Shoulder Surgery Archives

How Long Do I Have to Wear A Sling After Rotator Cuff Repair?

Arthroscopy, Rotator Cuff, Shoulder, Shoulder Pain, Shoulder Surgeon, Shoulder Surgery, Sports Injuries, Uncategorized

Screenshot 2024 02 27 at 11.22.26 AM How long do I have to wear a sling after rotator cuff repair?

You recently discussed rotator cuff repair with your orthopedic shoulder specialist and you are moving forward with repair. Hopefully you are seeing a talented specialist. A talented specialist will spend time with you and discuss the details of the after-surgery healing process.

One of these details is the use of an arm sling after your rotator cuff repair. After rotator cuff repair, your arm will be immobilized in an arm sling, sometimes called a “UltraSling.” It usually consists of a durable, high-quality, well-padded sling. It also has an extra “pillow” piece that will help keep your arm and elbow from moving too much.

For more information on use of your sling, see Dr. Nelson’s YouTube channel. You may also download and print this important document, Shoulder Arthroscopy: What You Need to Know. Or you may visit Dr. Nelson’s main rotator cuff repair page.

After surgery, the rotator cuff repair must be protected. If your arm hangs free, the movement in the early weeks after the surgery will be uncomfortable. However it also places too much stress and tension on the rotator cuff repair. If too much stress and tension is placed on the rotator cuff repair, there is a risk that the repair will come loose and fail.

The sling also serves as an important reminder. It reminds you as a patient that you should not be using the arm, and it reminds others around you that you had surgery and should not be expected to use the arm.

But how long do I have to wear the sling?

The answer to this question is different for different doctors. Dr. Johnny T. Nelson follows a very simple protocol. Rotator cuff repair patients will need to wear their sling full-time for 4 weeks after the procedure. Of course, Dr. Nelson will have you come out of the sling for simple hand, wrist, and elbow exercises and sometimes some very gentle movement exercises of the shoulder. However you will be wearing your sling 24 hours per day, including sleep. After 4 weeks, Dr. Nelson will permit you to remove the sling while at home only and use the arm for very gentle activities

Dr. Johnny T. Nelson will still have you wear the sling when you leave the house up until 6 weeks after surgery. This is because it is important that you do not use the arm to do things like open doors, drive a car, carry grocery bags, etc.

In the first 4 weeks, there are a few reasons to remove your sling.

For example, if you are taking a shower or getting dressed, it is necessary to remove your sling. In these situations, it is still important to be careful with the arm and not use it for grasping, pushing, or pulling, or lifting.

It is also okay to remove your sling if you are sitting or lying down, such as on a sofa or armchair. It is acceptable to remove the straps and remove the sling for comfort, allowing the arm to rest at your side. You may do this only if you are awake. Remember, the sling is a reminder above all else, which is most important when you are up and especially when you are out of the house.

If Dr. Nelson does not perform a rotator cuff repair, and shoulder surgery targets other problems (such as the biceps tendon or bone spurs), he may allow you to remove your sling earlier and begin using your arm earlier.

If you have shoulder pain, if you have a rotator cuff tear, if you are in need of an orthopedic shoulder doctor, call 919-872-5296 today to schedule your visit with Dr. Johnny T. Nelson, MD.

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When Can I Get Back to Work After Rotator Cuff Repair?

Arthroscopy, Rotator Cuff, Shoulder, Shoulder Pain, Shoulder Surgeon, Shoulder Surgery, Sports Injuries

Image 2 15 24 at 1.25 PM — A rotator cuff tear before repair

Return to work after rotator cuff repair.

You have a painful rotator cuff tear. You try oral medications and anti-inflammatories, physical therapy, chiropractic care, watchful waiting, massage therapy. You change your diet and lower your sugar intake. You try regenerative therapies like PRP injections.

You try everything, and yet still you have pain.

The answer is clear. While discussing with your orthopedic shoulder specialist, rotator cuff repair is your best and only option to get you back to living and loving your life.

Yes, a well-trained shoulder specialist such as Dr. Johnny T. Nelson, MD is able to repair your rotator cuff. But what does this mean for you? How will your life be affected?

One of the most frequent questions that patient’s ask while discussing rotator cuff repair is:

When can I get back to work?

This is not a simple question, and ultimately the answer is usually different for every patient. That is why it is very important to have a personal, one-on-one visit with your orthopedic shoulder specialist.

But if you are alone, searching for guidance and answers to this question, here are some pointers.

Rotator cuff repair procedure is always done as an outpatient, meaning you will go home the same day that the procedure is performed. No lengthy hospitalization is necessary. You will be back home, resting and healing in your home environment on the day of the procedure. More information about the healing process after shoulder arthroscopy can be found here.

But you cannot return to work after rotator cuff repair immediately.

You will need at least one week of strict rest, mostly spent lying down with ice on your shoulder allowing the swelling to subside. While this process under the guidance of Dr. Nelson’s protocol not very painful, it is important that you have at least one week devoted to rest of the shoulder and the entire body. During this time, of course it is okay to get up and walk, go from one room to the other, and go on simple short excursions outside the home. It is also important that you move your hand, wrist, and elbow.

But the first week after the procedure is certainly not a time to return to work, no matter what you do.

