Shoulder to Shoulder
Advancements in Arthroscopic Procedures
On a warm autumn day, zipping along in 20-knot winds, Ken Kurlychek yanked a line on his 26-foot sailboat and felt a twinge in his shoulder. No big deal. But the next day, his arm was too weak to raise higher than his chin. Lifting a gallon of milk or pushing open a door caused knifing shoulder pain. His movement was so limited he had trouble tucking in his shirt, combing his hair, and reaching on to shelves—not to mention hauling in the sheets the next time he went sailing.
Structure of the Shoulder
The problem? An injured rotator cuff, a key group of tendons surrounding the shoulder joint. According to the American Academy of Orthopaedic Surgeons, about four million people in the U.S. seek medical care each year for shoulder injuries, including frozen shoulders, torn rotator cuffs, sprains and dislocation. The most movable joint in the body, the shoulder is also the most unstable and can be affected by overuse, underuse, inflammation, arthritis and aging.
Options for Treatment
Although there is no typical profile of a patient with shoulder problems, the common denominator is pain. Roughly 80 percent of shoulder problems can be treated by physical therapy and other noninvasive means—approaches that restored Kurlychek’s mobility within about six months. But when surgery is called for, today’s patients are lucky to have the option of arthroscopy, in which an orthopaedic surgeon uses tiny incisions to insert pencil-sized fiber-optic instruments into the shoulder joint. The surgeon then examines and repairs the shoulder by viewing images transmitted via a micro-chip camera to a large TV screen.
Garrett Lynch, M.D., and brothers Louis Ruland III, M.D., and Charles Ruland, M.D., of Anne Arundel Orthopaedic Surgeons, each received a year of special training in shoulders and knees beyond their medical school and residency training.
About 40 percent of their cases are shoulder-related, and they performed nearly 350 successful arthroscopic shoulder repairs in 2002. “Our community is fortunate to have physicians who are fellowship trained in shoulders,” said Joseph Moser, M.D., AAMC’s vice president of Medical Affairs. “These doctors are outstanding in their specialties, and their work has brought AAMC the reputation of being a regional center for the treatment of shoulders as well as knees.”
The shoulder is the most movable but also the most unstable joint in the body.
At AAMC, the majority of shoulder surgeries are performed in the Edwards Outpatient Surgery Pavilion. Arthroscopic repair of seriously damaged shoulders can require two to three hours of complicated, tedious work in which the surgeon inserts anchors into the bone, sutures them to the rotator cuff, and ties nautical-like knots with the aid of special instruments.
In 1994 Dr. Lynch helped pioneer arthroscopic rotator cuff shoulder surgery in Maryland, initially using instruments he invented. Today, commercially produced instruments are available to give surgeons a close-up view of the internal shoulder area. Because of their skill in handling complicated shoulder cases, Lynch and his colleagues get referrals from doctors in all parts of Maryland, as well as Delaware and West Virginia. For example, Rose Morgan, 67, an operating room nurse at a western Maryland hospital in Cumberland suffered persistent shoulder pain and weakness that made her demanding job nearly impossible. Dr. Lynch, who repaired her badly torn rotator cuff arthroscopically, said she recovered with very little pain. “Rose is doing great a year after surgery and since then has referred several other patients to us.”
Back to Work for Police Officer
Closer to home, Dr. Lynch recently repaired the partially torn rotator cuff of Maryland State Police officer Michael Panos, 54, and started Panos on physical therapy a day after the surgery. “The shoulder feels great, with just a little tightness,” said Panos three days later. He was able to return to administrative work a week after surgery but had to wait until a sign-off from the State Police medical director to assume full duties.
At another local practice, the Orthopedics and Sports Medicine Center, arthroscopic shoulder surgery is offered by Cyrus Lashgari, M.D., Christina Morganti, M.D., and Jeffrey Gelfand, M.D. “Candidates for this surgery are patients with pain and mobility problems who haven’t gotten better with physical therapy,” Dr. Lashgari explained.
His one-year shoulder and elbow fellowship is an advantage, he said, because “any time you do a large volume on one body part you become very good at recognizing what’s wrong and fixing it.” One of Dr. Lashgari’s many success stories is a 16-year-old football player who suffered a S.L.A.P. (shoulder labrum anterior posterior) tear during a game. Because he was able to repair the torn tendon and biceps arthroscopically, the young athlete is once again able to play the sport he loves.