Hot Topics: Common Shoulder Injuries

Good morning guys. My name is Dr. Justin Kennon. I’m one of the shoulder and elbow surgeons here at Tennessee Orthopedic Clinics here in Knoxville and in Oak Ridge. I appreciate you guys taking the opportunity to allow me to present to you guys, certainly in the wake of the COVID-19 pandemic, things are a little different now. We had originally planned this, that I’d be sitting with you guys face to face. We’d have a nice question and answer session, it would be a lot more interactive, but in the times we’re in, I think safety is paramount. And so I think that doing this remotely and electronically is the right avenue for this time.

There’s some new technology I’d love to share with you guys around 3D printing and some other things I think would be really interesting down the road, hopefully after some of the pandemic is cleared and some normalcy has returned. But in any event today, I wanted to share with you guys really just an overview of common shoulder injuries and probably the four or five most common things that walk into my clinic, in terms of shoulder pain generators, and again, true injuries. And so, my plan is to share this with you guys. I’m going to tell you a little about myself.

About Dr. Justin Kennon

I’m not new to orthopedics or new to shoulder and elbow surgery, but I am a little bit newer to East Tennessee. So I want to share with you guys a little bit about my background, who I am, in the way of introductions, and then I’ll hit each one of the topics that we’re tasked with today, share some education, some anatomy that hopefully will help you understand what’s going on in your shoulder, or hopefully not going on in your shoulder. But whether it is a friend or family member what’s going on with them, and then talk a little bit about our treatment modalities and some of the new technology that’s out there that really has changed the way that we’re able to treat shoulder pain, just in the past five or 10 years.

So we’ll kind of hit each one of those topics, and then we’ll wrap up at the end. So again, my name is Dr. Justin Kennon. I was born and raised in Georgia. You don’t have to hold that against me. I’m not a Georgia bulldog, so you don’t have to go ahead and turn off the webcast at this point. But I did grow up in a very small town in the Eastern side of Georgia called Covington or Oxford Area. This is a picture of our quaint  little hometown square. You can see there’s only one stoplight in the whole town. So again, it’s a small place outside of Atlanta.

But I did spend a fair amount of time in East Tennessee. Prior to returning to East Tennessee, I spent four or five years living here and attending UT football games and things of that nature. I was not a student here. I had a career here. So I lived in East Tennessee, used to work in Oak Ridge. I used to work at Methodist Hospital in Parkwest and all of these hospitals that I’m back working in now. So, it has been a full circle, 360. So in the way of training and education, I did my undergraduate at Georgia Tech, certainly with ORNL I would imagine there are at least a handful of engineers that have a Georgia Tech background, I would hope.

And then took my training to Augusta Georgia at the Medical College of Georgia. I did both my medical school, as well as my orthopedic residency there. It’s Augusta, for those not familiar with it, there is a little golf tournament down there called The Masters, which we unfortunately just missed this year, but we hope that will return soon. It is a gorgeous place if you ever get the opportunity to visit. And then I did my fellowship at Mayo Clinic up in snowing, cold, Minnesota. Mayo Clinic’s been ranked the number one hospital, I think now for the third year in the row, in the nation.

I did a shoulder and elbow complex reconstruction fellowship, there are only about 30 or 40 of these spots each year in the nation. So I was fortunate enough to get into training with researchers and implant designers of all of the major implant systems. They perform more complex shoulder and elbow reconstruction there than anyone else in the United States each year. So I had a great opportunity there. We did almost 500 procedures. I had over 30 publications and presentations on a national and international level. We authored textbooks and I’ve received several awards on the national and regional level for the research that we performed, both in Georgia and in Mayo.So today the real topic at hand is pain in the shoulder and common shoulder injuries.

Why Live With Chronic Shoulder Pain?

So, typically speaking the way it creeps up on people is that they realized that their activities of daily living are being limited. It can be simple things like washing the dishes or doing your hair, putting your billfold in the back of your pocket and you realize you can’t do it anymore. And oftentimes this is secondary to pain. It may be secondary to stiffness, or maybe some combination of both. And so at some point over this, whether it’s pain first or stiffness, you realize that you’ve compromised your shoulder function and you just can’t do what you used to be able to do. You may have strength loss or a loss of motion. And so these are all the symptoms we typically see.

