Tennis Players Return to the Courts with Advances in Shoulder Surgery

Not too long ago, loss of mobility in the dominant shoulder was a tennis player’s permanent ticket off the court. Yet, a combination of new surgical techniques and methods that have been proven successful over the past decade is making shoulder surgery a good option for many athletes eager to get back in the game.

“Many fit, active athletes are familiar with hip and knee replacement surgeries, which are fairly commonplace,” says Kevin Plancher, M.D., a leading NY-area orthopaedist, sports medicine expert and official orthopaedic surgeon of the U.S. Ski and Snowboard teams. In fact, according to the American Academy of Orthopaedic Surgeons (AAOS), more than 700,000 Americans have hip or knee replacements each year, compared with just 23,000 shoulder replacements. But that number is on the rise. “Now, thanks to advances in techniques and technologies, shoulder sufferers have more options for treatment than ever before,” Dr. Plancher explains. Many tennis enthusiasts sidelined by shoulder trouble may be there due to osteoarthritis of the shoulder, a condition that can occur from overuse from overhead sports at a younger age or from a specific traumatic injury to the shoulder. “Many athletes who are candidates for shoulder replacement surgery have been playing overhead sports for decades,” Dr. Plancher notes. “The shoulder is the most dynamic joint in the body, capable of a tremendous range of motion. In fact, it is the inherent instability in the shoulder that allows it to work so well, permitting athletes to throw and hit with such accuracy and speed.”

Unfortunately, in overhead sports like tennis, microinjuries to the joint can occur during every match, and their effects can build over years. These overuse injuries can eventually wear on the ball and socket of the shoulder joint, causing osteoarthritis to develop. Previous traumatic injury such as a shoulder dislocation can lead to chronic pain and limited motion over the long term. These weekend warriors might be great candidates for a total shoulder replacement, although new alternative techniques are also available.

Three Options for Troubled Shoulders “Arthritis is seen more and more often among fit forty- and fifty-somethings, because Americans are
becoming — and remaining — more active through their midlife and senior years,” Dr. Plancher notes. “Fortunately, there are a number of options for those whose shoulder trouble is preventing them from resuming their active lifestyle,” Dr. Plancher says.

“REAM AND RUN” HEMIARTHROPLASTY is an excellent alternative for many candidates with severe arthritis who may not need a total shoulder replacement. In this partial shoulder replacement, only the humerus (ball) is replaced, and the glenoid (socket) is resurfaced to make it smoother and to reshape it or reorient its direction, if needed. This procedure avoids the use of a plastic socket. “Partial shoulder replacement surgery can improve the longevity of comfort and a high level of shoulder function in patients with severe shoulder arthritis,” Dr. Plancher explains. “The recovery of comfort may sometimes take longer than with conventional total shoulder arthroplasty.”

PARTIAL REPLACEMENT WITH TISSUE-REGENERATION TECHNOLOGY is the newest approach in joint replacement, and it has shown promise for partial shoulder replacement as well as other joint surgeries.

During this cutting-edge procedure, the surgeon can resurface the bone structures and replace deteriorated cartilage with new synthetic compounds that are designed to promote the body’s own healing within the joint, and dissolve away over time. “This type of partial shoulder replacement surgery is ideal for patients who would otherwise need bone grafts, since the compounds can work in place of grafted tissue,” Dr. Plancher explains. “This eliminates the need for a second surgical site to harvest the graft, and also avoids possible problems with donated grafts or other tissues,” he concludes.

TOTAL SHOULDER ARTHROPLASTY involves replacement of the entire joint — the ball, or humerus, and the socket, or glenoid — with plastic and metal parts. These components are more resilient and durable than those made even a few years ago; many can last 15 years or more before requiring reconstruction. What’s more, they’re more “anatomic” – meaning that the replacement can replicate true human movement more closely – than ever before. No small feat, considering that the shoulder is the body’s most flexible joint, having more than 1,000 possible positions.

As with any orthopedic surgery, Dr. Plancher urges patients to choose their surgeons carefully. A good
place to start is the American Society of Shoulder and Elbow Surgery (http://www.ases-assn.org), an invitation-only medical organization for surgeons specializing in these areas. Dr. Plancher, a member of ASES, advises: “Particularly in areas like shoulder replacement, where there are few surgeons with a deep level of experience and expertise, patients need to be their own best advocates in choosing a doctor with whom they feel comfortable and trust. “The news for tennis players and other ‘overhead’ sports enthusiasts couldn’t be better,” Dr. Plancher concludes. “The right shoulder surgery can restore a painless range of motion, allowing the player or weekend warrior to enjoy their favorite sport(s) again.”

Bio:

Kevin D. Plancher, M.D., M.S., F.A.C.S., F.A.A.O.S, is a leading orthopaedic surgeon and sports medicine expert with treatment in knee, shoulder, elbow and hand injuries. Dr. Plancher is a Clinical Professor, Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine in NY. He is on the Editorial Review Board of the Journal of American Academy of Orthopaedic Surgeons. A graduate of Georgetown University School of Medicine, Dr. Plancher received an M.S. in Physiology and an M.D. from their school of medicine (cum laude). He did his residency at Harvard’s combined Orthopaedic program and a Fellowship at the Steadman-Hawkins clinic in Vail, Colorado where he studied shoulder and knee reconstruction. Dr. Plancher continued his relationship with the Clinic for the next six years as a Consultant. Dr. Plancher has been a team physician for over 15 athletic teams, including high school, college and national championship teams. Dr. Plancher is currently the head team physician for Manhattanville College. Dr. Plancher is an attending physician at Beth Israel Hospital in New York City and The Stamford Hospital in Stamford, CT and has offices in Manhattan and Greenwich, Connecticut. http://www.plancherortho.com

Dr. Plancher lectures extensively domestically and internationally on issues related to Orthopaedic procedures and injury management. During 2001, 2002, 2003, 2004, 2005, 2006, 2007 and 2008, Dr. Plancher was named among the Top Doctors in the New York Metro area and to the sports medicine arthroscopy program subcommittee for the American Academy of Orthopaedic surgeons. In 2007 and 2008 Dr. Plancher was named America’s Top Doctor in Sports Medicine. For the past six years Dr. Plancher has received the Order of Merit (Magnum Cum Laude) for distinguished Philanthropy in the Advancement of Orthopaedic Surgery by the Orthopaedic Research and Education Foundation. In 2001, he founded “The Orthopaedic Foundation for Active Lifestyles”, a non-profit foundation focused on maintaining and enhancing the physical well-being of active individuals through the development and promotion of research and supporting technologies. http://www.ofals.org.