Transcription:
Orthopedic Surgery - Hand, Arm & Shoulder

Joey Wahler: From injured athletes of all ages to patients with carpal tunnel syndrome, we're discussing the great orthopedic care provided at St. Clair Health, joined by a doctor with a notable athletic background himself. Our guest, Dr. James Mullen, an orthopedic surgeon with St. Clair Health. This is Curating Care, a podcast by St. Clair Health, expert care from people who care. Thanks for joining us. I'm Joey Waller.

Host: Hi, Dr. Mullen. Thanks for being with us.

James Mullen, MD: Hi. Thanks for having me.

Host: Great to have you. So first, a bit about your background. You're originally from Mount Lebanon, Pennsylvania, attended Temple Medical School nearby there, six years of residency in New York. So, what's it like being back practicing near your hometown?

Guest: It's been great. So, you know, Pittsburgh's always been a special place for me and to be able to bring the things I've learned throughout medical school and training back to my hometown has been a lot of fun. I mean, it's especially been a privilege to be able to treat a lot of the people that I grew up with, parents, grandparents, children at this point, you know, of people I know right in the community where I grew up and is so close, near and dear to my heart, it has been a lot of fun. It just adds another dimension to practicing medicine.

Host: So, that really puts the community in community, right? Seeing familiar faces like that.

Guest: Yeah, exactly. I mean, I think a lot of where we are now with healthcare with regard to the specialization and going to offices all over various parts in this area of Western Pennsylvania, et cetera, you know, it can really kind of dehumanize the process a little bit and it can be harder to connect with their patients and get to really know them. Whereas here, I think I have a little bit of a headstart just because a lot of the people in the community are people that I do know or they may know someone that I know, and just a lot of the facets of what sports are offered, different things, what the teams are, what the coaches are like, that sort of thing I just feel like I have a leg up on. And so, it's a lot of fun to be a little more connected to the patients than I probably otherwise would have been.

Host: Sure. So, St. Clair Health prides itself on being a leader in advanced care close to home. So in a nutshell, what would you say drew you to practicing there in the first place?

Guest: There are many high level specialties that are offered here, including cardiac surgery, pretty much every surgical subspecialty. And that's something that most other hospitals of its size, especially ones that are not a major trauma center don't offer. And so, you really have a unique kind of opportunity as a patient to be treated in a smaller, closer knit type hospital with the same high level of care as some of the major academic institutions that are twice or three times or even four times the size.

Host: Gotcha. Now, I alluded to it at the top. You've been quite an athlete in high school, an All-Conference running back and two-time lacrosse All-American, and then playing both sports at Dartmouth College while earning a degree. So, kind of a two-part question, A, how did you find time for a social life with all that going on at an Ivy League school, and how much did being a high-level athlete contribute to becoming an orthopedic surgeon?

Guest: So to answer the first part of the question, although I was really busy, I actually felt like sports because I was almost always in season, I had to have a fairly regimented schedule, sort of helped me stay on track. I still definitely had fun in college but, at the same time, I sort of had like two different lives, where I definitely had to buckle down when it counted and needed to be. And so, I think that that definitely helped me throughout many facets of my life once I was in medical school and residency where time management just becomes really critical

The second part of your question, certainly sports had a huge effect on me going into medicine and healthcare. I actually have no family members whatsoever that work in any part of healthcare. So, I was the first one to kind of delve into this area. As you grow up playing sports, especially at various high levels, you have a lot of injuries and I've had orthopedic surgery myself and some of the doctors that treated me, I ended up looking up to as mentors and they helped me throughout the way, navigating from college to med school and that sort of thing.

And so, it was always something where I felt like I could really relate well to the field, the nature of the things I was passionate about and some of the injuries I had. And so, you know, it was something that has been a lot of fun and I think I've been able to utilize my sort of expertise in playing sports as well as my knowledge of the sports medicine and various parts of orthopedics in order to treat the patients and provide a more personalized approach and being able to really relate to them.

Host: Understood. And when you mentioned in the first part there about time management, I've covered sports a lot, and you hear that quite a bit, that big time athletes in college that have to manage their time often they do a better job of it out of necessity really than the average college kid that doesn't have nearly as much going on. Let me ask you about specializing in shoulder, hand, elbow, and arm surgery for both adults and children, why do you suppose you originally chose that specialty?

Guest: The way orthopedics is split up is usually with either joint replacement, trauma surgery or sports medicine arthroscopic-type surgeries. And so, there is a facet with this hand, shoulder elbow where you can essentially do all those things, but you just are relegated to a different part of the body, which in this case is the arm.

And so throughout my training, I really enjoyed a lot of aspects of orthopedics. So, I didn't just want to have to narrow down to, "Well, all I'm going to do every day is replace hips and knees," or "I'm just going to do arthroscopy of the shoulder or just fix various trauma-type fractures." And so, I really like the idea of being able to be kind of a one-stop shop where if you need your shoulder replacement, I can do it. If you break your elbow very badly, I can fix that. If your child breaks a finger, injured their fingernail or something like that, I can help with that. And so, there's a huge variation in terms of the different subject matters that's involved in the arm. And so, that's what I really enjoy about it. I think it keeps it fresh and never makes it monotonous or boring and allows me to essentially do almost every type of orthopedic surgery that exists, but just relegated to a certain part of the body.

Host: So from fingertips to the top of the shoulders, you're the man to see.

Guest: That's right.

Host: Excellent. So as you know, there's much more specialization among younger athletes today. How much would you say that's contributing to an increase in acute or chronic injuries?