And the most common issues that I see in my clinic, are a combination of bursitis or rotator cuff tears. And those kind of go together. An issue with the biceps or the labral, which we’ll talk about what these are. And then the other two big common ones are arthritis or fracture. Unfortunately, people have falls and oftentimes can fracture the shoulder. But in order to understand what is abnormal, we first have to understand what is normal. So this is bony anatomy. And if you look, here I’m showing you an image of the normal shoulder. You have a ball and a socket. And that’s what we think of as our normal bony anatomy. And then we have our collarbone at the top, and that’s the clavicle. And then the shoulder blade, which is kind of the basis where it attaches to your thorax. But really, when we talk about the shoulder in general, it’s usually the ball and the socket, which is also called the glenoid. So, those are really what make up the shoulder joint, the ball and socket. There are obviously a lot of soft tissues. We typically think of the rotator cuff, but there also a lot of other soft tissues around the shoulder. The shoulder is the most unconstrained joint in the body. And so because of that, it’s a shallow socket and a ball, we rely on a lot of soft tissue, ligaments and tendons and things of that nature, to stabilize the shoulder and allow us to reach up, to reach out, to grab things and do things on a daily basis. So, the rotator cuff has four primary tendons that make up the cuff. It’s not one veil of tissue, it’s actually four distinct tendons. And around that, you also have all of these many ligaments that we’re showing here in this middle picture.

I won’t bore you with all the names of them, but you have to understand that there are a lot of tendons and ligaments as well as a fixed shoulder capsule that surrounds the joint. And that’s what allows us to have a stable shoulder, and allows us to use it on a daily basis. One of the first things we usually start with is x-rays, this is a early preliminary step, where we look at a normal x-ray, again you can see here, the ball is on your right, and the socket is on the left, and the clavicle or the collar bone is running up above it.

Bursitis

It’s that thick structure above. So the first etiology and pain generator we’ll talk about is called bursitis or impingement. The bursa is a fluid filled sac. The image on your left, you can see, is that nice, small, thin almost looks like a water balloon that is up above the rotator cuff. And that’s designed to be a cushion absorber or a shock absorber or a cushion in the shoulder. Well unfortunately, as we raise our arm, and if we have a little information in there or what we call impingement, where the ball is hitting on the roof bone of the shoulder, that bursa can get inflamed and you get what we call bursitis.

Bursitis is an inflamed and angry shoulder. This is probably the most common thing that I see walk into my clinic on a daily basis. Well how do we treat that? Well, you’ll see the slide several times, and it’s not because I was lazy or intentionally being redundant with my slides, but it’s important that I want you guys to understand that even though I certainly am a shoulder and elbow surgeon, we perform a lot of surgeries on a daily basis, but typically speaking, the vast majority of our patients, I can get better with conservative treatment, and the vast majority of people don’t need surgery.

And so when we talk about nonsurgical options for shoulder pain, the majority of people respond to one of four things. We talk about lifestyle and activity changes. We talk about therapy, and we talk about medications. If those three fail, sometimes we do resort to injections that can help with inflammation and bring down some pain for the patient. But some combination of those four options, is usually what we use really for all of the problems I’m going to talk to you about, and can really help bring down pain and allow you to get through back to a more functional shoulder.

So, remember this slide, you’ll see it a couple times, but again, it is important to stress that not everyone needs surgery and in fact, the vast majority of my patients don’t need surgery. And we can get you back to doing things on a daily basis that are not going to require a nine month recovery or anything like that. Usually we can get you back pretty quickly. And unfortunately, if some people, if you have bursitis or impingement that doesn’t respond to conservative treatment, we do that very minimally invasive arthroscopic option. The image on the right is a patient that we saw roughly two weeks out from surgery and you can see very small little points on the shoulder, but they’re less than the size of your pinky.

