BULLSEYE!

Patients frequently present to our clinic with a lot of anxiety and worry about pain following their shoulder surgery.

While there is certainly a wide range of responses to surgery, we commonly find that many of our patients complain of very little pain following their surgeries.

There are almost 500,000 shoulder replacements and rotator cuff repairs performed every year. These surgeries can be performed using a variety of different techniques, with even greater variation in postoperative rehab protocols.

As such, it is not uncommon for some patients to experience more pain than others, as more “involved” procedures that involve fixing multiple affected structures can understandably cause more postoperative discomfort.

However, as our patient Greg has displayed this hunting season, shoulder surgery doesn’t have to keep you down! Just a few weeks after rotator cuff repair, Greg managed to bag this beautiful doe by shooting off a tripod and relying on some good old teamwork to get the deer out of the woods (all while wearing his sling, of course).

Hunting after rotator cuff repair- modified, but still a blast!

While Greg’s accomplishment is in no way a “typical” postoperative experience for our patients, his return to daily living and preoperative activity level is our goal in every experience.

If you are experiencing shoulder pain, weakness or stiffness that is affecting your ability to live life and do the things you want, come see us! You can head over to our homepage at http://www.dredwinspencer.com and use the appointment request form at the bottom of the page.

We look forward to taking care of you!

The Shoulder and Elbow Center- Championship Treatment

The staff at the Shoulder and Elbow center are incredibly excited to share that one of our patients recently captured his SECOND B.A.S.S. Nation Kayak Series victory. Jim had a total shoulder arthroplasty with Dr. Spencer earlier this year, and his victory offers a unique opportunity to address returning to activity following shoulder surgery.

One of the most common reasons patients give that brought them to our clinic is an inability to do their daily activities and exercises, usually due to stiffness, weakness, pain or a combination of the three. When discussing surgical treatment, the majority of patients are primarily concerned with being able to return to their pre-operative activity level.

While there are certainly outliers, the vast majority of our patients are able to return to their pre-operative activity level, if not exceed it.

Return to activity following surgery depends on a multitude of factors:

Surgeries performed with the aim of REPAIRING a damaged structure typically require about 6 weeks of relative rest/immobilization in the form of a sling, followed by 6-8 weeks of strengthening and another couple months of easing back into full activity with no restrictions.

Surgeries performed to REPLACE a worn out structure will still require roughly 6 weeks of immobilization to allow the entry points for the arthroplasty to heal, but this is usually followed by more aggressive strengthening and a quicker return to activity.

Other factors such as soft tissue quality, osteoporosis, tear size, arthroplasty type and body morphology can all play a role in your return to activity. After advanced imaging is obtained, discussion regarding return to activity after surgery can be much more informative.

As always, each patient presents their own unique history, expectations and mindset that must be considered before planning a surgical procedure.

If you have any questions or want to be seen in our clinic, please submit a request from the bottom of our homepage and one of our staff will be in touch with you shortly to schedule an appointment.

Spreading the Love- Dr. Spencer Speaks at the Shoulder and Elbow Society Meeting

Dr. Spencer recently participated in an event for the American Shoulder and Elbow Society Foundation at the Musician’s Hall of Fame in Nashville, TN. The event served to raise awareness on the recent innovations in shoulder and elbow care.

In preparation for the event, our team assembled a video of some current and former patients who are continuing their high school athletic careers at the next level, along with some history on Tommy John surgery, a surgical video of a labral repair, anatomy of common sports injuries to the shoulder/elbow, and some patient testimonials. We have also included some pictures from the event. This video can be found at the top of this post.

We have also included some pictures from the event as well as a link to the American Shoulder and Elbow Society Foundation for further information.

As always, thank you for taking the time to keep up with our blog posts, and don’t hesitate to reach out with any questions!

RESEARCH UPDATE: Rotator Cuff Repairs and Steroid Injections

This post will serve to kick off a new blog series from the Shoulder and Elbow team at KOC highlighting the latest medical research topics related to our area of practice!

These posts will be housed at our new Research page on the website where we will also include summaries and highlights of our past, current and future research projects. Stay tuned, as the page is still under construction!

