When to see an orthopedic doctor for Rheumatoid Arthritis | Las VegasEvery person affected with Rheumatoid Arthritis (RA) experiences slightly different symptoms.

Some patients may have only a few or no symptoms for long periods while others may experience symptoms for months at a stretch in an aggravation of the disease activity known as a flare.

A majority of patients have persistent issues with bouts of worsening of the condition. But there are dramatic changes in the situation due to innovative and earlier treatment. An increasing number of people are now experiencing low disease activity or even remission.

Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler provide treatments for the knee and shoulder to patients in Las Vegas, Nevada, and surrounding locations.

 

RA Symptoms in the Joints

RA is a disorder that almost always impacts the joints. The initial signs may take a few weeks or months to surface. The swelling associated with RA causes classic symptoms such as:

Stiffness

The patient finds it harder to use the joint, and it does not move properly. This situation is common in the morning. People with other types of arthritis also experience stiff joints in the morning. However, it takes people with RA over an hour, at times several hours, before the joint feels loose.

Swelling

The joint becomes puffy and tender due to the presence of fluid.

Pain

Swelling inside a joint cause it to hurt whether the patient is moving it or not. This can lead to damage and pain over time.

Redness and Warmth

The joints may be warmer and display color changes related to the swelling.

 

What Joints Does RA Affect?

RA typically initiates in the hands. However, it can impact any joint, including:

RA patients notice a symmetrical pattern. It manifests in the same joints on either side of the body, such as both hips or both wrists.

While not a frequent occurrence, RA can also impact a joint in the voice box making the patient’s voice hoarse.

 

Whole-Body Symptoms

Other than the symptoms in the joints, RA can also cause:

  • Muscle aches
  • Fatigue
  • Depression
  • Poor appetite
  • Bad all over (doctors refer to this as malaise)

Anemia or a deficiency of healthy red blood cells can be a reason for extreme fatigue. The doctor will examine this as an element of the RA diagnosis.

Some of these symptoms can also be a result of depression. It is hard to live with a chronic condition like RA. The patient should consult their doctor if they feel they may be experiencing RA symptoms.

The patient should reach out to their doctor if they experience any of the following symptoms. Gradual onset of the pain and stiffness could indicate the initial stages of RA, osteoarthritis, or another arthritic disease.

If the pain manifests quickly and is accompanied by fever, the patient may have infectious arthritis. If there is no fever, the patient may be developing gout (usually in the big toe) or pseudogout.

The patient may experience pain and stiffness in their legs, arms, or back after sitting for short durations or after getting up in the morning. This may be an indication of the onset of RA, osteoarthritis, or another arthritic condition.

A child with juvenile RA may display symptoms such as pain or a rash in the wrists, knees, and ankles, or experience fever swings, weight loss, and poor appetite.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Thomas and Dr. Bigler, receives patients for orthopedic surgery from Las Vegas, Nevada, and nearby areas.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Rheumatoid Arthritis Treatments | Las VegasRheumatoid arthritis (RA) treatment goals include inflammation control, pain relief, and reducing the disability associated with the disorder. In general, the treatment includes drugs, physical or occupational therapy, and regular exercise.

Some patients may require a surgical procedure to address joint damage. The key to good outcomes is early and aggressive treatment. The advanced treatment options available today can slow down, or in many cases, stop the progression of RA.

Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler provide treatments for the knee and shoulder to patients in Las Vegas, Nevada, and surrounding communities.

 

Drugs for Rheumatoid Arthritis

NSAIDs

The doctor will likely prescribe a nonsteroidal anti-inflammatory drug (NSAID) as a part of the RA treatment plan. While these drugs can provide pain relief and address swelling, they cannot slow down the progression of RA. Therefore, patients with moderate to severe RA will probably need to take other medications to prevent further damage to the joints.

DMARDs

“DMARDs” is the acronym for disease-modifying antirheumatic drugs. These medications slow or stop RA from becoming worse.

Doctors typically first prescribe methotrexate to treat RA. In case that alone does not adequately calm the swelling, doctors may try or add another type of DMARD. Other types of DMARDs include leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine).

RA involves an overactive immune system attacking the joints and other body parts. While DMARDs can control the immune system, they are not selective in identifying their targets. This may cause an infection and various other side effects.

DMARDs, especially methotrexate, are a very effective treatment for severe RA and they may help save the joints.