It’s like a very small … again, minimally invasive approach that we can utilize to clean up that bursitis and get you feeling better. So the recovery from this is very quick, and again, we hope that most people don’t need surgery, but if you do, we’re able to utilize a relatively new minimally invasive approach for this. Well, what if the bursitis and impingement has progressed and now you actually have the rotator cuff underneath that’s causing a problem? Well, rotator cuff pain falls into three categories. You have tendinosis, tendinitis and a true tear.

Rotator Cuff Pains: Tendinosis, Tendinitis, and Tear

A tear is obviously the worst of these, but tendinitis and tendinosis are two similar terms that essentially are just a progression. Tendinitis is when you have inflammation in the rotator cuff. And so that is painful. Tendinitis if it has not been treated or is not appropriately taken care of over many years, can become tendinosis, which is where the tendon has just been stretched. And the reality is, tendinosis does not need surgery, but tendinosis can be problematic for people and can be a warning sign of things that may come down the road.

Tendinosis is oftentimes a result of chronic tendonitis, or the inflammation has calmed down and may not be as painful. But the tendon itself is just not quite as healthy as it once was. So we do see this as people age and we get into our 50s, 60s and 70s, we certainly see more tendinosis than we probably did when we were 18. And then truly a rotator cuff tear can be a significant pain generator. So rotator cuff tears like I mentioned, they vary and they’re … I could spend hours talking to you about the morphology of these. It’s interesting to me, but probably would be boring to you guys and so I’ll spare you that.

But, the long and short of it is that these tendons can tear in any one of many patterns. Looking at the images on the right of the screen here, you will see the supraspinatus, which is one of the most commonly involved tendons. And again, you can see a big crescent shaped tear there and that’s a common situation for us. The other things to keep in mind here is that the rotator cuff is actually four tendons. So you have your supraspinatus, your infraspinatus, your subscapularis, and then the teres minor. The teres minor is very rarely involved and so I tend to not think about that one too much.

It’s usually one of the other three that is a problem. When I was doing my research for this and putting this presentation together for you guys, I went and did a little bit of looking back at things, and I wanted to share this information with you from two quick studies, one being a very educated group. You’ll appreciate the fact that these are evidence-based medicine. These are studies that have been published and pre reviewed. These are things that we as an academic community look into to kind of be the standard of care, and I share two quick studies with you to show you that not all rotator cuff tears need surgery.

So these are two studies. One was an ultrasound study. The other was an MRI study. And both of these studies looked at hundreds of patients. And what they showed us was that, we have a ton of people out there with asymptomatic shoulders, meaning they have no pain, they have full motion and they can do pretty much whatever they want. And we imaged them to see what incidence had a rotator cuff tear, and they don’t even know it. And we come to find out that either depending on the study you look at, one in three or almost one in four out of the patients we looked at, they had no shoulder problems whatsoever, have a rotator cuff tear.

And that incidence goes up as we age. And so you can see the numbers down there, as you reach your 60s, 70s and 80s, you have again, a one in three or up to almost a 50% chance that you’re going to have a small rotator cuff in there, and then not cause you any problems. So, the fact that you have a small rotator cuff tear, it does not really get to you having to have surgery. Typically, these patients, sometimes they can become problematic and may need something done, but oftentimes, having a small MRI or ultrasound finding of a rotator cuff tear, does not mean you have to have surgery.

So again, this was a summer MRI study, and again overall prevalence was 34%. So 34% of people with no pain or no problem still had a small rotator cuff tear. So I share that with you again to say, not all rotator cuff tears need surgery. So again, the typical conservative treatment and non-surgical treatment for these, is lifestyle changes, activity modifications, therapy, and then a combination of medications or injections. Then what happens if they do need surgery? What if you failed all those modalities? Or what if you have a traumatic injury, say you fall off a ladder, you had no shoulder problem before, and now you have a huge rotator cuff tear?

