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Scott Webb: Hello and welcome to Check-Up Chat with EvergreenHealth. I'm Scott Webb. Whether reaching for something on the top shelf, throwing a pitch or even scratching your back, shoulder pain from arthritis can limit your ability to do everyday tasks. We're here today with Dr. Michael Codsi, orthopedic surgeon at EvergreenHealth Orthopedic and Sports Care specializing in shoulder and elbow repair.

Doctor, thanks so much for your time today. We're going to talk about shoulder arthritis and surgical, non-surgical options when, you know, maybe even replacement might be needed. It's great to have your expertise today and pick your brain. So, is it mainly just wear and tear that causes shoulder arthritis?

Dr. Michael Codsi: The most common cause of osteoarthritis is wear and tear of the shoulder. Other causes, which are a little less common, are trauma. So, if you have an injury to your shoulder maybe when you were younger or you've dislocated your shoulder, that is a cause for some early arthritis. We're pretty sure that there is a genetic component to arthritis because there are some people who have arthritis in multiple joints much earlier than other folks, but we just don't know the actual specific gene to say this is the specific cause of it. We just know that certain family members have it. But most of the time, it's just caused by wear and tear. And as we get older, there's more wear and tear, so people who are older are more common to get arthritis.

Scott Webb: Yeah, that sounds right. That's definitely been my experience. The wear and tear, the osteoarthritis, some days better than others. How do we know when it's time to reach out to a doctor?

Dr. Michael Codsi: When the aches and pains start to become more frequent, and when they interrupt the activities you normally do. So if it becomes difficult to sleep at night, that's probably the most common reason why people come in to see me. It's usually their spouse actually who says, "Hey, go get that checked because you're waking me up too." Then, it's the simple things that people like to do, like their sport. They can't do it anymore because of the pain or they can't do even simple things like getting dressed and doing their simple chores around the house. So whenever that becomes difficult to do, that's a good reason to come in to get it checked.

Other times are you have pain for just a few days or maybe a week and it goes away, then that's probably not something that you need to be seen for. But if it continues for several weeks and you find yourself trying to reach for an over-the-counter medication to help solve your pain all too often, then that's a good reason to probably get it checked.

Scott Webb: Yeah. And there are those days, you know, you're in the shower and you go to wash your hair and that one shoulder, the osteoarthritis shoulder, you're like, "Well, I'll just use one hand." You know, to your point, it's that quality of life, right? When it begins to affect our lives on a daily basis where we can't sleep, we can't do basic things, let alone play tennis or golf or whatever it might be. So let's assume that somebody reaches that point, the breaking point, right? And they make an appointment and they come see you. What can they expect?

Dr. Michael Codsi: So, the first thing that we do is find out where the pain is and get the details about how your shoulder feels. And then, we examine your shoulder to see what types of motions of your shoulder, what kind of strength you have there. And then, we would also usually get x-rays of your shoulder. And it's a combination of all three of those things that allow us to come up with a diagnosis of arthritis.

Scott Webb: Yeah. So, let's talk about non-surgical options. You know, for most of us, surgery is definitely a last resort, even though, you know, today, there's minimally invasive surgery in smaller scars and faster recovery and all that good stuff. But generally, most of us would want the nonsurgical options at least to begin with. So, what are the nonsurgical options for the wear and tear osteoarthritis shoulders?

Dr. Michael Codsi: We always start with those and we start with the very simple things, which is, you know, if it only bothers you with one activity, is there a way to modify that activity so you can cope with the pain or the dysfunction you have in the shoulder? The second option is to just see, "Hey, if the pain is more just intermittent, can we treat that with medications?" And then, there's over-the-counter medicines from the simple things like Tylenol and Advil that everyone knows to maybe some prescription medications that can also be a little stronger and maybe give you some better relief.

And then, when the medications don't work, then we try things like physical therapy, which can definitely help. People always wonder like, "Oh, what is physical therapy going to do? I'm already physical. I'm already doing things." But they actually have a lot of techniques that they can do to make your shoulder better and it makes a big difference with them helping you through the exercises and them kind of manipulating your shoulder and doing specific exercises that you couldn't do on your own. And so, it's always worthwhile to see a professional therapist. I mean, they trained for several years, so you can't just think that, "Oh, we can do the same thing just by taking a band or pulling a weight." It's their expertise that really is the important thing.

And then, if therapy doesn't work on top of that, then there's certain things that you can do like injections. So there's steroid injections. There are now new things like stem cell injections that are a little more experimental, but those are on the horizon here as well to consider. Injections can definitely help with the pain. Unfortunately, we don't have a way of making new cartilage in your joint. And so when it comes to the point where all those things don't work and we still have a rough bone on bone type of arthritis, then that's when we start thinking, "Okay, now we start thinking about surgery as a way to solve that problem."