Biologics

The doctor may prescribe a biologic when methotrexate or other DMARDs are unable to relieve RA symptoms and swelling. Biologics are genetically engineered proteins.

They block specific areas of the immune system that are responsible for the swelling associated with RA. Biologics may slow or stop RA. Different biologics are used to target different regions of the brain.

Rheumatoid Arthritis Surgery

Patients experiencing unbearable joint pain and swelling or severely damaged joints may require joint replacement surgery. The most commonly replaced joints are the knees and hips, and at times, the shoulders.

Surgery can provide dramatic pain relief and mobility. A majority of patients wait for joint replacement surgery until after the age of 50 as artificial joint tend to wear down in a span of 15 to 20 years.

Artificial replacement is not very effective for certain joints, such as the ankles, which fare better with another surgery known as joint fusion.

 

Physical and Occupational Therapy

Physical and occupational therapy can make a vital difference in the patient’s day-to-day life. They are an integral part of any RA treatment plan.

Physical therapists can provide the patient with an exercise plan, explain how to use heat and ice, perform therapeutic massage, and motivate the patient.

Occupational therapists can help the patient manage their daily tasks, such as cooking or working on a computer, in an easier manner. Furthermore, they can recommend any gadgets that may help the patient.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Thomas and Dr. Bigler, receives patients for orthopedic surgery from Las Vegas, Nevada, and nearby areas.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

What is Rheumatoid Arthritis? | Las VegasRheumatoid arthritis refers to a chronic inflammatory condition that impacts the joint and may also lead to other problems.

Sometimes rheumatoid arthritis may damage various body systems such as the lungs, eyes, heart, and blood vessels. The patient may even need corrective and cosmetic surgery in very severe cases.

In many cases, rheumatoid arthritis can impact the hands, wrists, and extremities. Patients who require surgical intervention may consider hand surgery and plastic surgery.

Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler provide treatments for the knee and shoulder to patients in Las Vegas, Nevada, and surrounding locations.

 

Causes

Rheumatoid arthritis is an autoimmune disorder. In this condition, the immune system mistakenly attacks the body’s own tissue. Osteoarthritis-related damage is caused by wear and tear while rheumatoid arthritis affects the joints. This leads to painful inflammation which may gradually cause bone erosion and joint deformity.

Rheumatoid arthritis-related swelling can also impact other body parts. Advancements in drugs have improved the treatment options to a large extent. But patients with severe rheumatoid arthritis can still develop physical disabilities.

 

Symptoms

Rheumatoid arthritis symptoms may include the following:

  • Inflamed, tender, and warm joints
  • Joint stiffness, which may be worse in the mornings or after periods of inactivity
  • Fatigue, fever, and weight loss

In the initial stages, rheumatoid arthritis typically affects the smaller joints, specifically the joints that link the toes to the feet and fingers to the hand. Upon disease progression, these symptoms may also affect the elbows, wrists, hips, shoulders, and ankles. The patient usually experiences the symptoms in the same joints on either side of the body.

Rheumatoid arthritis can also impact non-joint body parts such as lungs, eyes, skin, kidney, heart, bone marrow, nerve tissue, blood vessels, and salivary glands.

 

Surgical Treatment

If these medications cannot adequately prevent or delay damage to the joint, the patient may require surgery to repair the damaged joints. Surgery can restore the ability of the patient to use the joint and may relieve pain and address deformities as well. One or more of the below procedures may be a part of rheumatoid arthritis surgery.

Synovectomy

This procedure removes the swollen joint lining. It can be performed on the knees, wrists, elbows, hips, and fingers.

Tendon Repair

Tendons surrounding the joint may loosen or tear due to swelling and joint damage. The surgeon will restore the tendons around the joint.

Joint Fusion

The surgeon may stabilize or realign a joint with surgical fusion. This procedure can offer relief from pain in cases where joint replacement is not an option.

Total Joint Replacement

The surgeon will eliminate the damaged portions of the joints and place a metal or plastic prosthesis in a total joint replacement procedure.

Thomas & Bigler Knee & Shoulder Institute, led by board certified orthopedic surgeons Dr. Thomas and Dr. Bigler, receives patients for orthopedic surgery from Las Vegas, Nevada, and nearby areas.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Biceps Tendon Surgery | Las VegasThe biceps tendon attaches the biceps muscle to the bone. It involves two tendon attachments in the shoulder. Therefore, the term “biceps” pertains to “bi”-ceps referring to these attachments. In addition, there is a tendon attachment of the muscle beneath the elbow.

