My friend Stewart retired from his corporate attorney job after almost 40 years, eager to fill his leisure with travel, golf, and his lifelong love of skiing. Schussing down the mountain one day in the crisp cool air, he was hit from behind by a snowboarder who gave little more than a backward glance. Stewart, 66, suffered a fractured shoulder along with bumps, bruises, and a concussion.
After his bones mended, his doctor recommended a reverse shoulder replacement, a procedure that I am also facing in two days as I write this article. Sharing my experience with my sixtyandme readers might resonate with those facing a similar situation.
I no longer ski, though I loved it once. Standing at the top of a mountain opened up a world of possibilities. However, years of pushing stretchers as a nurse, lifting patients, and supporting women through labor did a job on my shoulders, especially my right one. I have overworked and re-injured it several times by lifting heavy pieces of luggage, children, and moving furniture because I didn’t want to wait for help.
Living with rheumatoid arthritis, osteoporosis, and even hobbies like knitting and yin yoga have done additional damage. In short, my joints have been used and abused and now I have added severe osteoarthritis in my right shoulder to my diagnosis list, with multiple tears throughout the structures supporting the joint.
Therapies First
I’ve tried many treatments in my shoulder – injections of corticosteroids, hyaluronic acid, and multiple courses of physical therapy among them. Most helped considerably and kept my shoulder healthy enough to do my everyday tasks but over time, the pain worsened. I worked with a rehabilitation physician who tried an experimental procedure that failed me. I took oral steroids, rested it, and exercised as instructed by a licensed physical therapist.
All of these procedures strengthened some of the structures, delaying the inevitable, and enabled me to cope with the damage in my dominant arm until surgery remained the only option.
My physical therapy team touted the quick recovery of their patients who get reverse shoulder replacement and undergo rehab. They play tennis and golf again, for example. In the past, my team gave me exercises to increase weight tolerance and flexibility, but my last round of physical therapy consisted mostly of massage.
“Your joint is shot,” the lead PT told me.
I delayed longer than I should have as I did not want surgery. I didn’t want any part of anesthesia, a hospital stay, or the months of rehab that follow. My rheumatologist listed my options, which included everything I had done already.
“I’d rather see you do surgery now, than wait until you’re in your 70s,” he mused.
Selecting a Surgeon
Insurance companies like to tell us what pool of doctors we can choose from. There are great surgeons among them but that does not mean I did not do extra credit homework on the subject. I asked a doctor that I trusted for a referral. He recommended a particular surgeon with a stellar reputation who treated athletes with complicated shoulder injuries. Though I have never been accused of being an athlete, my injuries fell into a similar category of impairment. I read all the physican’s reviews and board certifications, reinforcing my confidence. He worked at a hospital two hours away.
I then researched the hospital, and was pleased to see it had an A rating, the top tier for institutions and a five-star rating from Medicare. A hospital with a lower rating may have an excellent surgical department as well so it’s important to delve more into the specific data that is used for ratings. For example, I recently had a minor surgery in another hospital that is rated C, but the surgical department itself is highly rated.
Procedures First
My surgeon required an MRI prior to my appointment though it is my understanding not all do. I’ve had MRIs before, in other regions of my body, and the shoulder was the easiest for me. The technician worked with my limited range of motion and pain tolerance to position the arm with care and the scan itself moved quickly. My best friend says she falls asleep during an MRI, a skill I’ve never mastered.
To endure the clackety clack and machine gun sounds of the machine, I repeat a soothing mantra to myself during each phase of the scan. I use three words, my children’s names, and that gets me through without added anxiety. Many people do need sedation prior to having an MRI. The test is important, so do what you need to get through it.
Surgeon’s Office Visit
My surgeon operates from a full-service satellite facility of the hospital. His physician’s assistant, who also comes to the operating room, performed a complete history and physical on me, reviewing my records. I had to get specific clearances from my rheumatologist and cardiologist as well. Because I am in a clinical trial for rheumatoid arthritis, my implanted device had to be turned off prior to surgery.
The surgeon spent ample time with my husband and me, answering our myriads of questions. He reviewed my MRI results and explained the procedure in detail. I had more X-rays taken of the shoulder, and, though he does 250 of these procedures a year, care was shown through his team’s patience and understanding of my situation.
