This article is a transcribed edited summary of a video Bob and Brad recorded in November of 2020. For the original video go to https://www.youtube.com/watch?v=FP4gka-BQ0o
Bob: Today, we’re going to talk about the seven most important questions to ask your shoulder surgeon. We actually have more than seven, but we have kind of seven categories of questions. Let’s start right into them. In any surgery that you have, has to be taken very seriously. You want to give it much consideration.
Brad: And I think this is really important, I can’t tell you how many times I’ve had patients or myself go to the doctor, and you leave, and you say, “I forgot to ask him that question. It was a really important question.” It could give other feedback that would be helpful for the therapist or for you and your family.
Bob: If you’re watching this program, if you go to Bob and Brad, our website, and go to the program section, find the shoulder program and look for this video. There is a printout that you can actually do that has all these questions listed for you.
Brad: Yeah, which is really nice. You can just highlight the ones that you want to ask your surgeon and just carry this with you to the doctor.
Bob: Right, and make sure they answer all your questions. Let’s start off with the first one. Now this isn’t self-promotional here, but can you try physical therapy first? That’s really the first question you should ask.
Brad: Right, it is.
Bob: Yes, if you can avoid surgery obviously you want to avoid surgery.
Brad: Some surgeons, that’s what they do. They will skip the physical therapy option, unless you ask for it. Then they’ll say, “Oh sure, we’ll give it a try.” So don’t be shy about it.
Bob: This second one kind of ties into that. You’d ask, “What is the risk to not performing surgery now? What would happen if you waited six months or a year?” Because in some cases, let’s say, the tendon was actually ripped away from the bone. Maybe the muscle is going atrophy so much, it’s not going to heal. That’s why we’re going to ask the surgeon. Can I wait at all? If you have an impingement and it’s the shoulder tear going to actually get worse, if you wait? These are all things to keep in mind. This is a good question also for people who are under the age of 30 who are considering surgery due to shoulder dislocation. Quite often when you’re younger than 30 and you have shoulder dislocations, they want to do surgery because it’s most likely to happen again. They don’t want to have you experience the damage that occurs with dislocations.
Brad: Sure, right, that unstable joint.
Bob: Yeah, I always hate to tell people that but if you’re younger than 30 and your shoulder has been popping out quite often, my recommendation is you have the surgery.
Brad: Get it tightened up and be done with it.
Bob: So, number three kind of ties into all the other ones. What are the alternatives to shoulder surgery? So besides physical therapy, there’s injection, taking anti-inflammatories. Sometimes just the education. Sometimes you need to avoid it. Let’s say, you’re an older person, has shoulder dislocations, don’t be doing stuff like grabbing back or grabbing behind the seat.
Brad: Like, when you’re driving, you need your bag and then, "ahhh", that can really cause pain sometimes.
Bob: You want to avoid shoulder dislocations, bring in the arm back beyond this plain.
Brad: That’s where it can really get unstable and cause some pain when it pops out.
Bob: Number four is a general question. Then there’s some sub-questions here.
Bob: It’s basically about the length of recovery off from the surgery. How many days will you be in the hospital after surgery? The norm seems like now, it’s in and out, right?
Brad: Right. Same day. Maybe one night for observation depending on the person’s other medical conditions if they have any.
Bob: I just want to state this. So, the first time I worked in a hospital as a physical therapy student, the first four patients I had, had rotator cuff surgery. They were all men, and they were all, I hate to say it, but they were all the biggest babies I’ve even seen. They were having so much pain. Maybe I’m just being judgmental after I found out how bad it is after. But I had some women after that and they acted like they didn’t have surgery.
Brad: They typically are tougher.
Bob: They are tougher. Alright, some sub-questions here. Will you need full time or part time care? You might. You can’t, if you’re down to one arm, you have to plan ahead and know this.
Brad: Sometimes after surgery, your arm is going to be completely immobilized for so many days where you can’t move it. Other times it’s going to be in a sling when there is some mobilization.
Bob: Yeah, and that’s the next question, Brad. How long will you be in a sling? Maybe 4-6 weeks. Your restrictions may be continual for up to six months. Again, your family has to plan from a functional and from a mental standpoint.
