Transcription:
All About Shoulder Replacements

Deborah Howell: If your shoulder hurts from an injury or repetitive movement, might you need a shoulder replacement? In this podcast, Dr. Brian Shiu, an orthopedic surgeon from UM St. Joseph Medical Center tells us why someone might need a shoulder replacement, what it is, benefits and complications and more. I'm Deborah Howell.

Welcome to live greater. A health and wellness podcast brought to you by the university of Maryland medical system. We put knowledge and care within reach. So you have everything you need to live your life to the fullest. This podcast is sponsored by UM St. Joseph Medical Center and the University of Maryland joint network. Thanks for being here, Dr. Shiu, what a pleasure to have you.

Dr. Brian Shiu: Thanks for having me.

Deborah Howell: All right, we're gonna jump right in what signs and symptoms indicate that I might need a shoulder replacement?

Dr. Brian Shiu: So I would break down the vast majority of patients with arthritis as either having some wear and tear of the shoulder or having large bone spurs, bone and bone arthritis, and for a shoulder replacement that treats the latter. I would say that people who have large rotator cuff tears and bull tears in addition to the arthritis can also be treated by certain prosthesis. And so what we do is when you see me in the office, we get x-rays. We look at any advanced imaging, such as CT or MRI that we have available.

And if we don't have it and we need it, we can obtain it. And that helps us grade, especially on the x-rays even more than MRIs. We're able to much better evaluate how severe that arthritis is. And basically when you seek care from us, right? When do you come and see us? When you have pain that stops you from doing your daily activities, get a good night's sleep. And when you can't do what you enjoy, it's a reason to come stop by and see us.

Deborah Howell: Sure. Now you hinted at this before, but are there alternative treatments that could be tried first? And if so, what usually helps?

Dr. Brian Shiu: We were taught early on in, let's say residency that the shoulder is a very, very receptive joint to physical therapy, whether that's YouTube, right during the pandemic, we had a lot of patients go to YouTube in lieu of formal physical therapy to help them. You buy some exercise bands. You go through that. Sometimes coupled with some anti-inflammatories like Motrin, Aleve, if you don't have the normal contraindications to taking those, if they're safe for your primary care doctor, physical therapy, and some of those anti-inflammatories or simple as Tylenol, can calm it down and calm shoulder pain down in a lot of patients.

Deborah Howell: Well, that's good news. Now. I've always wondered. What's the difference between a shoulder replacement and a rotator cuff repair, and could a person need both?

Dr. Brian Shiu: That's a very good question. And so a rotator cuff basically is the pulley or the tendons that help lift the shoulder and power the shoulder, the socket, and the ball is something separate. Right? That's the. Joint itself and the pulleys and the tendons are what moves that joint around. The rotator cuff helps drive the shoulder, and oftentimes in people who have arthritis, the rotator cuff is very, very healthy. But when actually the ball and socket are damaged, and instead of a smooth socket on a smooth ball, It's a rough sandpaper socket, right.

Versus a sandpaper ball, much like a hip and knee can get arthritic and worn out a shoulder can as well. When those two areas grind together, cause pain with or without separate from the rotator cuff, oftentimes replacing that ball to make it smooth on smooth again, can improve your range of motion. So I'll also add that arthroscopically repairing a rigid. It's usually done when there's a tear in the rotator cuff, but the ball and socket are healthy. Right. So we usually pursue and break down. You either have a rotator cuff tear that needs to be addressed, or you have a shoulder that's worn out that has to be replaced.

Deborah Howell: Well, that is a beautiful explanation. Thank you for that. What are the benefits of having a shoulder replacement?

Dr. Brian Shiu: So I alluded to it earlier in. The shoulder is a smooth on smooth joint that has some of the best range of motion of any joint in the body. And when you have a shoulder replacement, you turn a rough on rough side into a very balanced, very mobile socket and a ball. And the good part of having a shoulder replacement nowadays is that versus 34 years ago, when a lot of these things were relatively experimental. Now we have formalized processes and physical therapy, regimens and timelines to maximize your range of motion, decrease your pain and really minimize complications.

Deborah Howell: Speaking of complications, what are the most common ones?

Dr. Brian Shiu: So, as our hip and knee colleagues have dealt with shoulder complications are also present Present but they're fairly rare fortunately. Over the last few decades, we've really fine tuned it. Right? So common complications include infection. They include dislocation fractures in certain cases, if you fall on it from a certain way. And also rotator cuff failure, right? Because we rely on that rotator cuff to hold the prosthesis in some cases. Fortunately you know, we have developed certain antibiotic preparations before surgery, by the antibiotics during and very safe relatively quick moving physical therapy programs, to minimize some of those complications.

Deborah Howell: Let's get into the nitty gritty. Now doctor, how long does the surgery take and what happens during the surgery?

Dr. Brian Shiu: So every time I sit down in front of patients, in the preoperative area, I sit down and we go over the options and questions. And that's a very, very common question. Right? So the surgery itself takes anywhere from an hour or a little bit less, sometimes a little bit more than an hour, depending on exactly what the problem is. As you go to sleep as you wake up, as you get a nerve block to help calm the nerves down before surgery, so that when you wake up, you're able to have almost no pain and allow the anesthesiologist to use less anesthesia. All those processes from indoor to out of the door is about, I would say a couple hours.

