Andrew Pastor M.D.

Orthopedic Shoulder and Elbow Surgeon. Engineer. Edmonds, Washington

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What Questions Should I ask My Surgeon Before Undergoing a Shoulder Operation? #health #Seattle #rotatorcuff

Pain in the shoulders can significantly impact a patient’s quality of life and ability.  Luckily, there are plenty of options, both surgical and non-surgical, that can alleviate this pain.  If a surgical option seems prudent for your situation, you can ask these questions to ensure you are informed prior to the operation:

 What are the alternatives to shoulder surgery?

As with many other shoulder surgeons, it is common to practice a conservative approach to surgery, attempting to seek other options before resorting to surgery.  Understanding these options, like general pain management techniques or therapies, can better inform that patient on the wide array of options for regaining their quality of life.  Even if surgery is necessary, the patient will be informed on other options at the very least.

 What is the risk to not performing surgery?

A common question is whether avoiding surgery will compromise the long-term outcome. This is a case-by-case decision and must be considered carefully by both the patient and physician, but there is a lot of evidence that can be used to help predict this. For instance, with a partial rotator cuff tear the risk of tear progression is low and attempting conservative treatment for several months does not typically affect the long-term outcome. Conversely, an acute rotator cuff tear (one that occurs after a trauma such as a fall) typically responds better to being repaired within a few months rather than waiting several months to a year.

 What is the expected length of recovery?

The recovery from shoulder surgery can be lengthy and again varies from patient to patient depending on a number of factors. Patients should ask and understand how long they will be in a sling, when they can drive, when they can return to work, when they can return to sporting activities, and when they can expect complete pain relief.

 What are the risks of complications?

A patient considering shoulder surgery should have a good understanding of the risks of the surgery. These can vary considerably. An arthroscopic cuff repair, for instance, has an anticipated complication rate of about 1%. Conversely, the complication rate after a shoulder replacement may be 5 to 10%. Additionally, while volume is important as noted above, complications rates can vary between surgeons.

 Getting answers to these questions should help you make the right decision for you. Making sure you’re comfortable with your surgeon and your procedure, as well as understanding recovery expectations are all important for the success of your procedure.

 

Can an “old” treatment find new life for rotator cuff repair treatment? #AAOS #Health #Seattle


A study that was presented at the American Academy of Orthopedic Surgeons has demonstrated that transcutaneous electrical nerve stimulation may reduce the pain scores and opioid use after rotator cuff repairs.  In this study, 37 patients were randomized to use either an active or a sham TENS unit during the first week after a rotator cuff repair.  
Electrical stimulation for pain control was first used in ancient Rome.  The first modern, patient wearable TENS unit was patented in the United States in 1974.  It was initially used for chronic pain patients but its use has expanded to other areas.

TENS unit

TENS unit

Following  arthroscopic rotator cuff repair, the use of a TENS unit during the first postoperative week was associated with significantly lower pain scores and opioid pain medication use when compared to patients who received the sham TENS unit.

I have used the this treatment  as part of my shoulder pain protocol after rotator cuff repair surgery with good results.  I continue to research ways to decrease postoperative pain and improve the overall outcomes of my patients after shoulder surgery.  The study is encouraging and may provide an inexpensive and safe way of improving pain control after surgery.
 

American Academy of Orthopedic Surgeons Annual Meeting brief review #1

I had the opportunity to speak at the American Academy of Orthopedic Surgeons Annual Meeting last week in New Orleans.  My talk on virtual reality to curb opioid abuse highlighted how this novel technique can be used to treat patients for postoperative pain and chronic pain...

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