Transcription:
Shoulder Surgery? Call on Schneck Orthopedics & Sports Medicine

Bill Claproth (Host): It can be life-changing when you have a shoulder issue. Simple things like reaching into a cabinet, throwing a ball, or even sleeping can become very painful. Here to tell us more is Dr. Jill Mikles, doctor of osteopathic medicine at Schneck Medical Center. Dr. Mikles, thank you for being on with us. What are the most common shoulder problems that we have?

Dr. Jill Mikles (Guest): So, a lot of things that come into my office for shoulder pain have a lot to do with the rotator cuff, the joint itself such as osteoarthritis, also there are other tendons and muscles around the shoulder that can also cause a problem with shoulder pain as well. The shoulder’s a pretty complicated joint so there are multiple things to be concerned or worried about and what I look for on physical exam and imaging to figure out shoulder problems.

Bill: You’re right about the range of motion. We take shoulders for granted. At least I do, and when you think about what your shoulder can do, up, down, sideways, back, forward, there’s a lot of movement in there and a lot of things can happen. So, when is it time to see the doctor? What are the symptoms we should be looking out for that’s like an “Uh-oh! I have a problem here”?

Dr. Mikles: Sure. I mean, obviously, pain is one thing, especially if the pain is interfering with the activities of daily living. I think one of the most common reasons that people come to the office is because it’s keeping them up at night. So, that would definitely be something that someone would want to be seen for especially if there’s some weakness along with that pain or decreased range of motion. That’s probably something that we should check out further and make sure there’s not a more serious problem.

Bill: I have a question about the sleeping because I’ve heard this before. Why is it when you’re sleeping, you have pain? Your arm isn’t moving at all, so why is it we have pain when we sleep when we have shoulder issues?

Dr. Mikles: Sure. Good question. A lot of times when we are moving and doing stuff throughout the day, we’re kind of distracted by what we’re doing and we don’t really pay as much attention to the shoulder even though it might be hurting at that same time. So, at night when you’re sleeping and nothing really else to do but want to sleep, I think we have more focused attention to what ailments are bothering us. And then, too, I think just using your joints throughout the day, they may not be so sore but once you’ve done some repetitive motion or just overusing them throughout the day, they become more sore and painful by the end of the day and, unfortunately, that’s about when we’re all ready to sit down and rest and go to bed.

Bill: Right. Got it. So, when you talk about overuse. Someone comes to see you and you decide that it is overuse or, obviously, there are different degrees of shoulder problems and issues, how do you diagnose that and are most shoulder problems able to be rectified with physical therapy before shoulder surgery?

Dr. Mikles: Yes. I think the majority of the shoulder problems that I see in my office can almost always be treated conservatively or at least we always try a conservative treatment first. Therapy is an excellent tool to help with shoulder pain. And, also, for a conservative treatment, I do quite a few injections to the shoulder. The goal of the injection is to decrease any inflammation around the shoulder. I feel like I’ve done a lot with shoulder pain and through my physical exam alone, I typically can pinpoint exactly what the problem is and I would say 70% of the time, it’s going to be treated conservatively. There are, unfortunately, some issues that become chronic and just don’t get better with the conservative treatment and if those things fail, then sometimes surgery is an option but I’m almost always going to try conservative treatment first.

Bill: So, most of us, then, you said, you’re talking about 70%, you can treat with physical therapy, without having to do surgery. Is that where the tendons, the muscles are not torn, right? They’re stretched. It’s when somebody has a bad tear, is that when you usually have to do surgery? So, a mild tear can hear on its own? Am I going in the right direction? I’m just trying to understand what the different levels are of complications or when someone needs to have surgery and when they don’t.

Dr. Mikles: Yes. Correct. So, rotator cuff tears, we typically classify as partial tears or even beginning before that just inflammation or tendon atrophy is what we call it a lot of times. So, that’s just where the tendons are really inflamed and irritated and that definitely is going to be conservative treatment with the injections and therapy. Then, the next step is typically a partial tear to the rotator cuff tendon and a partial tear again is going to be a more conservative treatment because that actually can heal on its own. It’s when we get into the full thickness tears that typically we don’t see heal on their own and that is when surgery may be necessary.

