Frequently asked questions from new patients

Guest post by Stacie Ball, Receptionist

Patients who are seeing an orthopaedic surgeon for the first time often have a lot of questions about the process, insurance coverage, and more.

Here are some of the common questions we hear from new patients and some from existing patients.

How much will my insurance cover?

When you call to schedule an appointment, I’ll ask for your insurance information, including the insurance company, group number, and identification number. With that information, I can check your insurance coverage and confirm copay amount and whether a referral is needed. Most patients don’t require a referral to see Dr. Nolan, but some do.

How quickly can I get an appointment? Where can I get an appointment?

How quickly we can schedule an appointment varies due to several factors, but we’ll schedule your appointment as soon as possible. We have two office locations, one in Oklahoma City and one in Lawton, and some patients may choose an appointment time based on the location that’s most convenient for them. Other patients will want the first available appointment, which typically occurs in our Oklahoma City office. Your initial and follow-up visits can be done at either location. There are multiple options for hospitals where surgery can be done, if needed. Explore hospital options here.

What should I bring to my first appointment?

Be sure to bring your insurance card and any previous imaging of your shoulder or elbow, such as x-rays, MRIs, or CT scans. We have some new patient paperwork that needs to be filled out, so please arrive 20 to 30 minutes ahead of your appointment time to complete paperwork. You can also complete it online, or we can mail it to you prior to your appointment, if you prefer.

What will happen at the first appointment? How long will it take?

Your first appointment will include an exam by Dr. Nolan to assess your elbow or shoulder, including the level of pain, range of motion, and other details. X-rays may be taken in the office or Dr. Nolan may write orders for an MRI or other imaging tests.

After completing the exam, she will discuss treatment options, which may include surgery or non-surgical treatment based on your specific situation. The length of a new patient visit can vary based on the complexity of your issue, so please allow plenty of time for the appointment.

What do I need to know about pre-op or post-op instructions for surgery?

Your pre-op and post-op instructions for surgery will vary based on the specific surgical procedure and other factors. Dr. Nolan will discuss both pre-op and post-op instructions in detail when surgery is scheduled, and she will answer any questions you have. Most patients will need to complete pre-op blood work between three and 30 days prior to surgery, so be sure to factor that appointment in to your schedule when scheduling surgery.

If Dr. Nolan prescribes pain medication to treat my shoulder or elbow issue, how do I get refills?

While this is a question we hear from existing patients more often than new patients, it’s an important one to cover, especially for our patients in the Lawton clinic. Most pain medications are required by law to be submitted as a written prescription and can’t be refilled electronically or by phone or fax. If you expect to need a refill of your pain meds, be sure to plan ahead and contact us several days before you run out.

Have other questions about our new or existing patient processes? Call our office today, and I’ll be happy to help answer your questions.

Making the most of physical therapy

Guest post by Ken Caldwell, PT, DPT, CSCS

Many people strive to live an active, healthy lifestyle, but even minor injuries can get in the way of that goal. The good news is most people don’t have to live with a nagging injury that slows them down. Physical therapy is becoming more mainstream as a treatment option for minor injuries to help control pain and restore function.

Most patients start with visiting their family doctor or a specialist, and that doctor may then write them a prescription for physical therapy to address the issue. Some physical therapists treat a wide variety of patients, while others specialize in specific areas, such as pediatrics (children) or geriatrics (older adults). Talk to your doctor and explore your options for physical therapists in your area.

Here are some quick tips for first-time physical therapy patients.

Wear loose-fitting, comfortable clothing

Physical therapy involves movement, so you need to be able to move easily during a therapy session. If you’re coming straight from work, you may need to bring a change of clothes with you.

Be aware of your pain tolerance

Many people have some fear or anxiety about physical therapy being painful, and it certainly can be uncomfortable at times. Some patients may need to take pain medication prior to physical therapy to help lessen the discomfort. If your doctor recommends a prescription pain medication, which may cause sedation or impaired reaction time, be sure to have a driver to take you home. Physical therapy isn’t always painful, but it can be uncomfortable for some patients.

Bring a list of medications plus any meds you might need

While physical therapists do not prescribe medication, some medications can affect the therapy process, so it’s helpful to bring a current list of your prescription and over the counter medications. Also, if you have a medication you might need during physical therapy, be sure to bring that as well. For example, a patient with asthma should bring their inhaler to therapy sessions in case it’s needed.

Bring a copy of your x-rays or other diagnostic tests

If you’ve had x-rays or other scans, such as an MRI, done on the area of concern, bring a copy of those tests with you to your first physical therapy appointment. It may be beneficial for your physical therapist to see the tests and any physician notes related to the injury or area of concern.

Choose the best therapy time

Physical therapy requires both physical and mental energy from the patient. Some patients feel better in the morning, while others feel better in the evening. It’s important to schedule your physical therapy sessions during a time of day that’s best for you in terms of energy level and overall schedule.

Spotlight on Dr. Charles S. Neer

A native of Oklahoma, Dr. Charles S. Neer is commonly known as the father of modern shoulder surgery. Born in Vinita in 1917, he attended Dartmouth College and the University of Pennsylvania Medical School.

He began his residency on the fracture service at Presbyterian Hospital in New York City, and then interrupted his medical training to serve as a Captain in the U.S. Army serving tours in both Europe and Asia during World War II. After completing his service, he returned to finish his residency and also joined the faculty of the College of Physicians & Surgeons of Columbia University.

During his 50-year career at Columbia University and Columbia-Presbyterian Medical Center, he made countless contributions to the field of shoulder surgery.