The Procedure
A reverse shoulder replacement does not mean they put your shoulder on backwards, as my youngest brother jokes. In short, it means instead of the ball of the humerus (the upper arm bone) pointing upwards, it is removed and a prosthesis ball is seated in a man-made socket at the top of the humerus, upside down, its attachment at the joint. That gives a torn rotator cuff, whose job it is to support and control the arm, a way to retire. I appreciated this reenactment video which gave many great details that I was unaware of. It’s possible to access the full surgery on YouTube, but warning: it is graphic.
Preoperative Preparation
My hospital has an additional service to assure that the medical record is complete. A nurse reviewed all the instructions and a hospitalist did a quick exam. Fresh lab work and cervical spine X-rays were done to ensure that I am healthy and strong enough for any intervention. For the 48 hours before the surgery, I must wash the shoulder area each morning using two different kinds of antibacterial soaps in order to prevent an infection in the operative site. We have normal bacteria that lives on the skin that typically is helpful to us, as long as it stays on the outside. This pre-surgical scrub reduces the amount of those bacteria.
As with any surgery, I will be fasting and arrive at the hospital well in advance of the operative time. The anesthesiologist will place a regional block in my shoulder giving me relief from post-operative pain for the first 24 hours or more. I will have anti-inflammatories and narcotics if needed as the block wears off. I will stay overnight in the hospital but it’s an option. The plan is to go home the next morning with my arm in a sling for six weeks or so.
Infrastructure
It’s important to be prepared at home for the immediate post-operative period. I ordered a particular sling that my doctor recommends, and I expect I will wake up from surgery with it in place. My insurance covered this piece of durable medical equipment. There are other recommendations that I received both from medical advice as well as Stewart’s first-hand (one-handed?) experience. By the way, he is doing well. He can lift a full glass to his mouth and drive again. He expects to be golfing by fall, a mere six months after his surgery, having worked hard in rehab to regain strength and function.
It is recommended to use a recliner for sleep because the shoulder needs elevation which is harder to achieve by sleeping flat. We moved our existing recliner to the bedroom and that’s where I will start my home recovery. It is a short walk to the bathroom with no throw rugs in the way. The last thing I want to do is fall with my shoulder immobilized.
I invested in reliable footwear in the last several years, to increase my chances of staying upright after a series of falls. I purchased an inexpensive shoulder exerciser, a pulley that fits over my closet door, and have hand weights and other equipment that I’ve collected through the years. A responsible physical therapist will show you ways to do the same exercises with existing products in your home, like filled water bottles or dish towels so you don’t have to spend money on such equipment.
In addition, I have a machine to circulate ice water over my joint after surgery to keep inflammation at bay in the initial days. These machines are expensive and considered optional, but I was able to borrow one. Ice packs would work too. My wedge pillow will be helpful once I’m able to sleep in my bed again. An item that is recommended, though not covered by insurance, is amino acid replacement, the powder that dissolves in a beverage to help re-build muscle and enhance healing. I invested in this option after checking with my internist to make sure the ingredients won’t affect my kidneys or liver function.
My daughter is coming to help with my grandchild in tow for entertainment. I’m fortunate to have a husband who is healthy and strong as well. Pool your resources, especially if you are alone. Consider the feasibility of bringing in a home health aide to assist in personal care. If you are active in a church or other community group, put the word out. If friends offer, take them up on it for meals or rides to physical therapy or doing your laundry. If only I had someone who would keep my cat from climbing onto my sling!
What Comes Next?
I made an appointment for a physical therapy evaluation two weeks after my surgery. When I write Part II of this experience next month, I will have been through the surgery, the immediate postoperative period, and started active rehabilitation. I understand it will entail a great deal of time over the summer and well into the fall.
What I’ve learned in the past is physical therapy, when performed as instructed, works. I am dedicated to the follow through and reaping the benefits of using my arm to its full capacity again. With a reverse shoulder replacement, I may not have the ability to reach straight overhead or behind my back, but regaining adequate function and sleeping without pain will be worth the effort.
Let’s Have a Conversation:
I hope you don’t have to have joint replacement, but if you or someone you know does, Part II of my journey may be of interest to you next month. Please comment below and let me know if you are going through something similar. Have you any tips on the rehab process not listed above? I’d love to hear from you.