The biceps muscle is vital to both turning the forearm upward (supination) and bending the elbow (flexion). Biceps tendon tears can reduce the strength in these motions as well as cause a deformity of the biceps muscle.

Thomas and Bigler Knee and Shoulder Institute, led by dependable board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding communities in The Silver State.

 

Biceps Tendon Tears

Shoulder pain commonly occurs due to biceps tendon tears in the shoulder. Biceps are typically believed to be a significant cause of pain in the shoulder. Biceps tears are usually related to rotator cuff problems.

To completely relieve shoulder pain, the biceps tendon issue may need to be treated. Biceps tendon problems can be addressed in various ways, surgical as well as nonsurgical. One surgical treatment to address biceps tendon tears is known as biceps tenodesis.

 

Biceps Tenodesis

Biceps tenodesis is a surgery that aims to treat the damaged proximal long head of biceps tendon. This surgical procedure may be performed by itself or more frequently, as a part of a more extensive shoulder surgery such as a rotator cuff repair.

In this procedure, the surgeon will detach the normal attachment of the biceps tendon in the shoulder joint (if it is not fully torn already). After that, they will reinsert the tendon into the arm bone (bone of humerus). In case of a full rupture of the biceps tendon, the detachment of the tendon is obviously not required.

Biceps tenodesis involves the careful moving of the tendon from its normal position inside the shoulder joint to a new area further down the bone of humerus.

The attachment of the biceps tendon is moved, and it is no longer attached to the shoulder joint. This minimizes problems in the future as the compromised biceps tendon can create issues within the joint.

 

Biceps Tenodesis Candidates

This surgery can be used for the treatment of the following conditions:

  • SLAP tears
  • rupture of the long head of the biceps
  • biceps tendinosis
  • biceps tendonitis

 

Alternative Treatments

There is a strong debate on the ideal treatment for biceps tendon issues in the shoulder. In general, the most suitable treatment of a biceps tendon problem depends on the patient’s age and activities and type of tendon injury among other factors. Other types of biceps tendon surgeries include:

  • biceps tenotomy
  • SLAP repair

 

Tenotomy or Tenodesis?

There are benefits and limitations associated with both these procedures. Both are reasonable treatment options. While one may be more appropriate for some patients, the other may be suitable to others. Neither option is better or worse.

More active patients such as athletes or manual laborers choose biceps tenodesis, or if the patient has concerns on the appearance of their biceps muscle. Patients who seek faster recovery and want to avoid the complications of tendon repair and a longer procedure typically undergo biceps tenotomy.

Caring board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and other towns and suburbs in the southeast part of Nevada for orthopedic treatments.  


Board certified orthopedic surgeons
at the Thomas & Bigler Knee & Shoulder Institute receive patients from Las Vegas, Nevada, and nearby areas for knee and shoulder treatments.If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Rotator Cuff Injury Diagnosis | Las VegasAccurate diagnosis of rotator cuff injury and timely treatment is important to ensure that further damage is avoided. Advanced imaging and other diagnostic solutions are available today for correct diagnosis.

Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler provide treatments for the knee and shoulder to patients in Las Vegas, Nevada, and surrounding communities.

 

Key Causes

The two primary causes for rotator cuff tear development are injury and degeneration.

Acute Tear

The rotator cuff can tear if a person falls down on an outstretched arm or lifts a heavy object with a jerking motion. This tear can also occur along with other shoulder injuries such as a dislocated shoulder or a fractured collarbone.

Degenerative Tear

Most tears occur due to the wearing down of the tendon that occurs gradually over time. Aging leads to this degeneration, and rotator cuff tears occur more commonly in the dominant arm.

In case the patient has a degenerative tear in one shoulder, there is a higher possibility of developing a rotator cuff tear in the other shoulder as well. This can happen even if the patient does not have any pain in that shoulder.

 

Contributing Factors

Factors leading to degenerative, or chronic, rotator cuff tears are as follows:

Repetitive Stress

Repetitive motions in the same shoulder can stress the rotator cuff tendons and muscles. For instance, sports in the categories of tennis, rowing, and baseball present a higher risk for sustaining rotator cuff injuries.

