Surgery

Upper Extremity

Rotator Cuff Repair

Motion and function of your shoulder can be attributed to the various muscles and tendons that comprise the rotator cuff and connect your shoulder blade and upper arm. Rotator cuff injuries often result from periods of strenuous lifting, frequent use of your shoulder for overhead arm motions and other causes. Assessment of the injury is vital to surgical success, as the type of rotator cuff repair surgery you will undergo depends on a variety of factors, including the degree of your tear and the quality of your surrounding bone and tissue.

Some symptoms of rotator cuff injuries can be addressed through nonsurgical treatments, such as avoiding activities that trigger pain in the affected area, anti-inflammatory medications and steroid injections, physical rehabilitation programs and rest. These steps can help reduce pain associated with rotator cuff injuries, however, sometimes non-surgical treatment is not enough. While you can expect improved strength after rotator cuff repair surgery, we can't always guarantee the full return of shoulder strength.

Once the procedure is completed, rotator cuff surgery rehabilitation relies on the patient’s regular participation in physical therapy and avoidance of sedentary habits that could cause the joint to atrophy. Surgery and recovery vary on a case by case basis and depend on the size of the tear and other contributing factors. Patients are generally immobilized in a shoulder sling for one to two months post-operation and may require pain medication, such as anti-inflammatory medication, which may be prescribed by your doctor.

Once you begin rehab, physical therapists will implement protocol determined by your provider to help regain motion, and when ready, strength. As your rotator cuff heals, you will gradually increase the type and intensity of your exercises, which will allow you to increase strength and mobility over time, getting you back to normal activities.

Various factors can affect the success of rotator cuff surgery, including whether the injury occurred suddenly or over time, how soon the surgery occurs relative to the date of the tear, and the condition of the injured tendon immediately before surgery. Our providers will discuss surgery recommendations and recovery expectations and work together to develop an individual surgery strategy that is best suited for you.

Shoulder Replacement

Severe shoulder pain that exists due to shoulder arthritis, or decreased cartilage, rotator cuff tears and other conditions may be an indication for your provider to recommend total shoulder joint replacement surgery, when other treatment options have failed. This procedure is most commonly performed for older patients suffering from these issues and can be performed in several different ways, depending on a patient's age, activity level and other factors.

Your provider will assess your suitability for surgery, beginning with a physical, a complete review of your medical history, X-rays/scans and other tests as appropriate. After reviewing the information gathered from these activities and the viability of other nonsurgical options, including physical rehabilitation, injections, medications and other procedures, your provider will discuss with you whether total shoulder joint replacement surgery is right for your condition.

Shoulder joint replacement procedures involve modifying your existing shoulder ball and socket, and then fitting the area with a prosthetic replacement. There are different configurations that may be used, but partial and total replacement, traditional and reverse options. The post-surgical rehabilitation process for shoulder joint replacement surgery may require pain medications and rest, typically in a sling, immediately following the procedure. With the direction of your orthopedic provider, you will also work closely with a physical therapist during the several months following surgery to restore mobility and function of the arm.

Once the patient is fully recovered, he or she can expect to return to normal activities with a decreased amount of pain as compared to before surgery. The goal of shoulder replacement surgery is to allow the patient to get back to activities and maintain a healthy active lifestyle, and to be able to allow patients to perform daily activities that are important to them.

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Arthroscopic Labral Repair

When you incur labral damage due to intense and recurring motion, commonly found in occupational or athletic activities, labral surgery may be needed in order to restore shoulder strength, agility and stability and repair other affected areas, including the biceps tendon.

While regaining complete shoulder motion is typically a 3-4-month process, fortunately, performing the surgery arthroscopically, or with a shoulder scope, most patients experience reduced postsurgical pain and faster recovery time. You will initially be fitted with a sling to prevent arm movement for up to one month after surgery and during the initial stages of post-surgical pain and inflammation. Patients will be instructed when to begin mild exercises to test their level of mobility and movement within about a month after surgery. Athletes typically begin resuming activities after 4-6 months. This process involves balancing the need to move the shoulder and avoid stiffness to protect the repaired shoulder moving forward.

Recovery from shoulder labral surgery can be a time-consuming process and requires patience and commitment to a regular physical therapy program. During rehabilitation, you may feel uncertain about your mobility limitations and experience occasional shoulder discomfort and pressure. Even after your shoulder is fully healed, you may continue to experience lingering pain. Once recovered, you can resume overhead and other motions without limitation, however, you will also need to undertake exercises moving forward to avoid having shoulder issues in the future.

