Shoulder, Elbow & Wrist
Rotator Cuff Repair – Arthroscopic, Open, Minimally Invasive Open
A rotator cuff tear is a common source of shoulder pain and can cause weakness and disability, making daily activities painful and difficult. The rotator cuff stabilizes the ball-and-socket joint of the shoulder and allows for normal shoulder mechanics. An injury to the rotator cuff, such as a tear, may happen suddenly due to trauma or rotator cuff degeneration and aging. Rotator cuff tears can now be repaired with minimally invasive techniques such as arthroscopy and can be treated by physical therapy and injections.
During an arthroscopic repair, Dr. Kostman will insert a small camera, called an arthroscope, into your shoulder joint. The camera displays images on a screen, and he uses these images to guide surgical instruments. Because of the thinness of the instruments, he will use a very small incision the size of a pencil diameter. This is an outpatient procedure and the least invasive methods to repair a torn rotator cuff.
Dr. Kostman is experienced in open and minimally invasive techniques for treatment and repair of rotator cuff tears.
Biceps Tendon Repair – Open, Arthroscopic, Minimally Invasive Open
The biceps muscle is located in the front of the upper arm and allows the elbow to bend and the arm to rotate. The tendons that attach the biceps muscle to the bones in the shoulder and in the elbow can tear either completely or partially. Biceps tendon tears can occur due to trauma or when lifting heavy objects, or overtime, a tendon may fray and eventually tear.
There are two tendons that attach the biceps muscle to the bones in the shoulder, the long head tendon that attaches the muscle to the top of the shoulder’s socket (glenoid) and the short head that attaches it to the shoulder blade/coracoid. Tears are more likely to occur in the long head of the biceps tendon
Dr. Kostman may suggest surgery to reattach the torn tendon back to the bone for patients who continue to experience symptoms after non-surgical treatments. He will attach the tendon with stitches through a hole drilled inside the bone and/or small metal implant with one small incision. Following surgical repair, you will need to do flexibility and strengthening exercises to improve the range of motion in your shoulder.
Distal Bicep Repair
There is only one tendon that attaches the biceps muscle to the elbow. This is known as the distal biceps tendon. Tears are often complete and the muscle is separated from the bone, most often resulting from trauma or lifting heavy objects. In order to return arm strength, Dr. Kostman may recommend surgery to repair the torn tendon by attaching the tendon with stitches through holes drilled in the radius bone or attach the tendon through the bone using small metal implants (called suture anchors).
Shoulder Arthroscopy is a minimally invasive surgical technique that involves several small incisions into which a fiber-optic device (arthroscope) and tiny surgical instruments are inserted. Dr. Kostman can diagnose and treat many different shoulder conditions with arthroscopy, while patients benefit from less tissue damage, shorter recovery times, less scarring and less post pain. This technique also avoids cutting muscles or tendons in order to gain access to the affected area. Several conditions may be treated during the same procedure by inserting a few additional instruments in the joint area.
Arthroscopy can be used to treat many conditions that affect the shoulder such as rotator cuff tears, labral tears, supraspinatus, infraspinatus, subscapularis tears impingement syndrome, biceps tendonitis, and AC joint arthritis cartalage injuries.
Shoulder instability, dislocation and subluxation
The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone,) and the clavicle (collarbone).
Shoulder instability means that the shoulder joint is too loose. In some cases, the unstable shoulder actually slips out of the socket. If the shoulder slips completely out of the socket, it is a dislocation. If not treated, instability can lead to arthritis of the shoulder joint.
Dislocations happen when a force overcomes the strength of the rotator cuff muscles and the ligaments of the shoulder or they are inherently weak. Many dislocations are anterior dislocations, meaning that the humerus slips out of the front of the glenoid. Fewer dislocations are posterior dislocations, or out the back.
Sometimes the shoulder does not come completely out of the socket. It slips only partially out and then returns to its normal position. This is called subluxation. Shoulder instability can follow an injury that caused the shoulder to dislocate. This initial injury is usually fairly significant, and the shoulder must be reduced (put manually back into the socket). The shoulder may seem to return to normal, but the joint can remain unstable due to the ligaments that hold the shoulder in the socket, being stretched or torn. This can result in an unstable shoulder and repeated episodes of dislocation.
In some cases, shoulder instability can happen without a previous dislocation. Some shoulders are inherently unstable and activities such as swimming can put the shoulder at risk of instability symptoms. Eventually this can cause irritation and pain in the shoulder.
Cubital Tunnel Syndrome Repair
Cubital Tunnel Syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. Direct pressure, compression or stretching the ulnar nerve are common causes of cubital tunnel syndrome. Repetitive and constant pressure on the nerve or leaning on the elbow may lead to cubital tunnel syndrome.
Dr. Kostman may suggest surgery to relieve the pressure on the nerve which can in some cases involve moving the nerve to the front of the elbow, padding the elbow or removing scar tissue overlying the nerve. Therapy is sometimes needed after surgery.
Carpal Tunnel Syndrome Repair
Carpal tunnel syndrome is a condition that causes pain, numbness and tingling in the hand and arm and occurs when one of the median nerve to the hand is squeezed or compressed. Early diagnosis and treatment is important as carpal tunnel syndrome may worsen over time and lead to nerve damage. In some cases, splinting, therapy, or medication will relieve symptoms. Carpal tunnel surgery is an out-patient procedure utilizing either general or light anesthesia with sedation. Dr. Kostman will make a small incision in the palm of your hand and divide the upper portion of the carpal tunnel which relieves pressure on the nerve.
Wrist fractures can involve the small bones in the wrist or the ends of the forearm bones. Depending on the severity and location of the break, treatment may require a splint, cast or surgery. Some fractures will benefit from surgery to put the broken bones back together and hold them in place utilizing several device types such as pins, screws or plates.