Transcription:

Bill Klaproth (Host):  Your shoulders are the most moveable joints in your body. But that mobility comes with a price and may lead to shoulder disorders resulting in pain. So, let’s learn more with Dr. Eric Bava, a Physician and Orthopedic Surgeon at MarinHealth. This is the Healing Podcast from MarinHealth. I’m Bill Klaproth. Dr. Bava, thank you so much for your time. So, what are the signs and symptoms of a shoulder disorder?

Eric Bava, MD (Guest):  The most common complaints the patients seem to be bothered by the most are shoulder pain. Most of the pain usually is going to be happening at night with sleeping or the other times when people are bothered by pain are with reaching either away from their body or reaching overhead. The other signs that patients will complain about sometimes is weakness. So, like their arm is weak and have difficulty with reaching, with heavier items away from their body.

Host:  So, with someone with those signs and symptoms, that should pain as you described, when is it time to see the doctor?

Dr. Bava:  I think anytime that it’s persistent meaning if the pain lasts more than a couple of weeks then I think it’s worth visiting with a physician.

Host:  And then how do you generally diagnose shoulder disorders?

Dr. Bava:  There’s essentially two components probably two that for the diagnosis. One would be physical examination. When we examine the shoulder, we’re looking for either reduced motion or weakness in certain directions. Also things that we can see are certain locations in the shoulder that are painful. So, the physical exam is one key component. The other key component is usually imaging. Meaning either an x-ray or an MRI oftentimes is what we use to try to get a look at – and see what’s going on.

Host:  So, then tell us about the treatment protocol. Where do you generally start? Is it with physical therapy?

Dr. Bava:  Yeah, oftentimes it will be physical therapy that we’ll start with in addition to a nonsteroidal anti-inflammatory medication. That’s usually the first step. If someone continues to have symptoms despite that treatment, we then oftentimes may consider a corticosteroid injection to the shoulder what people often call cortisone shot. And if the pain persists even beyond that, then oftentimes, we are having to think about surgical treatments.

Host:  So, how do you come to that decision that surgery is necessary?

Dr. Bava:  The two key things that would determine whether or not someone would need shoulder surgery – one thing that we oftentimes would look at is whether or not someone fails to improve with the nonsurgical treatments. So, if someone has continued pain regardless of what the cause of their pain is, if they continue to have pain despite the injections and the physical therapy; that would be one reason to consider surgery. The second reason that we sometimes would go straight to surgery would be if there is a tear, what we call a full thickness tear in the rotator cuff. That sort of a problem is something that does not do well if it’s left untreated and so oftentimes, if someone had a full thickness tear in the rotator cuff; we would oftentimes be recommending we just go straight to surgery without trying the physical therapy or the cortisone shots.

Host:  And if shoulder surgery is called for, what shoulder surgery options would someone have?

Dr. Bava:  There’s two broad categories of shoulder surgeries that are typically performed. One is shoulder arthroscopies. Those are surgeries that we do with a camera through small incisions in the shoulder. We insert a camera into the shoulder and in that manner, we can perform a variety of treatments. We can repair torn tissues. We can plane down bony burrs that are causing pain. We can remove inflamed tissue. Those are a lot of the things that we are oftentimes doing through the shoulder arthroscopy surgeries.

The second type of surgeries that we are oftentimes performing are shoulder replacement surgeries. That’s not something that we can do through just poke holes with a camera. That’s something that does require an open incision to do. However, we can usually do that through a relatively small incision at the front of the shoulder. And with a shoulder replacement, that type of surgery is something we’re doing usually more for a problem such as arthritis where cartilage is missing, and we need to replace the missing cartilage with metal and plastic.

Host:  Is shoulder replacement surgery becoming more common?

Dr. Bava:  Yes, it is. Shoulder replacement surgery is now the third most common replacement after hip and knee replacement. It is also being done with greater success nowadays because we have come up with newer designs to account for different problems that we’ve had in the past with shoulder replacements and so we are seeing that the number of shoulder replacements being done is increasing.

Host:  What is the recovery like after shoulder replacement surgery? What should someone expect?

Dr. Bava:  Yeah, I mean typically after shoulder replacement, their arm is in a sling and that’s – it varies from surgeon to surgeon for how long but in general I would say it’s probably about a month that their arm is in a sling. Patients oftentimes go home the same day or the very next day after surgery. And so the hospital stay is pretty minimal afterward. And though your shoulder is in a sling, you are still able to use the hand, so people are still relatively functional after the shoulder is replaced which makes it manageable since people still need to use the hand oftentimes to do various activities of daily living.

But in general, people probably aren’t seeing a full recovery from the replacement until about three to four months after surgery. That’s the time at which they would be able to be reaching overhead, doing almost all activities that they want to do with full range of motion or near full range of motion.

Host:  So, with the treatment options that are available and the advancements in shoulder surgery including shoulder replacement surgery, there really is no reason for someone to live with debilitating shoulder pain.

Dr. Bava:  I would say that people should not feel like it’s something they have to live with. We have a lot of good treatments for it and it truly is a debilitating problem that many, many people do have especially as – as we get older, it is – the should is something that we injure more easily. And I would point out that probably the thing that bothers people the most is that it really bothers them at night with sleeping and that’s one of the – the biggest issues that people are probably bothered by is that they can’t get a good night’s sleep because every time they roll over or something while in bed, their should hurts, it wakes them up and it’s definitely not something people need to live with. Because we are able to treat this quite well.

Host:  And the result is people can dramatically improve their quality of life.

Dr. Bava:  Absolutely. I think that people are quite thankful the very small things that they are once again able to do, wash their hair, get a good night’s sleep and that sort of thing.

Host:  Absolutely. Dr. Bava, this has really been informative. Thank you so much for your time.

Dr. Bava:  Ah, no problem. Thank you so much.

Host:  That’s Dr. Eric Bava and for more information please visit www.mymarinhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.