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Distal Biceps Tendon Repair

You rely on your biceps muscle (upper arm) to enjoy complete functionality of your forearm, as it allows rotation, providing grip strength while assisting with the bending and positioning of your elbow and upper arm. Biceps tendon injuries (distal tendon injuries or injuries at the bend of your elbow) can occur as a result of overuse, heavy lifting and acute trauma, and can happen over time through accumulated injuries or due to a sudden, forceful event. The tendon tear can be full thickness, or a complete tear, severing the tendon in two, or partial tearing (when tendon is still intact but still injured). Those suffering from damaged biceps tendon often experience pain and weakness throughout their entire arm, including the elbow and shoulder areas, as well as increased cramping and muscle bruising and bulging.

Treatments for a biceps tendon injury consist of both surgical and nonsurgical options. Nonsurgical remedies include ice, rest, physical therapy and anti-inflammatory medicines. While the pain will diminish gradually, weakness and arm deformity may continue when not repaired. If nonsurgical steps are insufficient in controlling pain or other symptoms of the impaired biceps, surgery may be recommended. Recommendation for surgery can depend on many factors including age, activity level and personal goals for the patient. Our specialized orthopedic providers can work with you to determine the best treatment option, personalized for your situation.

After the surgery, your arm initially may be in a splint and/or be in a sling. Your provider will work with you and guide you during post-surgery rehabilitation, including regular exercise and physical therapy. Generally, mobility and strength of the biceps are eventually regained after the completion of the recovery process a few months after surgery.

Carpal & Cubital Tunnel Surgery

Age, heredity, overuse of your hand during long periods, and other diseases such as arthritis and diabetes can constrict your carpal tunnel passage. Pain and numbness are alleviated by carpal tunnel release surgery for many patients, with some experiencing continued symptoms or decreased strength after surgery, and hand mobility and force being diminished for others due to different but related conditions.

If any of the previously mentioned conditions should occur, your carpal tunnel passage may begin to swell, causing the fingers, usually the thumb, index, middle and sometimes ring fingers to tingle and feel numb over time. You may also experience sporadic pain in various parts of your hand that worsens with decreased activity. For many people, these conditions worsen if untreated. Your provider may encourage anti-inflammatory medications, bracing, splinting, modifications in activity level and other steps first. If your condition isn’t alleviated by nonsurgical methods within a short time or depending upon the severity of the pain and numbness in your hand, your provider may recommend carpal tunnel release surgery to restore your carpal tunnel passage.

As a routine, outpatient procedure, with just a small incision, the surgeon will perform a release of the carpal tunnel passage in order to alleviate compression and pain in the carpal tunnel passage to successfully correct the carpal tunnel condition.

The recovery time for most patients can range from a couple of weeks up to a few months after surgery, individual factors for each patient affect recovery time. Elevation of your hand above your heart and frequent finger movement, initially, will help avoid stiffness and inflammation. Some may benefit from wearing a splint or brace and limiting yourself to light activities will facilitate the healing process. Depending upon the severity of the condition of your median nerve prior to surgery, your gripping and pinching strength will return within two-to-three months. Pain and numbness are alleviated by carpal tunnel release surgery for many patients, with some experiencing continued symptoms or decreased strength after surgery, and hand mobility and force being diminished for others due to different but related conditions. Should pain persist, your physician may refer you to a hand therapist.

Cubital tunnel - a condition where the compression or stretching of the ulnar nerve (also known as the "funny bone" nerve) - causes tingling or numbness in fingers, pain in the forearm and weakness in the hand. This is generally due to irritation or compression of the elbow area. Cubital tunnel condition is treated similarly to carpal tunnel in their respective areas. Learn more about this condition.

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Trigger Finger Release

If you experience discomfort when attempting to move your fingers, swelling in your palm or fingers, tenderness in your palm, or your finger joints are catching, locking, or a sense of them feeling stuck, you may have the trigger finger condition.

Options include surgical versus non-surgical treatment. Talk with one of our highly specialized orthopedic providers to determine what options are available to you. Treatment options often depend upon how long you’ve had trigger finger release and the severity of your condition. While the trigger finger condition does not pose immediate health dangers, if your condition is not responding to nonsurgical treatments and your symptoms are severe, our specialists may recommend you for trigger finger release surgery. Those who require surgery will undergo a short outpatient procedure.

