Ashvin K. Dewan, MD

When surgery is required to treat a rotator cuff tear, a surgeon can administer several treatment methods depending on the circumstances and severity of the particular case. Rotator cuff tear surgeries typically involve re-attaching the torn tendon to the head of the humerus. On the other hand, partial tears may only require smoothing or trimming procedures known as debridement. When you sustain a complete tear, the surgeon will repair it by stitching the tendon to the original site on the humerus so you can effectively raise, rotate, and regain the function of your arm.

The three well-known surgical techniques used to treat rotator cuff repairs are mini-open, arthroscopic, and traditional open repair surgeries. Regardless of the method, patients experience pain relief, increased strength in their operated shoulder, and the satisfaction of knowing they'll eventually return to their ordinary standards of living.

Surgeons consider open repair surgeries for large or complex tears that are several centimeters long or if additional reconstruction is required, like a tendon transfer. Initially, this was the only form of treatment before the advancements in technology which have created less invasive means of carrying out the surgery successfully.

Arthroscopic surgery is an outpatient procedure and is the least invasive. During surgery, your surgeon inserts a small camera known as an arthroscope into your shoulder joint. The camera displays a live video on a monitor, and the surgeon uses the video to guide the movements of the miniature surgical instruments. The incision for arthroscopic surgeries is thinner and smaller than other treatment methods, allowing the body to recover faster.

Mini-open repairs incorporate open surgery and arthroscopic treatment methods, making the incision smaller than traditional open surgeries. Initially, the arthroscopy assesses and treats the damage sustained to other structures in the joint. After this, the surgeon continues to repair the rotator cuff through the mini-open incision, repairing the tendon by looking at the shoulder structure directly instead of the video monitor.

The human body is remarkable. It can carry out countless functions effectively and sustain itself over a long time.

Though you may get injured or break a bone, the others around it still perform their duties, so your body can continue operating as effectively as possible.

Ulnar Collateral Ligament Reconstruction surgeries repair torn ulnar collateral ligaments within the elbow. The function of a UCL ligament is to support and secure your elbow joint and resides within the inner side of your elbow.

UCL tears are most common among athletes who perform sports that typically rely on throwing, like a javelin, shotput, baseball, or basketball. Once torn, the UCL tear will require surgery to repair the ligament. Symptoms typically involve swelling and bruising, numbness or tingling of the ring finger, little finger, and hands, loss of function of your arms and elbow, elbow pain and stiffness, and a weakened grip.

When a UCL reconstruction surgery occurs, a tendon is harvested from the patient or donor and attached to act as a new UCL. Once complete, athletes would typically require more than a year of physiotherapy to return to their standard level of athletic performance where they once were before sustaining the injury.

UCL surgeries are also known as Tommy John surgeries because Tommy John was a baseball pitcher and the first to have the surgery and successfully return to baseball.

Among the many bright and gifted youth I have had the pleasure of treating, Adriano has been among those that have worked hard and shown how committed he is to improve his health.

We're proud of his efforts and commitment and are glad to report another smooth and successful recovery.

Your “why” can be the most significant motivating factor in moments of doubt or when you feel uncertain about whether your current path is right for you.

Regardless of your goal, every road has its ups and downs. It's part of the journey and is necessary for you to achieve your goals and become the person you want to be, but whether you succeed ultimately depends on if you can hold on to why you started and whether you can persevere through the hardships.

Previously, we dived into the difference between acute and chronic rotator cuff tears, why they occur, and how the methods of treatment for each condition. Similarly to both types of rotator cuff tears, Rotator cuff tendinitis is caused by repetitive overhead activities that are physically demanding, like throwing a ball or swinging a bat.

Those affected by rotator cuff tendinitis will experience swelling, inflammation, and discomfort caused by the pinching of tendons in the rotator cuff. Aside from athletes, laborers such as plumbers, carpenters, or construction workers may be at higher risk of experiencing rotator cuff tendinitis than others.

If left untreated, rotator cuff tendinitis, also known as shoulder bursitis or impingement syndrome, can lead to bony spurs, resulting in weakened mobility and strength of your arm.

To treat rotator cuff tendinitis, you can use ice therapy, over-the-counter medicine, and above all, refraining from extensive activity that will irritate your shoulder. If you haven't sustained a rotator cuff tear, you typically won't require surgery, and if you treat your injury effectively, you'll recover within two to four weeks.

Only 1% of people in the world are born with 13 ribs.