And during that procedure, we essentially will enter the joint from the. Really no tendons are cut. We really go between muscles. We lift off a bone, put the new prosthesis on the socket, a new prosthesis on the ball. As we trial. These they're multiple different sizes of every implant. So each patient gets the appropriately sized component. And not only that I tell people, well, look, we take it through a range of motion. We take it out for a trial run. And we're able to confirm that you have improved range of motion. And again, you have that smooth on smooth, functional joint before you even leave.

Deborah Howell: And do that during the surgery?

Dr. Brian Shiu: Correct. That's all during the surgery. And it's one of those where I would say most shoulder specialists nowadays, you know, get the shoulder team, right. A very good team where we know these steps and these are things that we hope we are a well oiled machine by now for.

Deborah Howell: Got it. The good part is the recovery process. What's involved with recovery?

Dr. Brian Shiu: Typically when you talk to most people, therapists, people who, other shoulder surgeons, it is about six months before you're able to do everything and lift and pull and push with relatively few restrictions. Okay. And by one year you reach that maximal improvement. Sometimes it can be a little bit beyond that, but by one year you're getting all the benefit that you're likely going to get. But by six months you're doing everything you want to do. Early on after surgery, I like to break it up into three, six week increments of which physical therapy guides you through the vast majority, the first six weeks you're wearing the sling.

We, I tell people, look, we're aggressively resting the arm, allowing the shoulder to heal. After six weeks, the swing gets put in the closet and you start lifting with physical therapy. And during those second six weeks, you work on a range of motion. And then at the three month mark, which begins the third, six weeks, you begin your strengthening. And so it's Immobilization. Getting range of motion back and strengthening 6, 6, 6. And that's all under a protocol that just about every doc will have you follow to you back and usually by about three and a half months, or so maybe before that you're done with your therapy and just doing home exercises.

Deborah Howell: How important doctor is it to stick to the Physical therapy?

Dr. Brian Shiu: I would say that. The physical therapists have an important role, right? Because those are the very highly trained individuals that not only see the progress week after week, measure your progress, but also find where you're deficient and get your range of motion back and your strength back where you need it. They fill out a report. We review those reports. We reexamine you back in the office and using all that data together. That gives us a good plan of how to proceed forward.

Deborah Howell: Are there things that can actually be done to prepare for the surgery, like prehab or exercise?

Dr. Brian Shiu: Yeah. The shoulder again is a very good joint in that it responds well to physical therapy. So for early arthritis, physical therapy works very, very well. the arthritis progresses, there are less benefits. But look, when I see people in the office, I say, look, there are some very easy noninvasive things that you can do, right? And that take up some time and a lot of it you can do on your own. And that's usually some gentle medicines to help with the pain, calm the inflammation down, coupled with that physical therapy. And by doing those things, knowing what we know on the x-ray, we put you in that program. And it's a left turn, right turm.

On the left hand side. If you do the physical therapy, it take some medicines and it helps you. You might get a little bit of benefit. You might get a lot of benefit. You might get a lot of long term benefit if that's what you end up getting. I say, look, I'll see you when I see you, right. If it bothers you, you're gonna come back and see me. But if it helps for a little bit, it gets better or it just eventually gets worse, then that really tells us that, you know what, we're gonna take the right turn and consider what options we have.

Whether it's surgery, whether it's maybe one or two Corone injections, depending on timing, and depending on the things in your life that you're dealing with. But really it's, the early things, the noninvasive things that help guide us for future action.

Deborah Howell: Well, it really sounds like you take each patient individual. and holy and, really work them through the best regimen that will work for them.

Dr. Brian Shiu: We do our best. We always do our best and it's always a discussion, right. But it's never, this is what I see and this is what we're doing. It's how do you feel what's going on in your own specific life, given your time constraints, right? And what can you do? And what can't you do?

Deborah Howell: Are there any other takeaways you'd like to leave with our listeners?

Dr. Brian Shiu: I would say that in general, you know, when things affect the quality of your life and you can't do what you want to do, that's the time in to come in and see us. And the vast majority of the things that we have to offer are non invasive they're nonsurgical. And when it comes down to options, someone who can balance. Those things, discuss them with you. I think that that's, the way to proceed and that's, I would think how most shoulder specialists approach, shoulder issues.

So regardless of what you have the vast majority shoulder problems can be addressed and in the end, whatever it is that we end up doing, you should not have long term shoulder pain. We should be able to treat you and get you at least a plan.

Deborah Howell: It's a resilient little joint. Thank you so much, Dr. Shiu for being with us today, we really appreciate your time and your expertise.

Dr. Brian Shiu: Thanks so much for having me.

Deborah Howell: This episode is sponsored by the University of Maryland Joint Network, UM Joint Network Surgeons are experts in total hip and knee replacements. Held to the highest standards of care, UM Joint Network surgeons produce better outcomes for patients compared to national averages, including lower infection rates and faster recovery times. The UM Joint Network, home to Maryland's leading joint replacement surgeons.

Find more shows just like this one at umms.org/podcast. Thanks for listening to Live Greater. A health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.