While some patients experience palm soreness immediately after the procedure, finger movement is also not generally restricted after surgery. To combat pain and inflammation, those recovering from surgery should perform regular finger exercises and, in some cases, physical or occupational therapy will help avoid finger stiffness. Complete recovery and finger usage occur within two or more weeks, however, stiffness and swelling may persist for several months after the surgery.

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Wrist Fractures (Distal Radius Fractures)

When you shake someone’s hand, grab your vehicle door handle or use your arm in any other way, you are using your forearm’s radius bone, the distal portion of which meets your wrist joint. The two primary reasons for a distal radius fracture, also known as a wrist fracture, are osteoporosis and accidental or unexpected falls. Swelling, sensitivity, bruising and pain in your forearm, as well as wrist deformity, are all signs of this type of injury.

When repairing a broken or fractured distal radius, your provider has several different treatment options to choose from, depending on the fracture type and the patient’s age and ability to remain inactive during the recovery process. This may include both surgical and non-surgical options. Surgical options may vary from setting the bone or performing a closed reduction, using temporary fixation pins without incisions in the skin, hardware implanted underneath the skin (plate and screws) or temporary hardware placed on the outside of skin which is called an external fixator. Non-surgical options typically consist of casting, splinting, removable immobilization and careful continued evaluation of the fracture through x-ray exams. Immobilization may be short-lived, a few weeks but may last many weeks up to 12 weeks in some cases. Routine follow-up and continued interpretation of x-ray studies performed by your orthopedic provider will be necessary to ensure proper healing.

Recovery can vary, depending on each patient’s individual factors and the corresponding difficulty of surgery, including whether their break affects the wrist joint area (intra-articular fractures) or not (extra-articular fractures) or resulted in multiple fragments (comminuted fractures) or is an open fracture. Your orthopedic provider will discuss with you what to expect long-term based on your particular ailment. It is always important that you avoid strenuous activity immediately after surgery and follow their provider’s instructions.

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Lower Extremity

Hip Replacement

Hip arthritis, hip disease and other factors can inhibit your hip’s full movement and can cause considerable pain. A total hip replacement involves the insertion of artificial instruments consisting of a stem, ball and socket prosthesis. After surgery, to ensure the stability and longevity of the hip replacement, most patients generally engage in low-impact exercise following a period of rehabilitation. Your provider will evaluate your candidacy for hip surgery. Factors that may influence the recommendation for surgery include age, BMI, activity level and overall health.

Most patients will stay in the hospital for 1-3 days. After discharge, close follow-up by our team will allow us to help get you back on your feet faster. Some patients undergo formal physical therapy, while others may utilize an at-home self-directed program and a planned diet. Many patients can engage in normal activities about six weeks after surgery, with total recovery typically occurring within six or more months following the hip replacement.

Knee Arthroplasty

The total knee replacement procedure typically takes around two hours. Immediately after surgery, most patients will spend 1-3 nights recovering in the hospital. Once you return home, the hard work begins, including: physical therapy to help regain motion, rehabilitation, exercise, healthy diet and more. We take special consideration for patients that are at high risk for any complications. Many people who follow this process see their ability to handle normal daily tasks improve within one to two months post-operation.

With the guidance of one of our expert providers, we will outline your treatment plan and recovery with you. Our providers will go over expectations post-surgery and your goals, as well as answer any questions you may have. Once your knee is fully healed, the status of which will be determined by your provider, you can expect expanded knee functionality that will allow you to enjoy walking, swimming and other non-strenuous activities. You can expect to resume most normal activities, such as driving and walking, after a few weeks. However, each patient’s recovery process will vary and should be developed with the assistance of his or her physician. While most people can expect to feel less pain and be better able to move, high-intensity activities such as running and jumping should generally be avoided to ensure optimal structural integrity for the knee replacement.

Arthroscopic Knee Surgery

ACL Reconstruction

Femur Fractures

Sometimes you may be in need of more urgent or emergent surgical intervention. Car crashes, blunt force trauma, or falls may leave you with a fractured or broken femur. Factors such as osteoporosis or underlying cancer can further attribute to femur fractures. While unmatched among bones in the body in terms of strength or durability, a femur fracture almost always results in the need for surgical intervention. Determining the type of surgery that is needed after a femur fracture is due to type of injury, location of the injury and patient’s normal activity level and overall health.