Though exceedingly rare, those with the extra rib known as the cervical rib are likely to experience neck pain. For this reason, those born with an extra rib often have them removed.

Rheumatoid Arthritis is a form of arthritis that affects numerous joints within the body, particularly in your wrists, hands, and fingers. Rheumatoid arthritis is an autoimmune disease which means that your body attacks the cells within your joints, leading to joint inflammation, and can permanently damage your body due to the changes in your bones caused by your loss of cartilage.

Those affected by rheumatoid arthritis will experience pain, swelling, and stiffness of the joints, especially morning stiffness. If untreated, the symptoms may extend to deformity of the joints. Other symptoms include weight loss, fever, and fatigue. In some cases, the symptoms may flare and affect other areas of the body, like the heart, lungs, skin, eyes, and nervous system.

To counter the effects of rheumatoid arthritis, you can take anti-inflammatory medicine for short-form treatment, but the most effective treatment is known as DMARDs (disease-modifying antirheumatic drugs). Rheumatologists prescribe DMARDs, but a sports medicine physician can refer the patients to one of these specialists.

Anya is celebrating her recovery from knee surgery! For a long time she struggled with severe knee pain and kneecap instability. So young she was missing out on a lot of activities. After careful consideration of her options she decided to proceed with surgical stabilization. Fast forward a few months and she is thrilled to report she is enjoying her pain free knee! We are proud of her dedication and hard work to get to this point.

Success is merely the result of knowledge and experience acquired through extensive trials and errors.

Though failure has negative connotations, it is an essential tool that can guide you toward a bright and successful path if you are willing to self-reflect, learn from your mistakes, and push forward.

Rotator cuff tears can range from minor to chronic injuries that may require treatment to remedy the painful symptoms and decreased grip strength.

The two main types of rotator cuff tears are acute tears and chronic tears. Acute tears consist of common symptoms like intense pain that stems from muscle spasms and bleeding, severe pain in the upper shoulder that travels down to the elbow, and in extreme scenarios with major tears, significant pain accompanied by the inability to move your arm.

Orthopedic surgeons typically recommend surgery to treat acute rotator cuff tears unless they are seventy or older.

Chronic tears consist of symptoms that occur for prolonged durations, like pain that worsens at night and interrupts the quality of your sleep, and limitation on the mobility of your arm. In addition, those with chronic rotator cuff tears suffer from weakened arm strength, which continues to decline, shoulder pain that increases with time, and issues lifting your arm above your shoulder. Treatments for chronic rotator cuff tears include ice therapy, physiotherapy, or surgery. Minimally invasive arthroscopic surgeries treat chronic rotator cuff tears, but the case may alternatively require an open tendon repair, tendon transfer, or shoulder replacement surgery instead.

Most forms of Arthritis occur due to a fault in the body’s immune system that causes the body to attack its tissues in the joints.

Arthritis usually develops during people’s mid-40s. There is no cure for Arthritis, but the pain and symptoms caused can be reduced by living a healthy lifestyle and exercising regularly.

Last week, we went into depth on how stress fractures occur and what you can do to reduce your chances of sustaining a stress fracture, but stress fractures are also common in high-impact sports like gymnastics, dance, tennis, basketball, or track, and field.

Regarding gender, women are at higher risk of developing stress fractures, especially women with abnormal or absent menstrual periods. In addition, those who have previous stress fractures, or osteoporosis, lack essential nutrients, or have flat feet or high arches are more likely to develop a stress fracture, especially if the support of the shoes has worn out.

If you’re suffering from a stress fracture, you’ll experience pain, swelling, or arching at the fracture point. Your skin will feel tender when touched, and you’ll feel pain once you engage in physically demanding activities which won’t subside until you stop. If you notice the following symptoms, it’s best to seek medical assistance during the early stages of a stress fracture to prevent the pain from becoming severe or experiencing further complications like fracture displacements where the fractured bone moves unnaturally and goes out of normal alignment. Hip fractures, in particular, are high-risk stress fractures that require immediate treatment during the early stages to prevent the need for surgery. Though surgeries for other stress fractures may be uncommon, they may be necessary for your bones to heal correctly, especially in areas of the body with poor blood supply. Another scenario where surgery may be preferred would be if a professional athlete or construction worker sought to return to their profession quickly.

Your review is truly appreciated, Sue.

Improving the quality of my patient's lives is something I always strive for when they come to me with their medical concerns and I’m glad that I was able to assist you as well.