Well, those oftentimes do need surgery. And the way we fix these and fortunately now we can do so, I would tell you that in my practice, probably 95 to 98% of these can be done arthroscopically, which is a little different than some of the folks in the community now. And some of my colleagues that have been doing this for a longer time, or perhaps trained in a different era. So we can do these arthroscopically where you don’t have a big incision. And we do this through a series of very small incisions. And so we can go in and put little anchors down, and repair the rotator cuff.

Rotator Cuff Repair: Advances

So in the way of advances, again being an educated audience, I hope that this will pique your interest to know that things are not the same way they were 15 to 20 years ago. Some of my mentors and people I trained with and things that I brought back to East Tennessee with me, they’re certainly not being done everywhere in East Tennessee. We can not only do these through a minimally invasive approach, but we also have knotless technology in double row repairs. And those are fancy technical terms. But what that means is essentially we’ve just found better mechanical ways to repair the rotator cuff tendon.

If you imagine the rotator cuff being pulled off the bone and pull it back like this, our job is to bring it back over like this and repair that back out. Well, traditionally speaking, we had to use sutures that had all these big knots in it, and you can imagine a big stack of knots hidden underneath your shoulder can be quite problematic. So now we have ways of doing this, with what we call knotless. And so it provides a much smoother low-profile type repair. And we also realize that having one point of fixation is not ideal. So we now use multiple points of fixation, and provide almost a ripstop type of technology to help really mechanically repair the rotator cuff back where it belongs.

So that sounds great. And that’s half the battle, but the other half of the battle is that the body has to heal the rotator cuff. And that’s something that up until just recently in the past couple of years, we had no way to really stimulate this healing. Now we have a new technology that’s only been used for the past handful of years, where we were able to stimulate the body’s natural healing response, and induce new tendon growth via these bio inductive implants. And so, it’s essentially a patch that goes over the repair or over the tendon and stimulates new tendon-like tissue growth and can also stop disease progression.

So, for some people we’re able to catch the issue before it is a full on big tear, we’re able to utilize this technology and stop that disease progression, and perhaps prevent them from getting a huge rotator cuff tear. So again, this is really new, it’s exciting for me. And I wanted to share it with you because I think this is going to be revolutionary in the way we treat people in the future. 

Biceps and Labrum Injuries

So the other big etiology that I see that goes along with the rotator cuff is biceps and labrum injury. The bicep tendon is a big problem for people. It is a long tendon that actually inserts up in the shoulder, but spans all the way down the front of the arm, where we traditionally think of our bicep here and it inserts down past the elbow. And so if you think about that, that’s a long working area that this tendon in this muscle is being asked to cover. And so they’re like most machines and systems of work, you’ll realize that there’s a lot of room for air there and there are things that can go wrong. And so, the biceps and the labrum tend to be a problem for some people.

The long end of the biceps oftentimes presents with a tendonitis, which is similar to the rotator cuff tendinitis, but it’s a different tendon that can be involved. This oftentimes presents with shoulder pain in the front of the shoulder. Oftentimes it can radiate down the front of the shoulder. So this is not uncommon and oftentimes goes along with rotator cuff issues. The second part of this would be that the bicep tendon itself inserts on what we call the labral which is a cartilage lining around the socket of the joint.

And that labral can also be injured from a dislocation, from a fall, sometime from chronic throwing or lifting or from a heavy object or some sort of jerking type injury. And so again, these biceps and labral problems can present as pain, loss of motion and other similar kinds of symptoms. Again, the treatment for these oftentimes can be conservative. We can oftentimes stabilize things with therapy and pursue the similar treatment options that we talked about earlier. So, I tend to think of biceps and labral problems in a similar category to rotator cuff problems, because it’s not uncommon if you have one, you can have involvement from the other.But they are standalone. It can be unique entities in and of themselves. 

Arthritis

What is probably the second most common thing that I see in my clinic and is a world where I’ve done a lot of extensive research, is good old fashioned arthritis. So arthritis is a common entity that causes pain for people. It’s a degenerative destruction of the articular surface and the cartilage that makes the ball and socket traditionally a smooth surface. And when that degenerates over time, it becomes incredibly painful and lifestyle limiting for people. And so, this is something that fortunately most of us don’t have this when we’re in our 30s and 40s, but oftentimes it does start creeping up in the 40s and 50s and then much more prevalent in the 60s and 70s.

