What Questions Should I ask My Surgeon Before Undergoing a Shoulder Operation? #health #Seattle #rotatorcuff

Pain in the shoulders can significantly impact a patient’s quality of life and ability.  Luckily, there are plenty of options, both surgical and non-surgical, that can alleviate this pain.  If a surgical option seems prudent for your situation, you can ask these questions to ensure you are informed prior to the operation:

 What are the alternatives to shoulder surgery?

As with many other shoulder surgeons, it is common to practice a conservative approach to surgery, attempting to seek other options before resorting to surgery.  Understanding these options, like general pain management techniques or therapies, can better inform that patient on the wide array of options for regaining their quality of life.  Even if surgery is necessary, the patient will be informed on other options at the very least.

 What is the risk to not performing surgery?

A common question is whether avoiding surgery will compromise the long-term outcome. This is a case-by-case decision and must be considered carefully by both the patient and physician, but there is a lot of evidence that can be used to help predict this. For instance, with a partial rotator cuff tear the risk of tear progression is low and attempting conservative treatment for several months does not typically affect the long-term outcome. Conversely, an acute rotator cuff tear (one that occurs after a trauma such as a fall) typically responds better to being repaired within a few months rather than waiting several months to a year.

 What is the expected length of recovery?

The recovery from shoulder surgery can be lengthy and again varies from patient to patient depending on a number of factors. Patients should ask and understand how long they will be in a sling, when they can drive, when they can return to work, when they can return to sporting activities, and when they can expect complete pain relief.

 What are the risks of complications?

A patient considering shoulder surgery should have a good understanding of the risks of the surgery. These can vary considerably. An arthroscopic cuff repair, for instance, has an anticipated complication rate of about 1%. Conversely, the complication rate after a shoulder replacement may be 5 to 10%. Additionally, while volume is important as noted above, complications rates can vary between surgeons.

 Getting answers to these questions should help you make the right decision for you. Making sure you’re comfortable with your surgeon and your procedure, as well as understanding recovery expectations are all important for the success of your procedure.

Early Rotator Cuff Shoulder Repairs Lead to Promising Results #Health #rotatorcuff #Seattle

Rotator cuff tears are a very common condition, causing pain and reduced movement of the shoulder. While these injuries may not demonstrate symptoms at first, gradual degeneration may cause shoulder pain and other symptoms to develop within a few years

 "Repairs of isolated supraspinatus tears maintained considerable improvement in clinical and radiographic outcomes at 10 years," according to the report by a French orthopedic surgery research group. The lead author was Philippe Collin, MD, of CHP Saint Gregoire Vivalto Sante. The study provides new evidence that early surgery for supraspinatus tears can improve long-term outcomes by preventing later rotator cuff muscle degeneration.

 The researchers, in a French multi-site clinical setting, identified 511 patients at 15 hospitals who underwent complete rotator cuff tear surgery.  These same patients were had a clinical longitudinal research follow-up ten years later, where 288 patients returned for follow-up evaluation, including MRI scans in 210 patients.

 The results of these patients saw substantial improvement of quality of life as well as general range of motion and use of the affected shoulder. The average Constant score -- a standard assessment accounting for shoulder motion, strength, daily activities, and pain -- improved from about 52 (out of a possible 100) before surgery to 78 at ten years' follow-up. The MRI scans showed similar results with a marked improvement in the quality of the tendon strength.

 Journal Reference

 Philippe Collin, Jean-François Kempf, Daniel Mole[Combining Acute Accent], Nicolas Meyer, Charles Agout, Mo Saffarini, Arnaud Godene [Combining Grave Accent] che. Ten-Year Multicenter Clinical and MRI Evaluation of Isolated Supraspinatus Repairs. The Journal of Bone and Joint Surgery, 2017; 99 (16): 1355 DOI: 10.2106/JBJS.16.01267