Brad: Right, or can you work? If you have a job, you have to have that arm, it’s a disability. If you’re going to have some kind of insurance so you have coverage financially during that time, if it’s available.
Bob: Absolutely. Ask the surgeon. When can you expect the shoulder to be pain-free? When can you lay on the operative side? When can you drive? Somebody could be driving around for a long time. When can you return to work? When can you return to sporting activities, if that’s your thing right now. And how soon can you resume housework and gardening and so on? That one for me, if I can’t ever get back to it, okay!
Brad: Yeah, no housework, no gardening. Let’s go. Maybe you can emphasize that to the doctor.
Bob: That’s right. Give me a note. Number five, okay, we’re back to the main questions now. This is kind of determining the competence of your surgeon and you shouldn’t be afraid to find this information out. You don’t want to ask the surgeon, maybe ask his nurse. Or get the information from the hospital. How many procedures do you perform every year? How many surgeries of this type have you done? Not surprisingly, they found out that the more times a person does a surgery, the better they are at it. Not shocking there.
Brad: Right, it’s a pretty basic thing and practice makes perfect sort of thing.
Bob: If they’re a general surgeon and they rarely do this surgery, I’m sorry, I’d go find someone else that’s done 100 of these last year.
Brad: There’s one thing, I have a friend who was going to get the ankle surgery and he said, “Oh, I want to go to Rochester, go to Mayo and have the guy who does all the athletic, the top people.” And I’m sorry, he was not an athlete. He just wanted to walk. So, I don’t now if that’s the best fit because he’s working with athletes. There may be a difference in treatment afterwards.
Bob: I understand completely.
Brad: All that, people need to understand that.
Bob: Just because they’re the best at treating athletes, doesn’t mean it’s good for you who are not an athlete.
Brad: If you’re a standard person, like us.
Bob: Right. Number six, what are the risks of complications? And what is your complication rate? Again, you don’t necessarily have to ask the surgeon, but you want to find this out. I remember this was a different doctor, he was a radiologist, but they do the test where they stick the catheter up through your femoral artery.
Brad: Right, up into the heart.
Bob: There’s actually generally a high percentage of problems with that. And at the time I’m just throwing a number out there, I don’t remember what it was. It was like 5% of people have problems. And he was one that would be like less than 1%. He’s like, I am meticulous at everything I do. So that’s the kind of person you want. It’s funny how I had a test done and I could just tell by meeting the guy, he was one of those guys that was really particular. I’m like, good, he’s, my guy. Alright, number seven, the final question. If you’re going to have a shoulder joint replacement surgery, you should ask these specific questions. Brad, do you want to throw one out there?
Brad: What is the implant made of?
Bob: Yeah, you want to know if you’re going to set off metal detectors in the airport.
Brad: You know it’s amazing because there’s the plastic component, there’s the metal, there’s ceramic. I’m trying to think of some of the other things they use.
Bob: I don’t know how long shoulders are suppose to last. I know knees are like 15-20 years.
Brad: Yeah, and they get better. I’m not sure of shoulders because really shoulder replacements have just really gotten popular in the last 5-10 years, I think.
Bob: When you think about it, a shoulder there’s not as much stress on it as a knee.
Brad: Yeah, the weight bearing.
Bob: No weight bearing. So, I don’t know with shoulder replacements, we have to find this out, we don’t know. And that’s one of the questions. How long will your shoulder replacement last? Number 3, Brad, what’s that?
Brad: What can you do to make the new joint last as long as possible?
Bob: What do you want to do? What you want to avoid. The Do’s and don’ts.
Brad: There’s different types of replacements. There’s the reverse in placement. So, that’ll all be informed. They’ll probably give you some literature to read on your own as well.
Bob: The last one ties right into that. What activities or factors could make your joint replacement wear out more quickly? So, you want to avoid these things obviously. That’s it. If you just happened to stumble upon this video, this video is a part of a series of videos on shoulder pain and rehab. Just go to bobandbrad.com and go to the program section and you’ll see all these different programs we have. We have one on shoulders. There’s a printout with each one as well. This one will have all these questions. You don’t have to write them down.
Brad: Okay, take care.
Bob: Thank you so much.
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