And so it’s not uncommon. You develop arthritis in the shoulder much like you develop arthritis in the knee or the hip. I’m sure the majority of folks on this call or on this webcast know people that have had shoulder or knee or hip arthritis. So the way I think of arthritis, these are slopes of snow that are pretty nice and smooth. This reminds me of being back in Minnesota, and with time as skiers go down these slopes, it creates little divots and ruts in this previously smooth surface. Well then what happens when summer rolls around is, the snow has melted and now underneath you have the mountain itself, which is rugged and rough.

And so this is the same thing that happens in arthritis. The way God made most of us is we have a very smooth surface and that cartilage caps the top of the ball and the socket. And it’s a beautifully smooth surface, just like those snow slopes. But what happens with time is we get ruts in there and things change as we age. And oftentimes once that cartilage has degenerated, we’re left with a rugged rocky mountain looking landscape of bone. And there’s no smooth cartilage over the top. And believe it or not, that’s incredibly painful for people. And also has as the motion is no longer smooth, it becomes stiff and painful.

So this is an x-ray, a typical x-ray that I see in my clinic many times a day, where a normal x-ray is there on your left and the abnormal osteoarthritis pictures on your right. You can see there’s no longer a joint space, and people have started forming bone spurs. And this is essentially what you call bone on bone arthritis. The black arrow is pointing there where the joint space instead of having space here has now been diminished almost entirely. And you again essentially have bone on bone arthritis. And so this is quite common.

This is a surgical photo, on the left you’ll see that that’s a normal looking very smooth ball and socket surface. You’ll see the humeral head labeled on the right, and the glenoid on the other side, nice, smooth, quite looking surfaces, kind of like those snow slopes. But down on the bottom, you’ll see a very hot and angry looking red appearance. And you can see that that humeral head, that ball is no longer smooth. It looks like somebody has been carving or whittling out of it. And so, that is the Rocky Mountains or the Smoky Mountains, so to speak.

And that is a no longer smooth surface. And so that’s a pain generator for people. Oftentimes also you can develop what we call secondary arthritis, and that can be from a rotator cuff tear that you may have had for many, many years that was not terribly problematic or you’ve dealt with it for many years. And the rotator cuff has essentially progressed to the point that it is no longer fixable, and people can live with it for many years, but oftentimes as we age, that does catch up to us. And so if we have an irreparable rotator cuff tear, then what happens is that all is no longer being pushed down in the socket, and it rises up like this.

And so, as it rises up, it is no longer articulating in a normal fashion and that can also create a lot of pain in this function. I often see people, they come in with this x-ray here, and they have no motion at all. When I ask them to raise their arm, they literally can’t get above here. And so, it’s a very debilitating state for people. And quite frankly, up until about 10 or 15 years ago, we did not have any sort of solution for this patient. It was essentially not a true death sentence, but a death sentence for the function of your shoulder. And it was a really bad diagnosis for you to get that you had an irreparable rotator cuff tear with arthritis.

Fortunately for us, we have good options now. So again, how do we manage these issues and how do we manage the pain? Surprise, you’ve seen this slide before. It’s the same four things, I won’t reiterate them, but again, we can oftentimes treat this non-operatively. 

Joint Replacement

Unfortunately, oftentimes arthritis does progress and people do have to consider other options. And for some people that is a shoulder replacement and so, joint replacement in the shoulders, the third most common type of joint replacement in the United States and worldwide, right behind knees and hips.

And so, most people know someone that has had a knee or a hip replacement, not as many people know someone who’s had a shoulder replacement, but it’s very common. In this slide here, we’ll show you this is recent research that has seen an enormous increase in the demand for shoulder replacement, for people that want a better quality of life and, this has really ramped up over the past 10 to 15 years. And the estimate is that there’ll be a 300 to 700% increase in demand over the next 20 years. And this data actually came out in 2015. And so if you look at it, if you think about it that way, really some of that has already started really ramping up exponentially.

