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Shoulder injuries, including rotator cuff injuries, are not just an issue for athletes. Steven Levin, MD, Sports Medicine at NorthShore, sees them in patients with a range of ages and experiences, and now provides his experience in treating these injuries and how new innovative procedures have changed the discussion:
When do you recognize that shoulder surgery is the best option for a patient?The most significant factor typically is patient age, as well as activity level. As patients age, the tissue quality declines and healing after surgery may be compromised, therefore; we recommend physical therapy - most patients in this category do well.
Patients who are active and younger, however; we recommend surgery, as we can repair the cuff back down to bone and prevent the tear from propagating. There is an open dialogue between the patient and physician; I educate each patient as to what I feel is the best option for his or her given clinical scenario based on patient outcome data published in the orthopaedic literature.
NorthShore’s team has led the field with new treatments for rotator cuff injuries – what are some of the procedures that you offer?For routine rotator cuff tears, I typically perform arthroscopic rotator cuff repair. For larger tears, I have been augmenting these arthroscopic repairs with allografts (tissue grafts taken from skin that have been treated to accept the patient’s own stem cells). These cells then populate the graft once they are implanted and over time transform the tissue into rotator cuff tendon tissue. I have long standing experience with this procedure and the results have been outstanding. There is a subset of patients who have massive tears that are not repairable, on whom I have been performing a relatively new procedure called Superior Capsular Reconstruction. This is a salvage type procedure done on younger patients with very large tears who have no other option. In this procedure, we are basically reconstructing the capsule above the shoulder joint to help provide motion and pain relief for the patient. The early-recorded results for this procedure have been favorable and the patients I have operated on have done well, however; the indications for this procedure are narrow.
Additionally, you have spearheaded NorthShore’s innovative reverse total shoulder replacement surgery – how does this procedure work?This procedure is meant for patients with massive non-reconstructable rotator cuff tears who have gone on to develop arthritis because of the long-standing lack of a functioning rotator cuff. These patients typically are older, have virtually no motion of their shoulder joint and have significant pain. The procedure is termed “reverse” because when we replace the shoulder joint in these patients, we put the ball of the shoulder joint where the socket should be, and the socket where the ball should be, i.e. the reverse of what we do when we put in a routine total shoulder prosthesis. Patients who don’t have a functioning rotator cuff rely on the large muscle around the shoulder joint, the deltoid, to motor their shoulder because all of the rotator cuff muscles are gone. The reverse shoulder prosthesis takes advantage of this biomechanically so that the deltoid can move the shoulder more efficiently. Patients who receive a reverse shoulder prosthesis gain remarkable motion and pain relief as a result of this mechanical advantage.
How is this different from other forms of shoulder surgery?The actual surgery is quite similar to a routine total shoulder replacement, however there are technical differences for the surgeon, but as far as the patient is concerned, there are really only minor differences. In some ways, the recovery can be a bit quicker, but overall it is about the same as a total shoulder replacement. The reverse is considered to be a constrained prosthesis meaning that the ball and socket components link into each other versus a total shoulder prosthesis where they are separate.
What kind of patients does reverse total shoulder replacement benefit?The most common use of reverse shoulder replacement is in patients with rotator cuff tear arthopathy, or patients with chronic rotator cuff tears who go on to develop shoulder arthritis because of their lack of a functioning rotator cuff. The prosthesis is gaining more popularity however for treating complex shoulder fracture patients in the elderly. It is also being used more frequently in patients who need revision shoulder replacements; meaning patients who have failed a total shoulder replacement and now need a new prosthesis.
How does shoulder surgery improve the quality of life for patients with chronic pain or joint problems?Shoulder surgery helps immensely. Some of my happiest patients are those that have undergone arthroscopic rotator cuff repairs or shoulder replacements. The surgery is very effective at eliminating pain and restoring range of motion in these patients. The post-operative recovery is really not as involved as most patients think. The overwhelming majority of patients who ultimately do undergo surgery wish they had done it sooner as their quality of life improves quickly and drastically.