Guest: I've definitely noticed an uptick in athlete injuries, especially, you know, in the younger population from let's say eight to about 15, mainly with regard to high-velocity throwing athletes such as pitchers in baseball or things like that. As people tend to play less and less sports at a young age and will resort to nine to 12 months of a single sport, you do see these overuse-type injuries become more prevalent and there are certainly many more Tommy John's or ligament reconstruction for the elbow in baseball type pitchers being done at a younger age than ever in, the history of medicine since that surgery first came out . And what we're finding out more and more is, especially for high-velocity throwing, it's really just probably not meant to be done year-round, especially at a young age.

Host: Sure. Switching gears, you also have a special interest in treating carpal tunnel syndrome. How common is that generally speaking? And what are its basic causes and symptoms?

Guest: So, carpal tunnel syndrome is probably one of the most common diagnoses that I make in the office, and it's probably the surgery I do more than any other. And the reason why is it's actually hard to know truly what causes it. But usually, repetitive activities or tasks often are associated with carpal tunnel, and the symptoms of it are generally numbness and tingling in your thumb, index finger and middle finger and sometimes part of your ring finger, it generally does not involve your pinky. And oftentimes, what people will notice is that if they're driving a car for a long period of time or doing a repetitive activity, it can make that numbness or tingling worse.

The other thing, which is usually most irritating the patients, is that it'll often wake them up at night when they're sleeping and they often have to shake out their hands or dangle them near the floor in order to get back to sleep, and that can be somewhat debilitating just because if you can't get a good night's sleep, I mean, that's a pretty miserable life in itself. So oftentimes, people will come in, they don't really mind the numbness and tingling, but really the sleeping at night and their issues with that are the main driver for treatment.

Host: And so for carpal tunnel, what are the usual treatment options? Because it includes a minimally invasive procedure that you do, right?

Guest: Correct. So usually, what we start off with carpal tunnel treatment, unless you're having very severe symptoms with muscle weakness, oftentimes surgery isn't necessarily needed right away. And so, you can actually sleep with wrist braces at night, which sounds like sort of an odd treatment, but it actually does work. And the reason why is because if the wrist is held in a neutral position as opposed to flexing your wrist and curling them up, like most people do when they sleep, there's less pressure on the nerve, which is being compressed in the carpal tunnel. And so, that can often be effective.

If that is no longer effective, other options you have are to try a cortisone injection with steroid to decrease the inflammation in the carpal tunnel. However, this is normally temporary and is not a curative-type procedure. The other option that you have is carpal tunnel surgery, which I've been doing as of lately endoscopically through a small camera and about an incision that's about a half an inch wide, it's sort of at the end of the wrist. And this now can be done as an outpatient, where you go home the same day and it can even be done wide awake, which I do frequently. And basically, I numb the area up before the surgery and perform with the patient talking to me wide awake. And often they can actually even watch it if they want to on the screen as I'm doing it with the small incision under camera guidance.

And basically, the procedure itself takes anywhere from five to 10 minutes, they end up leaving the operating room allowed to use their hand right away. And usually, one or two stitches, which are dissolvable beneath the skin, and a Band-Aid or two over the incision site. And they're on their way. They can drive themselves to the hospital. They don't have to fast, they don't have to do any of the pre-op testing, you know, that often comes with larger surgeries. And so, it's really kind of a game changer in the way that carpal tunnel used to be treated, which 50 years ago, patients would often stay overnight. They would be in a cast for a few weeks after, and it was really a long, drawn out, invasive type of treatment. And so now, it's become really something that is very efficient, the patient satisfaction is through the roof.

Host: Yeah, it sounds like it. How many people take you up on that offer to watch?

Guest: Actually, I would say probably 75% usually want to watch it. A lot of them are pretty interested in it. Oftentimes, we're talking to them throughout the whole surgery. If I am doing surgery wide awake, I'll often ask the patient if they would like to see anything that I'm doing and, you know, I'll certainly take the time to show them what we're working on. And it's kind of a fun experience. Usually, the staff we have in the operating room's very friendly. The patient gets to pick the music they want to listen to during the surgery. And so, we have a good time and try to keep it kind of a lighthearted atmosphere just to decrease the anxiety level around any kind of surgical procedure that a patient's having. You know, it's normal to me to be doing it on an everyday basis, but it's certainly not normal for the patient. So, we try to make it as comforting as possible.

Host: Sure. That sounds great. You ever pop in an old video of your Dartmouth football days or no?

Guest: That's a good idea. Some people ask about it every once in a while, but I think the video screens are taken up by the surgery, so maybe we'll have to add a couple more in the OR and we can fire that up too.

Host: Absolutely. And finally, in summary, doc, St. Clair's motto again is expert care from people who care. Why don't you tell us your interpretation of the meaning behind that?

Guest: I think that St. Clair's in a unique position because they offer very high quality and level of care, but in sort of a closer knit type setting. And a lot of the people that work at St. Clair Hospital are people that actually grew up in the community. They live, breathe the area that St. Clair Hospital is located in. And so, I think they can often relate to the patients much better than, say, if you have no ties to the area, and you didn't grow up in a setting that was similar to this type of area, and I think it just adds that extra little bit of personalized touch and personalized care that people really appreciate as healthcare becomes more of a commoditized type industry.

Host: Well, folks, we trust you are now more familiar with the orthopedic work at St. Clair Health. Dr. James Mullen, thanks so much again.

Guest: Thank you very much for having me.

Host: And to contact Dr. Mullen, please call 412-942-7262. Again, that's 412-942-7262 or visit stclair.org. Again, that's S-T-C-L-A-I-R.org. Now if you found this podcast helpful, please do share it on your social media. And thanks again for listening to Curating Care, a podcast by St. Clair, expert care from people who care. Hoping your health is good health, I'm Joey Wahler.