And I think we will continue to see that. That has really been a cornerstone and a keystone for my practice. So, the other reason that we think that shoulder replacement has grown in popularity is that it is really starting to be proven in longer term studies that’s safe and effective, and it’s relatively just as predictable as hip and knee replacement. So we have about a 90 to 95% chance of having less pain than we did before surgery, and having a good outcome. So the 90 to 95% number is based on national studies and international studies. And so those are ballpark numbers, but that’s pretty good odds to have a 95% chance of having better pain and better function than you did before.

So this is just a little bit about different types of shoulder replacements. We’ll keep this at a high level, but in general, doing a shoulder replacement, we are resurfacing the ball and the socket. And so those services were incredibly rough and painful, and so we’ve found ways to replace those services that make them smooth and provide an articulating joint and are no longer painful for patients. So, we have a lot of different options. We’ll go into more of this in a future talk, but we’ve gone from long stems like these that go way down the humerus and down the bolt, the shaft of the arm bone.

And we now have little stimulus options that are really small and they preserve a lot of your native bone and native anatomy. We use these in really young patients. This was one of my patients here, wanting to get back to sailing. He sent me this picture of his right shoulder. And again, you can see, his motion is better than my motion is, and I don’t have a shoulder replacement. And so, the goal of doing all this in younger patients is to get people back to the activities they enjoy. I have back home water here in the slide but, it’s back to work in the yard, back to biking, back to golfing, whatever it is that you enjoy. The goal of doing this is to get you back to the activities that you enjoy. 

Reverse Shoulder Replacement

What about for patients that might be a touch older that either have an irreparable rotator cuff tear or their rotator cuff just isn’t quite great, or as healthy as it might’ve been 30 or 40 years ago? Well, we have a great new option for those people called a reverse shoulder replacement. This is where we’ve reversed the ball and socket configuration. I could tell you and give you a lot of diagrams about all the biomechanics behind it, but I’ll spare you that today. But the long and short of it is that these options didn’t exist 15 years ago. And that over the past five to 10 years, we’ve made huge strides in the technology for this that provides in my opinion, an absolutely game-changing and revolutionary approach for these patients. Then again we just didn’t have this option 15 years ago. And frankly, several of my partners that do shoulder and shoulder replacements, don’t feel comfortable doing this implant because they just weren’t trained on it. They trained at a different time, and it’s just a different world now and frankly, I’m excited and passionate about this, and the options that we give for patients now that we didn’t have 15 years ago are immense.

Fractures

Then the other option or the other common issue we see along with the arthritis is kind of wrapping this up, is that fractures happen. And so, we talked about rotator cuff and soft tissue problems, biceps, and labrum. Then we talked about arthritis and the last one is fracture. So, oftentimes people fall and they have fractures. As we age, our bones get more brittle. We’re not able to take a fall like we did when we were 18. We can often crack the bone. And so that comes in a variety of flavors so to speak.

Again, I won’t show the slide for a fourth or fifth time, but oftentimes we can treat these conservatively with a period of rest and immobilization followed by therapy. Oftentimes we don’t need to operate on all fractures, but we do have some great options that we do. This was a bad injury that came into my clinic on the left. You can see the ball is no longer on the top of the bone. I tell people that the ice cream scoop has fallen off the ice cream cone. That’s a bad problem. And so unfortunately that patient did have to undergo surgery, but we have pretty good options. You can see on the right, we got the ball back up on top where it belongs, and we’re able to get that patient to heal.

And unfortunately, the failure rate with these for fractures is somewhere in the 20 to 30% range. So, that is not an ideal number. And up until about 10 years ago, we didn’t have a great option for the people that did fail these. Fortunately, an implant that we talked about just a few minutes ago was a reverse shoulder replacement, and now that we have that option for patients that don’t heal this, we do have a good option for them. Again 15 years ago, this was not an option for these people. And so again, I’m excited about it. I’ve done research in this arena and it makes me ecstatic to be able to have patients that 10 years ago, I know did not have an option or a good solution, and I’m able to provide them that option and a good treatment solution now.