After 1 week, most patients are able to sit up comfortably. For some patients, they are comfortable enough to sit at a desk or a computer, answer phone calls, and talk for extended periods on the phone. Therefore, some patients may be able to return to work at 1 week or 2 weeks if they do mostly sitdown, desk type work.

But even in these situations, you may require a shortened shift or periods of rest. So it is very important that your employer is comfortable with you using such accommodations.

Depending on the shoulder procedure that you had done, some patients must keep their arm strictly without movement, such as a rotator cuff repair. For other surgeries on the shoulder where rotator cuff repair is not performed, patients return to using their hand for waist level and gentle activities as soon as they can tolerate it. However, this does not mean that the patient returns to repetitive use or any forceful gripping, pushing, or pulling.

Are you having a rotator cuff repair? Plan out enough time for healing. Many patients are able to return to desk work at 1 to 2 weeks while wearing their sling. But some other patients may not be comfortable enough to do so.

If you work heavy labor, you will not be able to return to full work for 4 to 6 months.

You can probably return to work wearing your sling and without use of the operated arm 4 weeks after surgery. However, the use of the operated arm to push, pull, or perform any heavy lifting or climbing is not allowed for 4 to 6 months. This can be a long time to stay out of work. But it is absolutely essential that you do not perform heavy work with a newly repaired rotator cuff.

Do you have a rotator cuff tear? You need to learn more about your options. You need to discuss the healing process with an experienced shoulder specialist. Dr. Johnny T. Nelson, MD is a shoulder surgeon serving patients in Raleigh, Durham, Chapel Hill, Garner, Knightdale, Cary, and all of North Carolina. Call 919-872-5296 today to schedule a consultation.

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How Do I Know If I Have a Rotator Cuff Tear?

Shoulder, Shoulder Pain, Shoulder Surgeon, Shoulder Surgery, Ultrasound

US shoulder How do I Know If I Have a Rotator Cuff Tear?

Shoulder pain is very common, and many of those with shoulder pain wonder and worried about why they have pain. They would also like to take steps to figure out the cause of their shoulder pain and ask themselves: how do I know if I have a rotator cuff tear? And most importantly, they want to know what it will take to make their shoulder stop hurting.

If you have shoulder pain, and you are trying to figure out why, seeing a shoulder specialist like Dr. Johnny T. Nelson MD is a great place to start.

Before you start working on trying to make your shoulder feel better, it is usually a good idea to be evaluated by a specialist and make sure that you have the correct “diagnosis” before you start treating the condition. If you do not have a correct diagnosis, sometimes you can be performing the wrong treatment. Think of it like driving a car: if you were trying to get somewhere, you need to know where you are starting, or else, the directions you are, following will not take you to the right place.

Typically it is a good idea to start with simple things like an x-ray, physical examination, and several questions about the history of your pain: When did it start? How bad is it? What movements make the pain worse? Do any movements make the pain better? Have any treatments you tried made it better?

With these pieces of information, a highly trained shoulder specialist like Johnny T. Nelson, MD is able to give you more information about your specific diagnosis, and most importantly, the best treatment for that diagnosis. From there, you might consider anti-inflammatory medicine, physical therapy or chiropractic care, anti-inflammatory injections, simple home exercises or watchful waiting.

Sometimes Dr. Nelson may recommend an MRI of your shoulder. This is if there is more concern for a more major problem, or if you have been having severe pain for a long time and other treatment methods have not helped.

However Dr. Nelson is one of the only orthopedic surgeons in the Raleigh Durham area to offer in-office ultrasound for the evaluation of the rotator cuff.

How is in-office ultrasound helpful?

In office ultrasound is a great way to determine the health of your rotator cuff. While x-rays can be very helpful to shows US RC tear the bones, x-rays do not show us the health of the rotator cuff. Sometimes a specialist can get information on the health of the rotator cuff with a physical exam, but still rotator cuff tears can be missed. In-office ultrasound helps shoulder specialist such as Dr. Johnny T. Nelson see rotator cuff tears quickly and easily. Furthermore, ultrasound gives you and Dr. Nelson peace of mind that you do not have a rotator cuff tear, and performing simple nonsurgical treatment is probably the best way to go.

Ultrasound to check for rotator cuff tears takes only a few minutes, and you are able to see the results as they happen in real-time. Dr. Johnny T. Nelson loves to point out the findings on ultrasound as he sees them, and teaches patients about the anatomy of the rotator cuff.

Sometimes if a rotator cuff tear is found, an MRI examination is ordered to get more information. Because ultrasound is not a perfect tool, if there are signs that there is a tear of the rotator cuff, an MRI is able to give us much more information and confirm the findings on ultrasound.

Do you have shoulder pain? Are you worried that you have a rotator cuff tear? Are you interested in ultrasound examination of your shoulder? Call 919-872-5296 today to schedule an appointment with Dr. Johnny T. Nelson, MD, Raleigh shoulder specialist!

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

Arthroscopy, Rotator Cuff, Shoulder, Shoulder Surgery

Do 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!

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What is the Difference Between Standard and Reverse Shoulder Replacement?

Shoulder Arthritis, Shoulder Replacement, Shoulder Surgery

I 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!

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

Shoulder, Shoulder Arthritis, Shoulder Pain, Shoulder Replacement, Shoulder Surgery

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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