LEWISBURG — At 73 years old, you might think it was time someone like Albert Cook slowed his pace a little.
Cook, who lives in Steam Valley just north of Williamsport, would disagree.
“I like to go camping, I split my own firewood and I farm 250 acres in the mountains,” said Cook.
When he started losing range of motion in his shoulder due to a torn rotator cuff and labrum about 10 years ago, Cook opted for surgery to repair the damage. The surgery helped, but he still wasn’t quite where he wanted to be from a lifestyle standpoint.
“I could never quite get back to 100 percent,” he explained. “If I tried to bowl two days in a row, I would be sore. And as far as the basic things like farming and camping, I couldn’t quite get there either.”
As his shoulder progressively got worse again, Cook paid a visit to Dr. Matthew Reish at SUN Orthopaedics of Evangelical.
“I told him I wasn’t satisfied with my range of motion,” he said. “And he assured me that he could do a shoulder replacement, but I would have to be willing to work hard at rehabilitation in order to get that range of motion back.”
Reish said Cook was the perfect candidate for a total replacement surgery because he was willing to follow doctor’s orders to reap the full benefit of the procedure.
“He was very compliant,” said Reish. “He did everything to the tee — he went to pre-optive therapy and was one of these guys who had a great result from a really early point in time.”
Cook, he said, was “a patient with a pretty decent demand level who got a really good result and is happy with his shoulder.”
Who qualifies for shoulder
When a patient first shows up in Reish’s office, it’s usually because they are experiencing pain, stiffness and a loss in the range of motion.
“Usually people with shoulder problems find they are really modifying their activities and changing what they are doing because of the pain,” said Reish. “It can also cause difficulty sleeping.”
Often these symptoms lead to a diagnosis of arthritis, but to properly diagnose, patients are sent for X-rays and receive a physical exam. If necessary, they are also subject to an MRI or CT scan to evaluate the situation further.
Once a patient has that diagnosis, Reish explained, he or she could be candidate for a lot of different treatment measures including over the counter medications, physical therapy to optimize things, or cortisone shots.
“Ultimately, though, if they have issues and symptoms that warrant it, he or she may be a candidate for a shoulder replacement,” he said. “Arthritis is a progressive disease so if a patient (like Cook) is more active and physically demanding, it may progress quicker.”
Dr. Chris Grandizio, an upper extremity surgeon who specializes in shoulder and elbow surgery at Geisinger Medical Center, Danville, said his patients undergo the same sort of treatment prior to opting for surgery.
“It’s kind of unique for every patient,” said Grandizio. “I will never tell them they need to have a shoulder replacement - that’s a decision we will mutually come to when they feel like the non-operative treatments aren’t helping and are impacting daily living.”
It’s when day to day life is affected by the pain and range of motion issues that most patients will opt for surgery, he said.
“Some will try for years with non-operative options and they haven’t felt like they’ve needed surgery, but for others it can be a few months and they’re ready,” he said.
While there is no minimum or maximum age for a shoulder replacement, Reish and Grandizio said most of the patients they treat are over 65.
“Sometimes there are patients in 40s or 50s that will have them,” said Grandizio. “And we actually use different procedures and techniques designed for younger, more active patients that have shoulder arthritis.”
Surgery and Recovery
Shoulder replacement surgery itself lasts approximately 80-90 minutes.
“One thing to point out is that there are two types of shoulder replacement surgeries,” said Grandizio. “Shoulder replacement is a broad category - the two major types are total shoulder and a reverse total shoulder.”
A reverse replacement is designed for arthritis and rotator cuff tears. For that, surgery is needed to move the shoulder.
The surgery usually requires just an overnight stay and patients usually are able to go home the next day, following a physical therapy session in the hospital.
“We will then have a pretty advanced post operative pain protocol so we can minimize the pain they experience post op,” said Reish. “A lot of different things happen preoperatively, inter-operatively and post operatively to make a patient as comfortable as possible.”
That includes working with the anesthesia department to provide a regional block which helps with post operative pain.
“We are constantly striving to advance the pain control with all of our joint replacements so patients can get out of hospital faster and get back to functioning and accelerate their recovery process,” said Reish.
Patients are then released in a sling or immobilization device that stays on for about four weeks. Outpatient therapy is generally started within a week.
“He/she will need to get range of motion and get the shoulder functioning properly,” said Reish. “Then, six weeks post-op they’re back to their daily living routine and by three months out they are, for the most part, back to their normal activities.”
Putting in the work
Both doctors are quick to point out that the surgery alone isn’t going to entirely solve any issues - following instructions before, during and after the operation are a must.
Cook knows firsthand.
“I tell people every time it comes up - shoulder replacement is just wonderful, but you have to work the rehab program,” said Cook. “I see people at rehab that were there before I got there and they’re still there because they weren’t working the program in between.”
Cook said Reish assured him that he could get back his range of motion if he was willing to work the rehab.
“(Albert) had the entire ball and socket replaced,” said Reish. “He is super active and does a lot of outdoor activities. He had a really debilitated shoulder and so we replaced it.”
While it helped that the rehab center was right next to the bowling alley where he bowls, Cook said he made sure he followed his therapists instructions and got to know them.
“From the minute I went into rehab I wasn’t ‘right shoulder #12,’ they knew me as Al,” he said. “They wanted to know about my activities and really got to know me.”
For his part, Cook did what he was told.
“I would do everything at rehab in the morning, then I would come home, ice my shoulder and do it again in the afternoon,” he explained. “My goal wasn’t to have successful rehab but a successful life.”
All his hard work paid off. Cook said after just six weeks he was back bowling and he is still able to live an active lifestyle.
“There has been a tremendous difference,” he said. “I definitely encourage shoulder replacement,” said Cook. “I’ve been through both types of surgeries, and I worked hard at both and the shoulder replacement was a much, much much better situation for me. No one would even know I had a shoulder replacement - my arms go straight up and I can stack wood.”
Cook, said Reish was an ideal patient.
“He was very compliant and did everything to the tee,” said Reish. “And because of that, he did not have a lot of pain post operatively, he got really strong and back to his physical lifestyle quickly. He is a patient with a pretty decent demand level and got a really good result and is happy with his shoulder.”
Grandizio isn’t surprised.
“Most patients report big changes in term of pain relief following surgery,” he said. “Patients usually report a significant improvement in his or her quality of life.”
If you are experiencing pain and think you may be a candidate for a shoulder replacement, the first step is to get a proper diagnosis. Start with your family physician.
“Your family physician can do an evaluation,” said Reish. “Our colleagues in family practices are really good and have a good understanding of problems that exist and getting patients to the right doctor.”Getting correct diagnosis is important and most of the time gives a good result and ability to get back to doing what they want to do.”