Arthroscopic/Reconstructive Surgery
Whether throwing a ball, paddling a canoe, lifting boxes, or pushing a lawn mower, we rely heavily upon our shoulders to perform a number of activities.
Dr. Ian Lo is an orthopaedic surgeon and a clinician-researcher with the MIBJH who is working to help people with disabling shoulder pain. “This is an exciting and relatively unknown area in medicine,” says Lo. “There is still a lot about diagnosis of the shoulder that is unknown, and a lot of research to be done in terms of prevention.”
Many of the patients with shoulder pain that Lo sees at the University of Calgary Sports Medicine Clinic have rotator cuff problems, including tears and tendinosis in the shoulder. The rotator cuff is a group of flat tendons (tough bands of tissue that attach muscle to bone) that surround the front, back, and top of the shoulder joint, to provide stability and strength. Tendinosis occurs when the tendon degenerates, which in turn can contribute to tears in or around the tendon.
A rotator cuff tear may occur suddenly, following a single acute injury or trauma (caused by heavy lifting, a fall, or a sports injury), or gradually in the course of long-term overuse (such as repetitive overhead activities like painting ceilings or throwing a ball). Often, long-term tendon damage or degeneration is simply due to aging.
“Rotator cuff pain can be disabling, both with activity or while resting,” explains Lo. “Many of the patients I see have already experienced shoulder pain a long time. It is not uncommon for people to have suffered pain for one or two years before they see me. This makes treatment a lot more difficult.”
Treatment of partial rotator cuff tears can often occur without surgery to control pain and improve movement and function. However, if the tear completely severs the tendon, or the patient is very weak or has not responded to other treatments, Lo and his colleagues will repair the rotator cuff through arthroscopic surgery. Arthroscopy involves the surgeon inserting miniature instruments into small incisions, removing bone spurs or degenerative tissue and repairing larger tears.
“Although most of us believe that genetic predisposition, tissue degeneration, and external stresses on the shoulder all contribute, we still do not know exactly what causes rotator cuff tears,” says Lo. “Preventing these tears, or at least preventing the progression of degeneration, would help a lot of people.”
As a result of these injuries, Lo is working with a multidisciplinary research team including another orthopaedic surgeon, a molecular biologist, a cell biologist, and a biomechanical engineer to identify the specific factors that cause rotator cuff tears.
They hope to discover why and how the rotator cuff degenerates in some individuals as they age. In particular, Lo and his colleagues aim to identify how cells communicate back and forth in tendon tissue, how the cells function, and what happens when their function is altered.