Rotator cuff pathology is an exceedingly frequent cause of shoulder pain and disfunction. Data from a recent article cites approximately 4.5 million physician visits related to rotator cuff pathology every year. Many patients experience temporary relief of their symptoms with corticosteroid injections, but there has yet to be sufficient data analyzing the potential effect of these injections on surgical success rates.

This article, published in 2019, utilized databases from 2 national insurance providers to analyze the association between corticosteroid injections and subsequent revision operations after a rotator cuff repair. The data revealed a positive correlation between both the number and timing of corticosteroid injections and the need for revision rotator cuff surgery. Essentially, more injections and getting injections closer to the time of surgery decreases the surgical success rate.

So what does this mean in practice?

Extrapolating this data to produce a meaningful philosophy in practice requires further analysis. While it may seem at first glance that this data suggests never receiving any steroid injections, medical decision-making always requires a risk-benefit analysis for any potential treatment.

For example, it is first worth noting that the revision rate for patients who never received a steroid injection was approximately 3.2%, while the revision rate for patients who had received an injection was approximately 4.7%. This is a noticeable and statistically significant difference, but some patients may feel that the slight increase in risk for a revision operation is worth being able to delay surgery for a few months.

Additionally, the study also noted an increase in revision rate that correlated with the total number of injections received. Patients who received one steroid injection were observed to have approximately a 4.0% revision rate, while this rate climbed to over 6.5% after a second injection. In this case, the risk-benefit analysis of a first injection is far more favorable than that of a subsequent injection, and this is where the medical decision-making may lean more heavily towards rotator cuff repair as opposed to continued corticosteroid injection if surgical repair seems to be the ultimate outcome. Additionally, the study noted a significant increase in revision rates in the first month after an injection, with this increase becoming far less significant with each subsequent month between the injection and treatment.

Taking all of this data into consideration offers a very unique perspective on the use of corticosteroid injections in our practice. While injections can be a fantastic tool to help manage pain and disfunction without the need for surgical intervention, it is important to ensure we are not trading a good long-term result for a short-term fix. New advances in medical research, like the data discussed in this post, allow our team to provide effective short-term treatment for our patients while maximizing long-term outcomes.

Hopefully, this post has helped offer some insight into one of the many ways Dr. Spencer utilizes the latest in medical research to offer the highest standard of evidence-based care. The article has been attached below as a PDF if you would like to read further.

Thanks for reading!

Glenohumeral Joint Arthritis- Putting Some Wear on the Tread

Arthritis is a painful, inflammatory condition that affects the slick, white cartilage on the ends of bones. As we age, the limited number of cartilage-producing cells declines, and the articular cartilage begins to wear thin. While non-operative treatments such as injections and NSAID’s can effectively treat the symptoms, the only curative treatment is a shoulder arthroplasty.

During this procedure, the physician will replace the arthritic humeral head with a metal ball and the arthritic glenoid with a plastic cup. For a video of this procedure, click this link.

As discussed on our Total Shoulder Arthroplasty page, the hardware used in these cases varies tremendously. Traditional long stem components have recently given way to short stem or completely stemless components like the one shown below from our Fort Sanders West clinic in Knoxville, TN.

Stemless Shoulder Arthroplasty

As you can see, the bright white “ball” at the end of the humerus (arm bone) does not have a stem extending down the shaft of the humerus. Instead, the component is press-fitted into the softer cancellous bone at the top of the bone. This allows the surgeon to place the component more precisely, as the stem no longer dictates where the prosthesis can be placed.

Also note the thin space between the metal head and the bony “cup” (glenoid). This space is actually filled with a special plastic infused with vitamin E, dramatically increasing the wear characteristics and prolonging the life of the implant. Dr. Spencer worked on the design team for this new cutting edge material, and the results have shown the plastic can last upwards of 20 years. The reason this shows up as clear on x rays is that it is considerably less dense than the surrounding bone.

When implanted correctly and precisely, a total shoulder arthroplasty can make a world of difference regarding pain and function. The procedure essentially replaces the raw, painful bone with painless metal and plastic, allowing most patients to progress through surgery with minimal narcotic use.

