Post-Surgery Challenges After Car Accident: Orthopedic Insights

Q: Post-Surgery Challenges After Car Accident: Orthopedic Insights

Hello： <br>1. <br>In my personal opinion, the reason for the incomplete reduction of the greater tuberosity, where the rotator cuff attaches, may lead to functional limitations that cannot be fully restored. <br>However, there are many reasons for the malposition, such as various

Post-operative issues following a car accident?

Dear Doctor, I apologize for bothering you with some questions.
I previously inquired about post-surgery issues following a car accident and will consult the hospital again, but I still have some doubts and would like to hear different opinions, so I am consulting here once more.
Thank you in advance for your assistance.
My elder family member (around 60 years old) underwent surgery last September, and it has been about six months since then.
They are unable to lift their arm independently, so they are currently undergoing passive rehabilitation.

1.
The X-ray images were taken after the surgery last year.
Do they appear to be normal? Previously, when I consulted other doctors here, they mentioned that there might be a bone fragment at the attachment site of the supraspinatus muscle, which could be causing the inability to lift the arm.
[X-ray images links]
2.
From my research, it seems there is a possibility of a rotator cuff tear, which is more common in older adults.
The surgeon did not mention this issue, and during multiple follow-up visits, I was reassured that rehabilitation was safe and that they should engage in various movements at different angles.
However, I read that if this is the case, certain angles should be avoided initially to prevent further injury.
3.
I would like to understand how to confirm whether this is the situation.
What steps can be taken to determine if this is the cause? Can an X-ray reveal this?
4.
If it is indeed a rotator cuff tear, are there ways to improve the condition? Would you recommend surgical intervention again? If a second surgery is necessary, what implications would it have?
5.
Can rehabilitation continue at this stage? Currently, the rehabilitation mainly consists of wall exercises, internal and external shoulder movements, and towel stretches behind the back.
6.
I have attempted to start active rehabilitation, but I am completely unable to do so.
Is this progress considered too slow?

Mr. J, 30~39 year old female. Ask Date: 2021/03/10

Dr. You Dianqi reply Orthopedics

Hello:
1.
In my personal opinion, the reason for the incomplete reduction of the greater tuberosity, where the rotator cuff attaches, may lead to functional limitations that cannot be fully restored.
However, there are many reasons for the malposition, such as various difficulties.
I hope the purpose of this website is to provide an honest explanation of public concerns, but it should not disrupt the doctor-patient relationship between your family member and the surgeon; that is not my intention in providing this response.
2.
From the postoperative images, it is evident that there is incomplete reduction, which is not significantly related to activity levels.
3.
An MRI could be considered, but it may be somewhat affected by metal artifacts.
4.
Surgical fixation of the greater tuberosity where the rotator cuff attaches could be considered, but as you understand, any surgery carries risks and may not meet the patient's preoperative expectations.
5.
Regardless of whether surgery is performed, it has been over six months, and continued rehabilitation is necessary.
6.
I believe the inability to actively move is partially related to the incomplete reduction of the greater tuberosity, so it may not solely be a matter of your family member not being diligent in rehabilitation; perhaps he/she has already made significant efforts.
Therefore, it is not simply an issue of progress being slow.
Thank you.
The above is merely my personal opinion based on the images and descriptions you provided.
However, the accuracy of medical assessments is based on comprehensive face-to-face communication, physical examination, and imaging studies.
Without direct contact with your family member's situation, my insights may not fully reflect the reality.
I hope for your understanding.

Reply Date: 2021/03/10

More Info

Dear Henry,
Thank you for reaching out with your concerns regarding your post-surgery recovery after the car accident. It’s understandable to have questions and seek clarity, especially when dealing with complex orthopedic issues. Based on the information you've provided, I will address your questions systematically.

1. X-ray Findings: The X-ray images you shared indicate that there are no fractures, but the presence of a bone island in the humeral head and preserved joint spaces suggests that there may be underlying soft tissue injuries. The bone island itself is typically benign and not a cause for concern. However, if there is a suspicion of a rotator cuff injury, which is common in cases of shoulder trauma, further imaging such as an MRI would be necessary to assess the soft tissues around the shoulder joint.

2. Rotator Cuff Injury: You are correct that rotator cuff tears are more prevalent in older adults and can significantly impact shoulder function. If the rotator cuff is indeed torn, it can lead to weakness and pain, particularly when attempting to lift the arm. It’s crucial to avoid movements that exacerbate the pain until a definitive diagnosis is made. Engaging in certain rehabilitation exercises without proper guidance can potentially worsen the injury.

3. Diagnosis Confirmation: To confirm whether you have a rotator cuff tear, an MRI is the most effective diagnostic tool. X-rays primarily show bone structures and may not reveal soft tissue injuries. An MRI will provide a detailed view of the rotator cuff tendons and muscles, allowing for a more accurate diagnosis.

4. Treatment Options: If a rotator cuff tear is confirmed, treatment options vary based on the severity of the tear. Minor tears may respond well to physical therapy and rehabilitation exercises, while more severe tears might require surgical intervention. If surgery is deemed necessary, it typically involves repairing the torn tendon and can significantly improve function and reduce pain. However, surgery carries its own risks, including infection, stiffness, and the potential for incomplete recovery.

5. Rehabilitation: Continuing with rehabilitation is essential. Passive range-of-motion exercises are a good start, but as you progress, transitioning to active exercises will be important. It’s crucial to work with a physical therapist who can tailor a program to your specific needs and monitor your progress. They can help you safely increase your range of motion and strength without risking further injury.

6. Progress Evaluation: If you find that you are unable to perform active movements, it may indicate that your shoulder is still healing or that there is a significant injury present. Progress can vary greatly among individuals, especially after trauma. It’s important to be patient and allow your body the time it needs to heal, but also to communicate with your healthcare provider about any concerns regarding your recovery speed.

In summary, I recommend following up with your orthopedic surgeon or a sports medicine specialist who can evaluate your condition further. An MRI will be crucial in determining the exact nature of your shoulder injury. In the meantime, continue with your rehabilitation exercises as advised, and avoid any movements that cause significant pain.
Your recovery journey may be challenging, but with the right approach and medical guidance, there is a good chance for improvement. Please keep an open line of communication with your healthcare providers, and don’t hesitate to seek a second opinion if you feel uncertain about your treatment plan.

Wishing you a smooth recovery,
Doctor Q&A Teams

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