Lack of Blood Flow

Aging lessens the blood supply in the rotator cuff tendons. In the absence of adequate blood supply, the natural ability of the body to repair tendon damage is compromised. This can eventually cause a tendon tear.

Bone Spurs

The process of aging also leads to bone overgrowth (bone spurs) development on the underside of the acromion bone. Upon lifting the arm, the spurs rub against the rotator cuff tendon.

This condition is known as shoulder impingement. It will weaken the tendon over time and make it most susceptible to tear development.

 

Diagnosis

Health History and Physical Exam

The doctor will examine the patient’s shoulder after discussing their symptoms and health history. They will evaluate whether the shoulder is tender in a specific area or if there is a deformity. They will also ask the patient to move their arm in various directions to assess the range of motion of the shoulder. On top of this, the doctor will test the patient’s arm strength.

The doctor will check for other issues with the shoulder joint as well. They may examine the patient’s neck to ensure that the pain is not a result of a “pinched nerve” and to exclude other conditions, such as arthritis.

 

Imaging Tests

X-Rays

X-rays are usually the initial tests that are performed on the shoulders. However, x-rays do not show the soft tissues of the shoulder such as the rotator cuff. Plain x-rays of a shoulder with rotator cuff pain are typically normal or may indicate a small bone spur.

Magnetic Resonance Imaging (MRI) or Ultrasound

These tests can display soft tissues such as rotator cuff tendons in a clearer manner. An MRI or ultrasound can highlight the rotator cuff tear and its location within the tendon as well as the size of the tear.

An MRI can provide the doctor with a better indication of how “new” or “old” a tear is as it can show the rotator cuff muscle quality.

The injury type determines the prognosis for a rotator cuff injury. Severe cases of rotator cuff tears may require surgical correction to restore shoulder strength.

Board certified orthopedic surgeons at the Thomas & Bigler Knee & Shoulder Institute receive patients from Las Vegas, Nevada, and nearby areas for knee and shoulder treatments.If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Rotator Cuff Injury Symptoms | Las VegasRotator cuff tendinitis, or tendonitis, impacts the muscles and tendons that enable a person to move their shoulder joint. Tendinitis refers to the irritation and inflammation of the tendons. Rotator cuff tendinitis is also known as impingement syndrome.

Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler provide treatments for the knee and shoulder to patients in Las Vegas, Nevada, and surrounding locations.

 

Causes

Rotator cuff problems typically develop over time. An injury could occur due to keeping the shoulder in one position for a period, sleeping on the same shoulder every night, or performing motions that require lifting the arm overhead.

Athletes who play sports that require lifting their arm overhead generally develop rotator cuff tendinitis. For this reason, this condition is also known as:

  • pitcher’s shoulder
  • swimmer’s shoulder
  • tennis shoulder

At times, rotator cuff tendinitis may develop without any apparent reason. A majority of individuals with rotator cuff tendinitis are able to regain complete function of their shoulder without any discomfort.

 

Rotator Cuff Tendinitis Symptoms

Rotator cuff tendinitis symptoms tend to worsen over time. While the patient can find relief from the initial symptoms with rest, the symptoms can later become constant. Symptoms that extend past the elbow typically indicate other issues.

Rotator cuff tendinitis symptoms include:

  • Pain and inflammation in the front of the shoulder and side of the arm
  • Pain triggered by lowering or lifting the arm
  • A clicking sound when lifting the arm
  • Stiffness
  • Pain that causes the patient to wake from sleep
  • Pain when reaching behind the back
  • Mobility and strength loss in the impacted arm

Tears that develop suddenly, such as those from a fall, typically cause intense pain. The patient may experience a snapping sensation and instant weakness in the upper arm.

Tears that develop gradually because of overuse also lead to pain and arm weakness. The patient may experience pain in the shoulder upon lifting their arm, or pain that travels down the arm.

The pain may initially be mild and only occur when lifting the arm overhead, such as when reaching into a cabinet. Initially, over the counter pain meds such as ibuprofen or aspirin may provide pain relief.

However, over time the patient may find that the pain is more apparent at rest and does not go away with over the counter medications. They may experience discomfort when they lie on the painful side while sleeping.