Let us know what you think below! We would love to hear your thoughts and field any questions you may have.

Pushing the Envelope- Dr. Spencer’s Twist on the Rotator Cuff Repair

As 2021 progresses, Dr. Spencer and the team at Knoxville Orthopedic Clinic have been hard at work seeing patients, fixing bodies and pushing the medical envelope to ensure our patients always receive the utmost care and cutting edge treatment. Over the last 10 years, Dr. Spencer has been developing a new technique to perform an arthroscopic biceps tenodesis in patients already undergoing an arthroscopic rotator cuff repair. This technique is unique in the fact that it requires no additional hardware to complete, utilizing the same sutures and anchors to tenodese the biceps as well as repair the rotator cuff tear. If you have had an ALL arthroscopic rotator cuff repair and biceps tenodesis, this is most likely the technique used in your surgery. Check out the video below for a more in depth explanation as well as a description and video of the surgical technique by Dr. Spencer. Thank you for letting us take part in your care, and, as always, God Bless!

When Life Comes Full Circle…

Dr. Spencer and the team at KOC are proud to welcome Robert Sleadd, PA-S, back to Knoxville! Rob spent 2 years working as Dr. Spencer’s research assistant before starting Physician Assistant school at Bethel University in Paris, TN. Rob has spent the last year and a half in the classroom and various clinics in middle and west Tennessee, and has come to join us over the next 5 weeks for an orthopedic clinical rotation. We’re thrilled to welcome back such on important member of our team, and Rob’s impact on our standard of care and research endeavors have continued even after he moved on to further his career goals. Stop by and see us, and give Rob a big shoutout!

With love,

Spence and the Team

Introducing the Latest and Greatest in Stemless Shoulder Replacements

Dr. Spencer has been hard at work with the folks at DJO Global, and we are incredibly excited to announce that the newest advancement in stemless shoulder arthroplasty, the CS EDGE system, is now being used. The updated design ensures better fixation while mitigating the amount of bone loss. See the video below for a 15 minute explanation and demonstration of the surgical techniques and considerations for this cutting-edge shoulder system. DJO was kind enough to provide professional videographers and video editing, so check it out!

Rotator Cuff Repairs- Different Strokes for Different Folks

Rotator cuff tears are very common. Rotator cuff repairs are the fifth most common surgery performed the United States. Most tears are degenerative and occur with greater frequency in patients over the age of 50. They can, however, occur from traumatic events such as falls or dislocations.

Most rotator cuff tears occur when the tendon or tendons pull away or avulses from the bony attachment at the greater tuberosity. The tear pattern can vary greatly from patient to patient. Most rotator cuff repairs are performed with anchors that are placed into the greater tuberosity. The sutures from those anchors are then passed through the rotator cuff tendons and tied down to the tuberosity bone. This provides very secure fixation. A demonstration of this typical rotator cuff repair can be seen at the bottom of our Rotator Cuff page, here.

The following is a video of an atypical rotator cuff tear where the rotator cuff tendon tore within its mid substance. These types of tears are less common and can be much more difficult to treat as we are not able to use anchors in this situation. However with arthroscopic techniques we are able to achieve a good repair with a very good clinical result.

A Note from Dr. Spencer on Instability

Posterior instability (instability where the shoulder dislocates or partially dislocates backwards) is not as common as anterior instability were the shoulder dislocates towards the front. Anterior instability is usually secondary to a traumatic event where is posterior instability is frequently associated with repetitive loading. Repetitive loading is common in sports- especially in football lineman.

As opposed to anterior instability, posterior instability is frequently associated with pain and can occur without a true labral tear. It is more commonly associated with laxity in the posterior capsule. In cases where Physical Therapy does not achieve stability, surgical reconstruction of the posterior capsule can be performed.

The following is a case of an arthroscopic posterior capsulorraphy. In this case the posterior capsule and inferior capsule are tightened to treat the laxity and restore stability to the shoulder. These arthroscopic techniques allow the capsule to be tightened with minimal disruption of the surrounding soft tissue envelope.