Scott Webb: Sometimes after trying everything, everything in the toolbox, you get to a point where shoulder replacement surgery is the next best or the last best option. So, let's talk a little bit about that and what makes someone a good candidate.

Dr. Michael Codsi: So, a good candidate for a shoulder replacement is anyone who has arthritis on an x-ray, who has a significant pain with their daily activities or just like a constant ache in the shoulder, they can't sleep at night, and who is obviously willing to go through all the rehab afterwards because it's one thing to go through the surgery, but there is a lot of work that goes into the rehab afterwards. And you just have to be committed to that and committed to following the precautions because the outcome of surgery typically is directly related to how well you follow the instructions afterwards.

Scott Webb: Yeah, that's also been my experience with any kind of replacement surgeries. You really have to follow the instructions, the guidance, the PT, all of that to really know and find out if it's been successful. Just wondering, has there ever been a time where you've had to replace both shoulders? So I've known people who've had at least one done, but I don't think I've ever met anybody that had both done. Is that a thing?

Dr. Michael Codsi: That definitely is a thing, and it's pretty common to have arthritis in both shoulders. And usually, there's one that is much more severe. And usually, the other one is something that is maybe more of a nuisance but not as severely limiting as the other one. So we usually do one at a time, mostly because you usually have to wear a sling after your surgery, and it would be honestly very difficult to just take care of basic toileting and things like that if you had both of your arms in a sling. And so, we usually let you have at least one arm free to do things like eating and getting dressed and taking care of yourself while the other one's recuperating. And then, typically, you know, four to six months later, assuming you have the same severe pain in both shoulders, you could get the other one done. There are definitely people who have shoulder pain in both shoulders that we could take care of relatively quickly.

Scott Webb: So what's the recovery process like? I know you said it really puts a lot on the patient, obviously. If the surgery's gone well and there were no complications, then a lot of it is on the patient afterwards, the physical therapy and so on. So let's talk about the recovery, the outcomes for the surgery. And really, I think what most patients want to know is when can they get back to the things that they weren't able to do? When can they get back to tennis or golf or whatever it might be?

Dr. Michael Codsi: Right after the surgery, patients are in a sling, so you can't use your arm to go reach for things, pull on things, push open doors, and you're in that between two to six weeks after your surgery to let things heal. And then, most patients start physical therapy exercises though the day after their surgery. So, even though you're in a sling, you do take it out of the sling to do very careful exercises to start the rehab process. And that will continue up to, you know, four to six months after your surgery. And it's a very progressive type of program so that in the beginning you're not lifting anything. You're lifting maybe a pound. And then, as time goes on, you're doing more reaching, you're doing more lifting with the arm. And by, you know, four months, that's usually when we have people start doing simple things like, if they like to play golf, they could get out there and do some putting and maybe some easy chipping. If they like to fish, they could do some easy things where they're just practicing casting and things like that. So, it's a gradual process. But usually, I say most patients are back to what they like to do by six months from their surgery.

Scott Webb: Yeah. Wondering when it comes to shoulders, will someone need another shoulder replacement? Does that really depend on what age when they had the shoulder replacement? Or is it possible that once they get that new shoulder, especially if they do their part and maybe, you know, right after surgery, they didn't compete in a longest drive competition or something, right? As you say, some easy chipping, some putting. If they do their part and you did your part, do these shoulders pretty much last forever? Or would somebody live long enough that they might even have to consider getting another one?

Dr. Michael Codsi: I would say that, you know, 80% of patients have one shoulder replaced and that lasts them the rest of their life. There are people who are relatively young when they get their first shoulder replacement, and so there is a lifespan for these. They do tend to wear out over time and, you know, they usually last about 15 years. And so if after 15 years, you are still being very active with your shoulder, sometimes you might need another procedure to put in a new replacement. And those replacement procedures in general are successful and can get you back doing most of the activities you were doing before. It's usually not quite as good as the first replacement, but it's usually good enough to do the basic activities that you want to do. Every case is a little different. But I would say that most people don't need another replacement and the few that do tend to do well.

Scott Webb: Yeah. And certainly better than their original shoulder before their first replacement, right? So as you say, maybe it's not perfect, but better than what you had when, you know, this whole process, this whole journey started. So, doctor, very educational stuff today. Thanks so much for your time. You stay well.

Dr. Michael Codsi: Thank you very much, Scott. Appreciate it.

Scott Webb: Don't let shoulder arthritis stop you from daily tasks and the activities you love. Visit evergreenhealth.com/ortho-sports-medicine to learn more and to make an appointment. Please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.