Bill: So, if you have like a bad tear, is that usually from a fall or an accident? You usually don’t get a tear in just normal, everyday use, is that right? So, usually it’s some kind of traumatic injury that creates a tear or can that happen just in everyday use?

Dr. Mikles: Actually, probably more often than not I see more rotator cuff tears from what we call degeneration. So, basically it’s usually in a little bit older patient populations where they’ve been in labor most of their lives and it just kind of slowly progresses to a full thickness tear. It doesn’t necessarily have to be a traumatic event but definitely a traumatic event can cause a tear as well. So, it’s kind of both, I guess.

Bill: Okay and when it does come to surgery, can you tell us what happens? What’s the process for that? I’m sure there have been advances in shoulder surgeries. Just give us the overview of shoulder surgery and what we need to know.

Dr. Mikles: Sure. So, I guess there are multiple surgeries for the shoulder. Again, like we were talking about before, there are so many different factors to figure in on shoulder surgery. But, probably the most common shoulder surgery that I see is rotator cuff repairs. That, typically, is done athroscopically which means that you poke holes around the shoulder and go in there with a camera and small instruments to repair that tendon and, usually, that’s a same-day surgery, so no overnight stay in the hospital or anything like that. The more severe shoulder ailments like advanced osteoarthritis of the shoulder could require a shoulder replacement and that is going to be a little bit more of a major surgery and usually we would keep patients just overnight in the hospital. Recovery for almost any shoulder surgery is six months to a year. However, I know that scares a lot of people but, actually, we’re doing stuff and there are definitely improvements along the way but it just can take awhile to fully recover, to get back to normal, completely normal and one hundred percent satisfaction, basically, on the shoulder.

Bill: For the same day shoulder surgery, if you will, the one where you said you do the two small holes and usually the person will go home that day, what is the recovery time for that? I’ve seen people with the slings on. How long do they usually have to wear those? And, when does real, normal function then return?

Dr. Mikles: The fortunate thing is, I tell a lot of people that come into my office like, “Well, my friend was good to go in four weeks,” or whatever and, again, even though it’s just a few little poke holes around the shoulder, that doesn’t necessarily mean you know exactly what happens inside the shoulder. So, for instance, if someone has a chronic ailment and we just remove the debride the rotator cuff, we don’t actually have to repair it, that recovery is pretty quick. They’re usually in the sling for a couple of weeks and then starting physical therapy after that and we can get you moving pretty quickly. If you have a full rotator cuff tear, that needs time to heal. That needs three months for that tendon to heal down to the bone. So, you’re in the sling anywhere from four to six weeks depending on how large your tear was and then, you’re doing therapy starting from two weeks after surgery but, again, depending on how large the tear was, it kind of depends on how aggressive the therapy is and how long we keep you in the sling.

Bill: So, that sounds like good news for the clean-up or debridement, as you call it. That seems like it is minimally invasive and you get that person back on track fairly quickly which is excellent news. That also makes me think, then, that the sooner you feel that you have problems, the quicker that you should get in to see the doctor before it gets worse. Is that correct?

Dr. Mikles: Yes, I would agree with that. If we can get to your shoulder pain before it really get inflamed the likelihood of it getting healed with conservative treatment would be very good and we can get you on the road to recovery pretty quickly. The full thickness rotator cuff tear and it’s going to need surgery, obviously, the sooner we can get to that, the better the chance of it healing.

Bill: Dr. Mikles, this is all so very interesting. I appreciate your time today. Why should someone choose Schneck Medical Center for their orthopedics and sports medicine needs?

Dr. Mikles: Well, we have three excellent surgeons here at Schneck Medical Center for orthopedic care. Two of us are fellowship trained in sports medicine which gives us some expertise, especially in shoulder injuries with rotator cuff tears and other ailments of the shoulder. We’ve done an excellent job as far as keeping our infection rate to almost nothing and we’re, obviously, here in the community where these people live, so I think that’s always important for follow-up care. We take a lot of pride in what we do and we want to see the people in our community where we live do well and live a pain-free and normal lives.

Bill: That sounds great, Dr. Mikles. Thank you so much again. For more information visit www.SchneckMed.org. That’s www.SchneckMed.org. This is Schneck Radio. I’m Bill Claproth. Thanks for listening.