an added addition to evaluate the shoulder is a significant assistance in providing a diagnosis during the evaluation that can guide treatment without the delay that is encountered in waiting for an MRI. This can serve to expedite the care on one’s condition and as well providing a more appropriate direction in considering the potential for therapy and non-operative treatment versus surgery.
Ultrasound is a modality that has been used for decades in the field of obstetrics. ultrasound is a technique that does not require radiation or putting one in a “tube”. It can be done for many body parts such as the shoulder, elbow, hand and wrist, hip, knee and foot. For the shoulder the use can at times eliminate the need for an expensive MRI, providing very much the same information. The modality works off of sound bouncing off structures in the shoulder joint. It can evaluate for rotator cuff tears, biceps problems,inflammation in the joint as well as areas of fluid accumulation. The device can also be used for guiding injections. The shoulder evaluation is done with the patient seated, with the arm at the side. Evaluation of the rotator cuff can be done while the patient moves the shoulder back and forth. This has the advantage over the MRI, in that it can see the tissue move. This can then improve the accuracy of the test. Partial tears are more likely to be identified with the ultrasound more so than the MRI, It also allows better evaluation in those individuals who have undergone previous surgery. All of these advantages without have to leave the physicians office. When using the ultrasound with an injection, it can help guide the needle into the correct area, thus avoiding giving the injection into the tissues that may not benefit from the injection. This again is a way providing more accurate and expeditious treatment.
One of the other additions in the treatment of the shoulder is the advent of the reverse shoulder replacement. Both of the shoulder surgeons at Fullerton Orthopaedic have been performing these types of surgery as long as anyone in the area. When the shoulder is affected by arthritis, pain can develop due to the loss of the covering of the bone, a loss of cartilage. This is arthritis. Think of it as a square peg in a round hole. When the joint becomes deformed secondary to arthritis it can not glide well, causing the shoulder to catch, pop, and be painful. In those instances when there is a functioning rotator cuff, a total joint replacement can be performed. This is a replacement of the “ball and socket”. In some individuals the rotator cuff is not working because of a large dysfunctional tear in the tendon. If the tendon can be repaired then this is the best option., In those situations when the tendon is scarred and can not be repaired, the shoulder may lose motion. When one can not lift the arm overhead and is impaired by loss of function, a reverse shoulder replacement can be considered. This type of replacement places the ball part of the joint on the socket part of the joint, the cup on the humerus, the ball part of the joint. Hence the name of the procedure – REVERSE shoulder replacement (reversing the components). In doing so this restores the mechanics of the shoulder allowing the individual to raise the arm overhead. This type of procedure is not recommended for all.The individuals who would be candidates for this are usually 70 years old and older. Only those specialist trained in total shoulder replacement shoulder perform such a procedure. This can ensure the most optimal results for a bad condition. Prior to this procedure, those patients with a un repairable rotator cuff had essentially no options. This offers the potential to improve with a reduction in pain and an improvement is arm use. Of course if one is not a candidate for this type of procedures the shoulder surgeons can determine what may be helpful if all means of non-operative treatment fails.
Arthritis of the Shoulder
Rotator Cuff Tears
Shoulder Joint Replacement
Shoulder Pain Booklet
American Orthopaedic Society for Sports Medicine
American Shoulder and Elbow Surgeons
New York Online Access to Health: Shoulder Problems
Patient Resources on Shoulder Problems
Questions and Answers about Shoulder Problems
Shoulder Injuries and Disorders
Virtual Hospital: Patient Guide to Shoulder Surgeries and Injuries
Low Back Pain
How to Prevent Back Pain
Back Pain Exercise
Spondylolysis and Spondylolisthesis