What can I expect when I go in for surgery? #Health #Seattle

Often times people will experience some anxiety when heading into a surgical procedure.  Whether it be because they are going to have to be put under anesthesia,  the thought of waking up with some pain, or the fear of the unknown it’s common to have feelings of apprehension.   Luckily,  knowing what to expect can help alleviate these feelings and lead to a more stress-free pre and post-operative experiences.     The first thing to remember is that everyone who you will come in contact from the moment you enter the facility is highly-trained and there to make your experience positive.    As far as time commitment,  typically you won’t spend a great deal of time waiting before going into the operating room.   During the operation, it can take anywhere from one to two hours to complete the operation however you will not remember this.    Post-operation, you may be required to stay in the hospital for some time in order to monitor your healing and how you come out of the anesthesia and then you will likely have to participate in some sort of post-operative physical therapy that can last from a few sessions to sessions that will span over a series of weeks.   While this may seem like a long process, it is a small price to pay for better quality of life in the long term and the advancements in medical sciences today have allowed for a quicker and more effective healing period than ever before. 

Frequently asked questions: Why does my shoulder hurt? #Health #Seattle

Dr,. Andrew Pastor

Q: I have been suffering from worsening shoulder pain and stiffness for several months. I finally had to stop exercising or playing sports because of the pain. The pain is waking me up at night and it's difficult to raise my arm above my head. I don’t recall injuring my shoulder. What could the problem be?

A: This is a question that I am asked on a daily basis. There are many possible causes of your shoulder pain.

The shoulder is a very complex joint that is vulnerable to overuse injuries and arthritis. It is actually the most mobile joint in the body.

The most common causes of shoulder pain are tendinitis/bursitis, arthritis, and rotator cuff tears.

The shoulder is actually comprised of two joints. The acromioclavicular (AC) joint is between the tip of the scapula (shoulder blade) and the clavicle (collarbone). The glenohumeral joint is between the humerus (upper arm bone) and the scapula.

The shoulder joint has a much more shallow socket called the glenoid (on the shoulder blade) than the deep hip socket.. Surrounding the glenoid is an O-ring made of cartilage, called the labrum. The labrum deepens the socket and adds stability. The four rotator cuff muscles and tendons stabilize the shoulder joint in the socket as well as rotate the shoulder. There is a fluid-filled spongy tissue known bursa sac that lubricates and cushions this joint space above the rotator cuff. The biceps muscle attaches to the shoulder in two places and helps control motion at the shoulder and elbow. The strongest muscle in the shoulder is the deltoid which help rotate, flex and lift your arm.

The shoulder joint

Injuries or inflammation of any of these structures can cause shoulder pain, stiffness and diminished range of motion.

In your case, in the absence of an acute injury, overuse of your shoulder (especially repetitive overhead activities at your job or with exercise) and aging may result in inflammation of the rotator cuff (tendinits), bursa (bursitis), and gradual deterioration and eventually tearing of the rotator cuff.

Inflammation in any of these areas almost always cause night pain, especially if you sleep on the affected side. Chronically inflamed shoulders may develop scarring in the shoulder over time that eventually completely immobilize the shoulder joint, which is known as adhesive capsulitis or frozen shoulder.

Osteoarthritis, which is the wearing down of cartilage in the shoulder joint, is another common cause of shoulder pain, especially if you had an old injury that damaged your cartilage. Osteoarthritis may also cause night pain, weakness and limited range of motion.

A torn labrum may cause pain, locking or clicking, or the feeling that your shoulder will dislocate.

There are other diseases that can cause shoulder pain like a herniated cervical disc, but your history doesn’t really support this.

Depending on your history and physical examination, your doctor may want to do X-rays, an MRI, or an ultrasound for more specific diagnostic information.

Treatment options include applying ice or heat, non-narcotic pain medication, TENS (transcutaneous electronic nerve stimulator), physical therapy (including a home exercise program to continue stretching and strengthening and prevent recurrence).

I recommend activity modification by refraining from any aggravating repetitive activities, but you must maintain the range of motion in order to prevent stiffness. Gentle range of motion activities can almost never make your condition worse. .Ask your physical therapist or doctor how much you can use it and don’t immobilize the joint or wear a sling unless specifically told to do so. I hope this helps!

Andrew Pastor