If you want to create a lasting impact and touch the lives of countless people, pursue your passion. By doing so, you will love what you do and constantly work toward being the best version of yourself.

By continuously striving to do your best and be your best, you’ll attract endless opportunities, positivity, and support to help you reach and achieve your goals while inspiring others to do the same.

If you continue to feel pain after an extensive duration of time in your shoulder when performing simple activities, like getting dressed or combing your hair you may have sustained a rotator cuff tear.

Your rotator cuff consists of a group of muscles and tendons that help to strengthen and stabilize your shoulder joint and keep the head of your humerus within your shoulder socket which allows you to perform simple tasks you wouldn’t think twice about, such as throwing, carrying, or reaching for objects. When you damage your tissue and injure your rotator cuff, you’ll notice discomfort, pain, decreased mobility, and grip strength which will increase the difficulty of simple tasks significantly.

Rotator cuffs are sustained from repetitive wear-and-tear or strain that is placed upon your shoulders as you age which specifically applies to those that play sports, like tennis, weightlifting, baseball, or swimming that require extensive shoulder movement. Rotator cuff tears may also affect those with professions that require extensive manual labor, like construction and factory workers, plumbers, plasterers, and mechanics. In addition, bony overgrowths, or bone spurs may also cause rotator cuff tears and a lack of blood supply would prolong the speed at which you heal.

Have you wondered why physically strenuous tasks become harder to do as you grow older?

As you age, you may develop osteoporosis and find that your bones are more susceptible to breaking down faster than the speed at which your new bones develop. If this occurs, your bones may become fragile or have holes, affecting their strength and durability. Osteoporosis in later stages can affect your height and cause you to sustain a fracture from falling or neck or back pain.

Stress fractures are injuries that affect both recreational and professional athletes. Stress fractures may be widely known in sports but can lead to serious medical issues if left untreated.
The first documentation of the injury goes back to the late 19th century, particularly among soldiers that engaged in highly intensive military training during world war two with fractures sustained in their lower body from marching.

Stress fractures, also known as hairline fractures, occur from extensive stress placed upon the body, such as lifting significantly heavy weights or light loads that the person is unfamiliar with and uncomfortable using. A notable example of this would be someone who decides to change their inactive lifestyle and immediately goes through intensive training five times a week. Due to the sudden imbalance, the repetitive stress caused by the excessive loads impacts the process of osteoclastic bone breakdown and reformation. The impact then leads to the outstripping of the osteoclastic formation of new bone, resulting in your bones being weaker and more vulnerable to injury.

To prevent any injuries that stem from stress fractures, you must reduce the pace and intensity of your workouts. Instead, focus on making gradual improvements to your training and physical activities by increasing the amount and intensity of your training by no more than 10% each week. Ensure your footwear fit well and are effective for performing your activity. Integrate low-impact exercises to prevent the application of repetitive stress on the body when you train, and make changes to your diet to guarantee you’re receiving enough calcium, Vitamin D, and other essential nutrients your body needs to function effectively.

Thank you for taking the time to leave a review, Judy.

I believe that tackling medical issues head-on and being proactive with your medical health can contribute significantly to your well-being, and I’m happy I was able to assist in your recovery.

Regardless of how difficult the task or goal may be to achieve, you still have a chance of obtaining it as long as you keep striving forward and making the active decision to keep pursuing what you want for yourself.

Acupuncture is a highly effective treatment for those seeking an alternative to surgery and is commonly used to manage rotator cuff tears.

When the injury occurs, shoulder muscles often contract, which prevents blood from reaching the rotator cuff. For this reason, acupuncture is widely seen as a highly effective treatment method because it implements trigger point needling, which effectively targets the knots and tense muscle fibers through a twitch response. These responses release a spasm in the particular area that causes the tension to reduce and stimulates blood flow and lymphatic fluids to the rotator cuff to promote pain relief and healing.

Though it may sound intimidating to those afraid of needles, trigger point needling causes minimal to no discomfort and has been used in case studies that have reported the shoulder function of patients improving after 4 weeks of treatment.
According to one of the studies, acupuncture promotes the release of neuropeptides along with other substances through the stimulation of muscle tissue and nerve endings on the skin. In addition to this, the release of hormones within brain tissue during and after acupuncture treatments improve joint function and minimize the pain caused by the rotator cuff tear.

Though time may significantly influence the strength of your bones, predetermined factors such as size, shape, thickness, porosity, trabecular bone morphology, and intrinsic properties of bony tissue also affect how strong your bones will be.