The weakness and pain in the shoulder may make it challenging to perform regular activities such as combing the hair or reaching behind the back. Notably, some rotator cuff tears do not cause pain. However, these tears may still lead to arm weakness and other symptoms.

 

Rotator Cuff Tendinitis Diagnosis

If the doctor suspects rotator cuff tendinitis on the basis of the patient’s symptoms, they will start by evaluating the shoulder. They will assess where the patient is feeling pain and tenderness. The doctor will also check the patient’s range of motion by asking them to move their arm in certain directions.

The doctor may also test the strength of the shoulder joint by asking the patient to press against their hand. They may assess the patient’s neck for conditions such as arthritis or a pinched nerve that can lead to symptoms that are similar to those of rotator cuff tendinitis.

The doctor may order imaging tests to confirm the rotator cuff tendinitis diagnosis and exclude any other reasons for the patient’s symptoms.

Board certified orthopedic surgeons at the Thomas & Bigler Knee & Shoulder Institute receive patients from Las Vegas, Nevada, and nearby areas for knee and shoulder treatments.If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

How do I know if I damaged my rotator cuff? | Las Vegas A rotator cuff is a group of tendons and muscles that surround the shoulder joint enabling the head of the upper arm bone to remain firmly within the shallow shoulder socket.

A rotator cuff injury can lead to a dull ache in the shoulder which typically worsens when the patient tries to sleep on the affected side.

 

A Possible Threat Due to Repeated Motion

Rotator cuff injuries develop most frequently in individuals who perform repetitive overhead movements in their line of work or sports — for instance, carpenters, painters, and individuals who play tennis or baseball. Aging also increases the risk of rotator cuff injury.

Board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler provide treatments for the knee and shoulder to patients in Las Vegas, Nevada, and surrounding communities.

 

Symptoms

  • Dull, deep ache in the shoulder
  • Disrupted sleep, especially if the patient lies on the impacted shoulder
  • The patient finds it challenging to comb their hair or reach behind their back
  • Weakness in the arm

 

When to Consult a Doctor

The patient’s family doctor can assess short-lived shoulder pain. The patient should consult the doctor promptly if they experience immediate weakness in their arm following an injury.

The cause of rotator cuff disease may be either a substantial injury to the shoulder or progressive wear and tear of the tendon tissue. Repetitive heavy lifting or overhead motions for an extended duration may damage or irritate the tendon.

 

Risk Factors

Age

Aging increases the risk of sustaining a rotator cuff injury. Rotator cuff tears occur most frequently in people over the age of 50 years.

Certain Sports

The risk of sustaining a rotator cuff injury is higher for athletes who regularly perform repetitive arm movements, such as archers, tennis players, and baseball pitchers.

Construction Jobs

Professions such as house painting or carpentry warrant repetitive arm movements, usually overhead motions. These can cause damage to the rotator cuff over a period.

Family History

Genetics may be a factor in the development of rotator cuff injuries as they occur more frequently in certain families.

 

Diagnosis

The doctor will press on various parts of the shoulder and move the arm into different positions during the physical examination. They will also test the strength of the muscles around the shoulder and the arms.

Furthermore, they may recommend imaging tests in some cases, such as:

X-Rays

While a rotator cuff injury will not show up on an x-ray, it can detect bone spurs or other potential reasons for the pain, such as arthritis.

Ultrasound

This test makes use of sound waves to generate images of the structures inside the body, especially soft tissues such as tendons and muscles. It enables dynamic testing, evaluating the structures of the shoulder as they move. Ultrasound allows a comparison between the impacted shoulder and the healthy shoulder.

Magnetic Resonance Imaging (MRI)

This technology involves the use of radio waves and a strong magnet. The images acquired provide an in-depth view of all structures of the shoulder.

To a large extent, the image quality depends on the quality of the equipment used.

Board certified orthopedic surgeons at the Thomas & Bigler Knee & Shoulder Institute receive patients from Las Vegas, Nevada, and nearby areas for knee and shoulder treatments. If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Shoulder Replacement | Las Vegas Orthopedic SurgerySevere shoulder joint arthritis can be treated with a shoulder replacement. As the arms are not used for walking, shoulder arthritis can usually be managed by noninvasive procedures more easily than knee or hip arthritis which is why knee and hip replacements are much more common.

However, shoulder replacement may be considered for patients who do not experience relief with nonsurgical treatments. Thomas and Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding locations.