Custom Shoulder Replacement

So, just a little bit away in the ways of advances, we also now have custom shoulder replacement. I believe I’m one of the few if not only people in East Tennessee that’s doing these, but we get 3D models printed for patients. That’s a whole nother topic that we’ll talk about in the future, but essentially this allows us to provide a better surgical outcome for patients. It’s an individualized custom replacement for each patient that I’m able to provide. And in my opinion, it gives you the best chance of a better outcome in the long run. And so again, this is our goal here. This is a patient that I saw in Oak Ridge. This is six weeks after a shoulder replacement, she’s pain free.

She was previously taking narcotics for pain and is no longer taking narcotics. And as you can tell, you can barely tell which side I operated on. And this is only at six weeks. And so she’ll continue to improve, but at six weeks, she was doing wonderful, very small incision on the front of the shoulder. 

And then people ask, “Well, how long do these last?” Well, we’re starting to have really good data coming out now that says, at 10 years, you got about a 95% survival rate of this implant. So again, pretty good option for a lot of people. And so in terms of finding a solution for you, whether it’s joint replacement, rotator cuff problems, labrum problems, or whatnot, the solution is finding the right surgeon and the right hospital.

There are good studies that again, this is all very academic research that show that 75% of shoulder replacements are done by a general orthopedic surgeon out in the community that only does a handful of cases each year. And so frankly, this is less than ideal and I may be casting stones, but I’ll live with that. The reality is we know that people do better when you have a specialist and you have someone that does a higher volume. So there are a number of studies, I could show studies for days that show that high volume surgeons and hospitals performing shoulder replacements and shoulder surgery, provide a better outcome with less blood loss, lower surgical time and shorter hospital stay.

So overall, this provides the patient with a lower complication rate and a higher chance of a good outcome. And so I think this is critical for you, whether you come to see me or not is fine. I just highly encourage you to do your research and find someone that is a specialist. This is another study, just showing direct correlations between shoulder volume and patient outcomes. 

Steps to Solutions

So success factors overall, things to consider when you think about having a shoulder problem, consider the quality and the condition of your bone, as well as the soft tissue in the muscle around your bone. Consider the quality of the muscles around the shoulder. Your age, your activity level, your overall health. And then the last one I would add would be your goals. Because everybody’s goals are different. If I see a lady that is pretty minimally active and she’s in her 80s and her primary goal was to get back to just essentially doing things around the house, doing dishes and playing bingo, then we have a great solution for that, but I’m going to treat that patient a little different than I’m going to treat the patient that may be 75 or 65, but they still mountain bike four days a week and are incredibly healthy with no comorbidities. I’m going to treat that patient more like they’re 50, than they are 70 or 80.

And so, it just depends on the patient and your goals. And our overall goal is to get you committed to a good outcome. And we find the right solution for you and a committed rehab afterward. And then these are just a few of the quotes from some of my patients. Again, “Most days I forget that I’ve even had a shoulder operation. It works better than my normal shoulder. I can’t tell you how great it is that I’m able to reach and lift and be pain free.” One of my patients told me that his new shoulder is better than his traditional shoulder. And again, needless to say, some of these patients, the goal for this is to get you back to doing things like riding bikes, performing Pilates, or doing weight training, just normal things, gardening, golfing, whatever it is that you enjoy.

The goal is to get you back to living your life, understanding that there are both great surgical and nonsurgical options to take care of shoulder pain and dysfunction, and more than anything, like I said, my goal is not to necessarily save lives, but to make your life better, and allow you to enjoy it at its highest level and get back to the activities you enjoy most. 

So, thank you for your attention. I hope that this was well received. Again, my apologies that I’m not able to be out there in person. I do look forward to seeing you in person down the road, and we can talk about some other neat things that we’re doing in the shoulder and elbow world, and have some face to face discussions along with hopefully some question and answer. But for now, again, I appreciate your attention. I’ll remind you that we do see patients both at Parkwest, as well as Oak Ridge with Tennessee Orthopaedic Clinics, and we look forward to seeing if we can ever help you. Thanks. Take care.

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