Shoulder Surgery

do i have to have surgery for a rotator cuff tear 62767fac148b3

Do I Have to Have Surgery for a Rotator Cuff Tear?

do i have to have surgery for a rotator cuff tear 62767fac148b3Do I have to have surgery for my rotator cuff tear?

You may have recently been given a diagnosis of rotator cuff tear. Often, this can be given by a surgeon based on physical exam, a physical therapist based on your symptoms, or even based on imaging studies such as x-rays or MRI.

This diagnosis may lead to many questions for you.

Some patients think that just because rotator cuff tear is present, there is an immediate need for surgery. This is not actually true, as rotator cuff tears come in many different “flavors.” That is why it is very important to allow a shoulder expert like Dr. Johnny Nelson to examine your shoulder and discuss your unique situation with you.

It is important and helpful to look at the rotator cuff like a rope made out of a bunch of fibers. Some ropes are extremely new and extremely healthy, completely intact without any tearing or fraying. Other ropes may have some tearing and fraying of the fibers but overall remained intact. Then again other ropes may be completely torn, cut, or snapped and unable to be used.

The rotator cuff tendon is the same way.

Some patients have completely intact rotator cuff, with no tearing or fraying or even inflammation. Some patients have mild tearing of a few of the muscle and tendon fibers, while some patients have complete tears where the muscle is not connected to the bone.

We do have some evidence that smaller rotator cuff tears are less likely to become large tears, possibly scarring in place and healing. We also have evidence that large rotator cuff tears are more likely to get larger over time, and are less likely to be repairable the longer they are left without repair.

As a general rule, younger more active patients with more severe tears are more likely to be offered surgery and are more likely to respond well to that surgery. Patients with small tears are less likely to be offered surgery because there is evidence that these patients will often heal without surgery. However, even for small tears surgery is sometimes offered when treatments such as physical therapy, anti-inflammatory medications, and injections do not bring lasting relief of their pain and weakness.

If you have been told that you have a rotator cuff tear, or if you have been told that you need surgery on your shoulder, do not hesitate to make a visit to see Dr. Johnny Nelson to discuss your shoulder.

Sometimes knowing is half the battle!


what is the difference between standard and reverse shoulder replacement 62767fa2b1d72

What is the Difference Between Standard and Reverse Shoulder Replacement?

what is the difference between standard and reverse shoulder replacement 62767fa2b1d72I have heard of shoulder replacement, but what is the difference between reverse and standard shoulder replacement?

The easiest way to understand this is to look at the normal arrangement of the human shoulder. It is basically a ball and socket joint, with the upper part of the arm bone as the ball, and the shoulder blade as the socket.

A standard shoulder replacement, also known as an “anatomic” shoulder replacement, simply re-creates this normal arrangement of the human shoulder. The ball at the top of the arm bone is refinished or replaced with a shiny metallic surface, and the socket in the shoulder blade is replaced by a special type of advanced plastic.

A “reverse” replacement simply “reverses” this arrangement. At the top of the arm bone, a special type of advanced plastic cup is placed, usually at the top of a stem that sits inside the arm bone. On the shoulder blade side, a shiny metallic ball is implanted into the shoulder blade, usually held in place by screws.

But why do some patients get reverse replacements and other patients get standard replacements?

There are 2 main reasons to use a reverse replacement.

The first reason is due to rotator cuff problems. Some patients with bad arthritis also have very large and long-term rotator cuff tears, and some may have complete absence of the rotator cuff altogether. The reverse replacement changes the arrangement of the shoulder joint and allows the patient to overcome this lack of rotator cuff and use the “meaty” muscle on the outside of the shoulder to lift and move their arm.

The second reason is due to the severity of the arthritis. Very advanced and long-term arthritis can cause wear and tear of the socket part of the joint that is so bad that doing a standard replacement places the patient at risk of complications such as instability and implant loosening. If this is the case, a reverse replacement may be the best option to avoid the risks of these complications.

If you are struggling with shoulder arthritis pain or rotator cuff problems, a visit with Dr. Johnny T. Nelson will shed some light on your unique situation. Using a combination of your history, physical examination, and review of available imaging, a treatment plan will be created that is right for you.

Call 919-872-5296 today to make your appointment!

arent i too old for shoulder replacement 62767f6caf59a

“Aren’t I Too Old For Shoulder Replacement?”

arent i too old for shoulder replacement 62767f6caf59a

“Aren’t I too old for a shoulder replacement?”

This is a common way of thinking amongst older patients who struggle with chronic shoulder pain due to to things like arthritis and long-term rotator cuff tears.

But while it is very common, this way of thinking is actually based on several misconceptions about shoulder replacement surgery and the impact it can have on one’s quality of life.

In fact, shoulder replacement surgeons such as Dr. Johnny Nelson believe that the overall benefits of shoulder replacement surgery are higher in older patients compared to younger patients.

Some of this is because any joint replacement, including shoulder replacements, have a limited life span.  Even if perfectly placed, shoulder replacement implants over time experience the same wearing tear that our normal joints experience over our life times.  Because of this, shoulder surgeons are less likely to recommend shoulder replacement on very young patients, even if the arthritis and pain is very severe.  Younger patients are more likely to wear out their shoulder replacements and require a second procedure.

Older patients are much less likely to have this problem.  This is because the needs and activities of older patients are very different from those of younger patients.  Older patients are much more likely to use their shoulders for simple, less strenuous activities: hygiene, dressing, cooking, etc. They are less likely to need their shoulders for heavy lifting, pushing, pulling and repetitive overhead motions. Therefore they are actually much better candidates for shoulder replacement surgery than younger patients because they are less likely to have complications with their implants.

Another reason why older patients are better candidates for shoulder replacement surgery is that the pain relieving benefits of shoulder replacement can be life-changing for them.  While younger patients with chronic shoulder pain certainly could benefit from shoulder replacement, they are less likely to lose their independence and rely on friends, family, and other loved ones for help.  Many older patients who struggle with chronic shoulder pain find it very difficult to stay independent, take care of themselves and maintain their living environments.  Those who do not receive proper treatment for their shoulder pain may find themselves increasingly dependent on others, even having to sell their homes and move into assisted living facilities or in with family. Many older patients who undergo shoulder replacement surgery are able to maintain or even improve their level of independence and quality of life due to the improved ability to use their once painful arm.

Are you struggling with chronic shoulder pain that is interfering your independence and quality of life? Schedule a visit with Dr. Johnny Nelson to see if shoulder replacement surgery could be a life-changing option for you!

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