Improving these factors which influence your bone strength will result in increased bone strength which can counter the complications caused by Osteoporosis, such as bone fractures.

Ultrasounds are widely known as the means for monitoring a pregnant woman’s fetus, but they serve multiple purposes and have numerous uses. In sports medicine, ultrasounds are highly effective tools that identify abnormal tissue and injuries associated with muscles, soft tissue, and tendons, making them a more affordable alternative for tracking tissue repair.

Compared to MRI scans, ultrasounds provide images in real-time, allowing us to see the movement of soft tissue structures such as tendons, joints, or any extremities found in the body. The technological advancements made with diagnostic ultrasounds have increased the efficiency of our treatment, allowing laborers to return to work earlier and athletes to return to competitive training sooner because the medical decisions are evidence-based and not estimations or guesswork.

Let me know in the comments below if you’ve incorporated ultrasound treatment as a doctor or received an ultrasound as a form of diagnostic treatment as a patient and if you believe in its capability to effectively identify those suffering from tissue damage.

Josiah is celebrating his recovery from a bad collarbone fracture sustained in football. Josiah came to us in our evening injury clinic one day, right off the football field, after sustaining a severely displaced clavicle fracture. One of the advantages of an orthopedic injury clinic is we were able to rapidly assess, diagnose, and come up with a definitive treatment plan for him. Within days we were able to get his surgery complete, relieve his pain, and start the path to recovery. Fast forward hardly a few months later, and he is ready to get back into the mix. We are proud of his dedication and determination to get healthy. Best of luck this year!

Life consists of various stages, all of which require you to learn, grow, and evolve into the person you’re meant to become.

Through the challenges you face during your lifetime, it’s important to have a support system of friends and family that will support you and be there for you in your time of need. The moment you gain that, no problem will be impossible for you to tackle.

Knowing when to seek emergency care after your rotator cuff surgery is vital to maintaining your health and well-being. In scenarios where you experience any side effects such as numbness, tingling, or a bluish color in your fingers or hand, nausea or vomiting, or pain that doesn’t subside after taking medicine, it’s important to voice your concerns to your doctor and request medical assistance.

Other important signs include difficulty breathing, loss of consciousness, bleeding from the area of your incision through your first bandage, sustained bleeding from the incision area after 3 days of your surgery, no bowel movement after taking a laxative, or signs of an infection that would be noticeable if you got a fever, experienced increased pain, swelling, warmth, redness, or pus around the area of the incision.

By prioritizing your recovery and well-being, having an effective support system in place, and voicing the medical issues you’re facing, you’ll be able to identify any potential side effects sooner, allowing us to help you resolve any medical concerns or complications so you can experience a smooth and pleasant recovery process with all your medical concerns put to rest.

Have you ever wondered what holds your eyes in place?

The human eye resides within the bony eye socket, also known as the orbit. Within each socket are six muscles that move in all directions and those muscles are surrounded by fat to cushion and protect them.

ITB syndrome, also known as Iliotibial band syndrome, occurs when your tendon, the iliotibial band, gets swollen or irritated from being rubbed against your knee or hip bones. This particular tendon exists in the outer area of your leg, starting from your pelvic bone down to your knee. When the iliotibial band gets too tense, it tightens and rubs against your bones.

While it may not cause long-term damage to your legs, it extends the duration of time needed to recover, which is why those suffering from ITB syndrome must refrain from activities that may irritate or bring discomfort to the area of their body. Those who take action to treat the syndrome usually require 4 to 8 weeks to heal.

To optimize your recovery you can incorporate ice therapy, massages, anti-inflammatory medication available over-the-counter, or undergo physical therapy or PRP therapy to remedy the painful symptoms. Once the pain from the symptoms has reduced, you can implement exercises such as side planks, hip flexor stretches, clamshells, and lateral band walks to restore the functions and motions of your body.

Though the symptom rarely requires surgery, the pain will continue to increase if it isn’t treated and can greatly inconvenience people with highly active lifestyles. For this reason, you must implement the necessary forms of care to ensure it doesn’t affect your daily life.

Thank you for providing your feedback, Elizabeth.

I always ensure that I provide the best care, support, and guidance for my patients so they can experience improvements to their quality of life and leave feeling better than when they arrived.

Pain can be the catalyst for change and positive growth.

By facing things that instill fear in you and make you uncomfortable, you’ll be able to develop the skills to overcome those challenges and the lessons learned from that experience will be tools you’ll carry with you on your path toward success.