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Don D'Agostino - Rotator Cuff Tear
For 20 years, Illinois resident Don D’Agostino suffered from an increasingly painful shoulder injury. A Senior Master Sergeant in the U.S. Air Force, D’Agostino was stationed in West Germany in 1984 and remembers the day the pain started. “I was throwing camouflage netting up and over my head and I wrenched my left shoulder,” he recalls. “For years, my shoulder would ache, but it got to the point eight years ago when I just couldn’t even lie down and sleep on that side. I said to myself that enough was enough.”
D’Agostino went to his physician and was diagnosed with a torn rotator cuff. Don, one of an estimated 13 million people in the United States who seek medical care for shoulder problems each year, tried physical therapy, anti-inflammatory drugs, and over-the-counter and prescription painkillers. Offering little relief, D’Agostino eventually turned to the shoulder experts with Washington University Orthopedics.
“Shoulder injuries are fairly common. The shoulder is characterized by a fine balance between mobility and stability that is maintained by a series of muscles, ligaments and tendons which allow for a wide range of movement,” says Leesa Galatz, MD, shoulder surgeon with Washington University Orthopedics and D’Agostino’s shoulder specialist. “The rotator cuff is composed of four muscles that surround the shoulder joint. They can be torn either through repetitive use over time or because of a traumatic injury. The incidence of these types of tears increases with age and can be present in both shoulders even though a patient feels pain only in one joint.”
Dr. Galatz ordered x-rays, an ultrasound, and an MRI to fully evaluate D’Agostino’s shoulder. She recommended repairing the rotator cuff with the use of an arthroscope for a minimally invasive approach to treatment.
“By doing this, we did not have to make a large incision,” explains Dr. Galatz. “Rather, we performed the repair through a few small (< 1 cm) entry sites around his shoulder. The end of the torn tendon was secured back down to the bone using specialized instruments and fixation devices. Tying the tendon back down to the bone in its anatomic position allows the healing process to begin.”
“She was fabulous,” says D’Agostino. “I was worried about not being able to keep up with all of my activities because of the shoulder pain, but the surgery fixed everything. I can finally sleep throughout the night. I’m back to bicycling regularly and still playing hockey and golf. I’m doing so well that I’ve forgotten what’s it like to feel pain in that shoulder. It’s been a great recovery.”
D’Agostino went through a rigorous post-surgery rehabilitation program that involved physical therapy and strength-training. The athletic 51-year-old is eager to hit the fitness gym, doing 75 push-ups at a time and lifting weights. “More repetitions with lower weights, but I can do it all without pain,” he says.
D’Agostino is now part of an NIH-funded study evaluating the progression of pain in his opposite shoulder. Although he feels no discomfort, Dr. Galatz found a second tear in D’Agostino’s right rotator cuff. The NIH study, overseen by Ken Yamaguchi, MD, Chief of Shoulder and Elbow Surgery with Washington University Orthopedics, will track hundreds of patients over the next five years to determine why some rotator cuff tears are painful while others cause no outward symptoms. Dr. Yamaguchi and his team also want to determine the probability that a patient with bilateral tears and pain on one side will develop pain in the opposite side and if a partial rotator cuff tear will enlarge over time instead of healing itself.
“We want to know if the progression of pain correlates with the enlargement of the rotator cuff tear or with degenerative changes in a patient’s shoulder,” says Dr. Yamaguchi. “We’re also examining some of the risk factors associated with tears and already have correlated preliminary information that shows a strong association between smoking and the prevalence of rotator cuff tears.”
Dr. Yamaguchi, Dr. Galatz, and Jay D. Keener, MD, comprise the shoulder and elbow specialty team with Washington University Orthopedics. The three are actively involved in patient care as well as both basic science and clinical orthopedic research to help advance the treatments available to their patients. For the past several years, Dr. Galatz has collaborated with Dr. Yamaguchi on the rotator cuff research project by referring patients for the NIH study.
“Her skill as a surgeon enables her patients to gain optimal mobility and reduce their pain significantly or entirely,” says Dr. Yamaguchi. “By identifying appropriate patients to our study, Dr. Galatz and others will gain further insight into the causes of rotator cuff injuries as well as identify innovative ways to enhance the treatment for such conditions.”
For more information about the NIH study on rotator cuff tears, contact Washington University Orthopedics at (314) 747-2496.
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