 

Implants

Similar to knee and hip implants, most shoulder replacements implants comprise plastic and metal. These implants positioned by using cement or by wedding them tightly in place.

To recreate the worn out top of the humeral head (arm bone), a metal ball is used. A plastic cup is used to replace the damaged shoulder blade socket (the glenoid).

 

Surgery

This surgery is typically performed using general anesthesia, and the patient may also receive a regional nerve block to minimize shoulder pain upon waking from the anesthesia.

The time taken for the replacement surgery is around two hours. However, the total time spent in the operating room may be over three hours including the preparation and recovery period. The surgeon places an incision between four to six inches in length, along the front part of the shoulder joint.

The surgeon commences by eliminating the arthritic cartilage and bone. They use special instruments to align the artificial shoulder in the correct position.

Temporary implants, known as “trial implants,” are placed in the bone to enable the surgeon to evaluate the stability and mobility of the new joint.

After the procedure, most patients remain in the hospital for at least one night. More surgeons are increasingly trying to perform joint replacement surgery as outpatient surgery. However, in outpatient replacement, the patient requires detailed presurgical education to prepare them for their return home after the surgery.

 

Rehabilitation

Rehabilitation starts right after the surgery. Patients typically meet the therapist on the day of the procedure itself. In general, surgeons will place their patients in a sling. However, they will allow this sling to be taken off for activities related to physical therapy.

A majority of surgeons will allow some range of motion right after the surgery. Patients are typically able to resume most of their normal activities within two to three months. At this time, they can also focus on muscle strengthening around the shoulder and increasing their mobility.

 

Risks

Shoulder replacement surgery has the same general anesthesia risks that are associated with any surgical procedure. Certain risks specific to shoulder replacement surgery are:

 

Infection

The occurrence of infection around the joint implant is a serious complication. To avoid this risk, significant measures should be taken.

 

Dislocation/Instability

The implanted joint has a ball-and-socket design. Therefore, it is vital for the surgeon to balance the soft tissues surrounding to shoulder to make sure the implant remains in position.

 

Implant Loosening

Implanted joints may become loose over time. There are on-going efforts in the development of implants with higher longevity, but this has not yet been perfected.

Board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas for orthopedic treatments.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Acromioclavicular (AC) Joint Repairs | Vegas OrthopedicA separated shoulder refers to a condition that causes the clavicle (collarbone) to detach from its normal attachment on the shoulder blade. This condition is frequently misunderstood as a shoulder dislocation. However, it is a different type of injury.

Shoulder separation usually occurs when a patient falls on the outside of their arm or shoulder. It leads to a bump and pain on the top of the shoulder. The bump develops due to the end of the clavicle pushing up against the skin.

Noninvasive treatments are a suitable option for most patients with a separated shoulder. A majority of orthopedic surgeons also agree that all type I and type II separations can be treated nonsurgically.

Thomas and Bigler Knee and Shoulder Institute, led by board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and surrounding communities.

 

Surgical Treatment Options

The primary objective of all surgical shoulder separation procedures is to restore the normal alignment at the end of the clavicle with the shoulder blade’s outer edge (the acromion). The ultimate goal is to restore the alignment of these bones, stabilize their position, and provide pain relief at the acromioclavicular joint.

 

The main surgical options are:

Repairing the AC Joint

It makes sense to repair the acromioclavicular joint. The most visible facet of this injury is a joint disruption. Therefore, aligning and holding the joint in an appropriate position seems logical. The AC joint is usually held in position with metal pins or plates known as Kirschner wires (k-wires).

The disadvantage of this surgery is that it does not address the damage to the strong ligaments that hold down each end of the collarbone. In addition, the patient may experience pain due to the metal implants placed to position the joint. These may have to be taken out, and a more concerning complication is the likelihood of these implant moving from their position.

This involves the movement of these implants within the body. In some frightening instances, there have been reports of k-wires placed in the collarbone ending up within the chest cavity over a period.

 

Holding the Clavicle Down

There are many techniques to treat AC joint injuries that involve holding the clavicle down. Some of these approaches use metal while others employ heavy sutures. Typically, the clavicle is held to the coracoid process which is a hook of bone in front of the shoulder right underneath the collarbone.