Typically, femur fracture surgery is done on an urgent basis, within 1-3 days from the initial injury.

Femur fracture healing requires a great deal of long-term healing. Many rehabilitate at a nursing facility and extensive Physical Therapy and Occupational therapy are utilized. You will continue to follow-up closely with your provider regarding specific activity for your situation. Weight-bearing activities of the leg should be undertaken with the approval of your physician/provider.

Those who had particularly severe breaks, or who are older, may experience slower healing timeframes and some complications, including working to avoid infection from skin wounds due to the fracture. Check out our History of Orthopedics display wall at our office to take a look at some of the various types of implants used to fix femur fractures!

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Ankle (Fibula) Fractures

The ankle is made up of the tibia (inside ankle bone or shin bone), fibula (outside ankle bone) and talus (the bone that the tibia and fibula overlap) bones all meet in your foot and are held together by the ligaments. When an overextension of the ankle happens, an injury such as a sprain can happen, but also fractures or breaks in any one or more of these bones. The causes of an ankle fracture can be due to hyperextension, rolling, twisting or high-impact landing resulting from athletics, work or everyday activities or falls. Ankle injuries carry immediate symptoms, including foot pain, significant swelling, and skin deformities, even punctures. Bruising may also occur.

It is generally recommended that those with such injuries seek professional medical assistance, to determine the extent of the diagnosis and develop a treatment plan. A fracture is confirmed after both physical examination and interpretation of x-ray studies. Your provider will then determine the next steps which may include a splint or cast and immobilization of your ankle/foot and they will advise whether surgery is recommended.

An ankle fracture, both surgical and non-surgical, typically requires a period of immobilization from just a few shorts weeks up to 12 weeks in rarer, more serious occasions. During the recovery phase, your ligamentous injuries are also beginning to heal. Most fractures or injuries will fully heal in a few months. Restoring range of motion and strength can take a bit longer, and typically requires a self-directed at-home therapy or formal physical therapy. Your recovery progress will be monitored by your provider through physical examination and repeated x-ray exams.

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Achilles Tendon Repair

The Achilles tendon is located near your ankle and attaches your heel bone to your calf muscles to create the downward strength that your foot requires to undertake daily motions, including walking and jumping. Despite being your strongest and largest tendon, it can become damaged under circumstances such as:

• Being overstretched/overused
• During activity following periods of atrophy
• After direct force is applied or a sudden movement of the ankle beyond its normal boundaries

You can take steps to minimize the risk of an Achilles tendon injury by avoiding physical activity that is immediately high-intensity or that is not preceded by adequate stretching and warm up.

An Achilles tendon injury is indicated by significantly impaired walking, shooting pain, a loud popping noise and a warm feeling near your Achilles tendon area. An Achilles tendon injury may be treated surgically or non-surgically. When surgery is performed to the Achilles tendon, the tendon gets repaired or reattached to the calcaneus or heel bone. If it is determined that your Achilles tendon injury can be treated conservatively, this may be achieved through casts or similar devices to immobilize your leg and anti-inflammatory medications, physical therapy, rest and ice. Determining surgical versus nonsurgical options varies with each patient’s activity level, age and injury as one option may be better than another for different patients. This decision can best be made after evaluation and discussion with your orthopedic provider.

During your recovery, most patients will begin to bear weight after several weeks. Your provider may place you in a removable boost or cast. You will progress with activity as directed by your provider. This period depends on many factors including the amount of damage to the tendon, and other factors specific to each patient's situation.

Generally, most patients can return to their pre-injury activity level, however, each recovery depends on certain factors, including when the surgery occurs, the patient’s age, the degree of the tendon injury and more. Expectations regarding your return to activities will be discussed with you on a patient dependent, case by case scenario.

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Workers’ Compensation Injury Specialist

Some of the most common workplace injuries include orthopedic-related ones. At Cedar Valley Orthopedic Surgery & Physical Therapy/Occupational Rehab, we are skilled in performing these surgeries and have treated many workers’ compensation cases. If you have sustained an injury or condition while on the job, here are the type of surgical treatments we can perform:

• Hand
• Wrist
• Elbow
• Shoulder
• Hip
• Knee
• Foot
• Ankle
• & More!

If you have any questions about the surgeries above or would like to get in touch with our team, please give us a call or stop by one of our locations. We can’t wait to meet you.

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