Carter ready to keep shoulders moving

Image provided by UPHS – Portage Dr. Michael Carter is a board certified orthopaedic surgeon who specializes in sports medicine at UPHS – Portage.

Dr. Michael Carter, one of two board certified orthopedic surgeons at UPHS – Portage, is a sports medicine specialist. Dr. Carter sees patients with a wide variety of conditions, but his specialty is the rotator cuff.

“Like the hip, the shoulder is a ball-and-socket joint, but in the hip, the ball goes deep into a socket. In the shoulder, the ball just sits on a shallow depression,” said Dr. Carter. “That’s why you can move your shoulder in ways that you can’t move your hip, but it’s also why you can dislocate your shoulder so much easier than you can dislocate your hip.”

The shoulder joint relies heavily on a group of the four surrounding muscles that make up the rotator cuff. These muscles do not just hold the shoulder joint in place, but also assist in strength and range of motion.

Like any part of the body, the rotator cuff can be damaged by “acute injury” like a fall. However, the rotator cuff can also be damaged by overuse and age-related wear-and-tear injuries. Athletes who regularly use their shoulders in the same basic motions are particularly susceptible to rotator cuff injuries, including problems such as bursitis, impingement, tendinitis, partial and complete tears.

“If you’re a baseball pitcher or a quarterback, we have those athletes doing rotator cuff strengthening exercises to avoid these kinds of injuries,” said Dr. Carter. “You can find examples of these type of preventative exercise programs pretty easily online.”

Generally, rotator cuff strengthening exercises involve internal and external rotation of the arm by the side and lifting in the plane of the shoulder. That is, at a 45 degree angle to the body.

“We’re not built like Spongebob, we don’t have a flat back and a flat front,” said Dr. Carter. “Our body is oval in cross-section and our shoulder blade lie at an angle.”

If you have a mild acute injury, you can try to apply ice and rest it a short time. Avoid resting it too long however, as this can lead to other problems. If you have a significant injury, seek immediate care. It is sometimes more confusing with an overuse injury or general wear and tear because there’s often no clear point at which it started and symptoms may come and go.

With rotator cuff problems, there is generally pain on the corner of the shoulder that radiates towards the elbow. The pain generally is much better with the arm by the side, and worse as you lift away from the body, especially overhead. It may wake you up if you roll over on it at night.

“When people come to the doctor is usually a function of the severity of the pain and the duration of the pain,” said Dr. Carter. “It’s a balance between those things. People will put up with nagging symptoms for a while, but seek help sooner when their symptoms start to affect sleep or work.”

Once people seek treatment, evaluation consists of taking a history and doing a physical exam. This is typically enough for the initial evaluation to get a treatment plan in place. Sometimes, further testing with advanced imaging techniques are needed.

“The treatment for rotator cuff problem usually begins with specific exercises which target reconditioning the muscles of the rotator cuff to hold the ball on the socket better,” said Dr. Carter. “It is keeping the ball on the socket which ultimately resolves the pain and allows the shoulder to function normally again.”

Sometimes people can do the exercises on their own at home after proper instruction. Other people benefit from working with a physical therapist, especially if they have lost range of motion. When people fail to get better with therapy, surgery is sometimes indicated.

“When surgery is needed, it is almost always performed arthroscopically, or through small puncture holes using a closed circuit TV, rather than through large incisions,” explained Dr. Carter.

Surgical treatment can include “decompression,” or making more room for the rotator cuff by the removal of spurs over the shoulder. If there are significant tears or damage to the rotator cuff, this can also usually be repaired arthroscopically. These operations are almost always outpatient. The recovery time is dependent on how much repair work has to be done.

“Most people go to physical therapy for a period of time after surgery as ultimately it is restoring the strength to the rotator cuff that makes you better,” said Dr. Carter.

Sometimes, damage to the rotator cuff is no longer fixable and doctors have to resort to what is call a “salvage procedure.” Examples of this include reverse total shoulder arthroplasty and superior capsular reconstruction.

“Reverse shoulder arthroplasty is basically a shoulder replacement where instead of replacing the ball with an artificial ball, we screw the ball onto the shoulder blade where the cup was and make the end of the arm bone into the cup,” said Dr. Carter. “This allows the shoulder to have some moderate function in spite of not having a good rotator cuff.”

This type of procedure is generally reserved for elderly patients. The superior capsular reconstruction is a relatively newer procedure that can be performed arthroscopically and preserves the native ball and socket joint creating a strip of tissue tethered above the ball and socket joint to help hold it in place.

“Any one individual’s result is going to be dependent on the type of problem they have, the extent of the damage, how long they have waited before seeking treatment, and to a large extent how hard they work in therapy after surgery,” said Dr. Carter.

Dr. Carter started working at UPHS – Portage in 2015 after closing his practice of 20 years in his native North Carolina.

“I count my time here by winters, and we just finished our fourth. My wife developed health issues, and ultimately we decided a lifestyle change was needed,” said Dr. Carter. “… We decided to travel around and see some of the country. We ended up getting a chance to come do some part time work here and we fell in love with the area.”

He and his wife fly back and forth from North Carolina every month, spending half of their time at Portage and half of their time at their home in North Carolina.

“I am blessed to have a great partner on our staff, Dr. Ron Ronquist, as well as a great physician’s assistant, Jesse Primeau, who both pitches in and covers when I am away,” said Dr. Carter. “We have a strong team of nurses, athletic trainers, and therapists that I think take great pride in serving their community. I couldn’t be more pleased with the job they do.”

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