The surgeon may either put a screw from the clavicle into the corocoid or wrap the two bones together firmly using sutures. The drawback of these methods is that the screws usually have to be taken out and sutures can cut through and break the bone.

 

Reconstructing Ligaments

In this category of options, the ligaments that hold the end of the collarbone in the appropriate position may be reconstructed. There are various options for this procedure using either donor tissue or the patient’s own tissue.

A commonly performed procedure in this category is known as a Weaver-Dunn surgery. This involves the shifting of the major ligaments that connect to the acromion over to the end of the collarbone.

This holds the collarbone in its proper place. Another option is the coracoclavicular ligament (that were torn at the time of the shoulder separation injury) reconstruction with either a donor tendon or one from the patient’s leg.

The surgeon wraps the tendon graft around the hooked coracoid and then into the collarbone. Dedicated board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and other towns and cities in this part of the country for orthopedic treatments.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.

Shoulder Surgery: Rotator Cuff Repairs | Vegas Orthopedic SurgeryRotator cuff treat treatment usually initiates with a significant effort at conservative therapy. The type of rotator cuff tear (acute versus longstanding), the size of the tear, and the patient’s activities will impact the effectiveness of nonsurgical treatment options.

Over 50 percent of patients with rotator cuff tears will find non-surgical procedures effective in relieving their symptoms.

Thomas and Bigler Knee and Shoulder Institute, led by astute board certified orthopedic surgeons Dr. Steven C. Thomas and Dr. Gregory T. Bigler, provides orthopedic treatments to patients in Las Vegas, Nevada, and other suburbs and neighborhoods in The Sagebrush State.

 

Open Surgical Rotator Cuff Repair

All rotator cuff tear repair treatments involved the surgeon looking directly at the torn tendon through an incision around six to ten cm in length before the advent of arthroscopic surgery. The benefit of open rotator cuff repairs is that the surgeon can clearly view the rotator cuff tendons in this technique.

The process of repair itself is straightforward, and a majority of surgeons consider this surgical procedure to be more efficient and effective. A disadvantage is that the incision is significant making the recovery duration longer and more painful.

 

Mini-Open Rotator Cuff Repair

The mini-open rotator cuff repair method involves an arthroscopic part of the surgery as well as a small incision to access the torn rotator cuff. The surgeon can view the shoulder joint by using an arthroscope and remove any bone spurs or damaged tissue. They can make preparations for the rotator cuff repair arthroscopically.

After the arthroscopic part of the procedure is complete, a smaller incision is placed to repair the tendon back to the bone. This incision is around 3 cm in length, and the recovery may be more comfortable in comparison to an open cuff repair.

Similar to open rotator cuff repair, this procedure also involves some deltoid muscle trauma. However, there is no detachment, and the damage is less severe.

 

All-Arthroscopic Rotator Cuff Repair

An arthroscopic rotator cuff repair involves the placement of tiny incisions, and the repair is performed with the surgeon viewing the torn rotator cuff tendons and their repair through a small camera which projects on a television screen. In the area of rotator cuff tear treatment, this is a recent development. This procedure cannot address all types of tears.

In addition, arthroscopic rotator cuff repairs can be technically challenging. The surgeon must have expertise in this repair method. There is no consensus between surgeons that arthroscopic repair is as effective as repair carried out via an open incision. The deltoid muscle sustains only minor damage using the arthroscopic rotator cuff repair method.

 

Shoulder Replacement Surgery

More significant rotator cuff tears that have been left untreated for many years cause the shoulder joint cartilage to wear out eventually. These large rotator cuff tears are also known as massive rotator cuff tears. They involve a minimum of two of the four rotator cuff tendons.

A condition known as rotator cuff tear arthropathy is a dual problem which involves a large rotator cuff tear and shoulder arthritis. Since the rotator cuff is damaged, a standard replacement is typically not suitable in this case.

The patient will receive special implants to compensate for the abnormal functioning of the rotator cuff. One of these special implants is known as a reverse shoulder replacement.

Reliable board certified orthopedic surgeons Dr. Thomas and Dr. Bigler receive patients from Las Vegas, Nevada and nearby areas across the horizon for orthopedic treatments.

If you would like to schedule an appointment or learn more about the Knee and Shoulder Institute procedures & treatments performed by Las Vegas, Nevada board-certified surgeons Steven C. Thomas, MD and Gregory T. Bigler, MD. Contact the office today click here.