A few of his career highlights include:

  • Served on the inaugural Committee for Shoulder and Elbow Surgery for the American Academy of Orthopaedic Surgeons.
  • Served as the Organizing Chairman of the Fourth International Congress on Surgery of the Shoulder in 1989.
  • Developed the first dedicated fellowship for shoulder and elbow surgery in 1976.
  • Founded the American Shoulder and Elbow Surgeons in 1982.
  • Served as Founding Chairman of the Board of Trustees for the Journal of Shoulder and Elbow Surgery.
  • Designed and performed the first modern total shoulder replacement.
  • Created the classification system for proximal humerus fractures.
  • Developed the acromioplasty procedure for impingement syndrome.
  • Served as visiting professor or lecturer at more than 40 colleges and universities in the U.S. and more than 20 international institutions.

When he retired, Dr. Neer returned home to Vinita but continued to serve as Emeritus Consultant in Orthopaedic Surgery and Emeritus Professor & Special Lecturer in Clinical Orthopaedic Surgery until he passed in 2011.

Each year, the American Shoulder and Elbow Surgeons names two Charles S. Neer Award recipients for outstanding clinical or research papers that contribute to the field of shoulder and elbow surgery. This award is the highest honor bestowed upon a shoulder and elbow researcher.

Dr. Neer’s outstanding contributions certainly make us proud to recognize this world-renowned Oklahoman.

Choosing the right physical therapist or clinic

Guest post by Ken Caldwell, PT, DPT, CSCS

Physical therapy can be used to reduce pain, restore function, and prevent disability in the shoulder, elbow, and many other parts of the body. Physical therapy can be prescribed in response to minor injuries or concerns, or it can be used following surgery to help restore function to a specific area.

Here are some tips for choosing the right physical therapist or clinic.

See your physician first

Oklahoma is a direct access state, which means a patient could choose to see a physical therapist directly rather than through a physician referral. However, most patients who seek physical therapy do so following a physician referral.

If you are experiencing pain or problems, the first step should be to see your doctor for an evaluation. They can discuss your symptoms, check range of motion, and order x-rays or other diagnostic tests. Then, if they feel you would benefit from physical therapy, they will write orders for physical therapy that you can take to the clinic of your choice.

Check credentials and licensure

While physical therapy may seem like a broad term, it’s a specific type of therapy performed only by trained and licensed physical therapists. Before you choose a therapist or clinic, be sure to ask about their credentials and training. You can also go to the Oklahoma Medical Board of Licensure and search by last name to confirm you will be seeing a licensed physical therapist.

When checking credentials, you may find a lot of letters after someone’s name. The abbreviation PT means physical therapist (although it’s also sometimes used by personal trainers), DPT indicates the person has a doctorate of physical therapy, and CSCS stands for certified strength and conditioning specialist. In general, more credentials after someone’s name indicate that they have additional schooling or expertise in the field.

Another option is to check and see if your therapist is a member of the American Physical Therapy Association, which is the credentialing society for physical therapists. You can use their Find a PT feature to locate members of the APTA by zip code. Membership in the professional society helps ensure the therapist you see is up to date with the most current research and techniques, although it’s not mandatory for a licensed physical therapist to be a member.

Visit a couple of clinics

When it comes to what clinic to use, the choice is yours. Some people choose a physical therapy clinic based on the recommendation of their doctor. Others choose a clinic based on how close it is to work or home, which can help with scheduling or situations where it’s uncomfortable to sit in a car or you’re unable to drive yourself to therapy.

Drop by the clinic and ask to look around and meet some of the therapists. It’s not a consultation specifically, but most clinics should be able to give you a quick tour of the facility and answer any questions you have about the process. Is the staff friendly? Does it feel comfortable? You may be going to physical therapy for several weeks or longer, so it’s important to find a clinic where you feel comfortable.

Verify your insurance coverage

The clinic you plan to use may request your name, date of birth, and insurance information to call and verify your insurance coverage in advance. This may include verifying the copay amount, what percent of each session is covered, and if there’s a limit on the number of sessions.

If your doctor writes an order for 12 physical therapy sessions but your insurance only allows 10, it’s helpful to know that up front. For people who have limited coverage for physical therapy, a therapist may be able to show you some exercises to do at home in between sessions.

Start physical therapy when cleared by your physician

In some cases, patients who are referred for therapy may start immediately. Patients who need physical therapy following surgery will typically need to be cleared by their surgeon prior to starting therapy. This is typically done at a post-operative appointment with your surgeon.

Where can I have my surgery?

Many patients have a favorite hospital. It may be their favorite because it’s close to home, their primary care physician works out of that hospital, or they’ve had a positive experience there in the past. Whatever the reason, many patients want to ensure their surgery can be done at their favorite hospital.

As an independent physician, Dr. Betsy Nolan has admitting privileges and can perform surgeries at multiple hospitals in the state of Oklahoma. While hospital choice for the patient is important, other factors may impact where your surgery takes place.

Some area hospitals have dedicated joint wards with specialized nurses and therapists who spend all of their time taking care of joint replacement patients. Specialized joint wards have a lower risk of infection since nurses are not also treating patients with major infections.

For some patients, the availability of other specialists impacts hospital choice. For example, a patient with a history of lung issues might be best treated at a hospital with a pulmonologist readily available.

Availability of certain implants can also affect hospital choice, as different hospitals may have contracts with different device companies. Most patients will select a hospital simply based on availability for when surgery best fits their schedule.

Dr. Betsy Nolan works with each patient to determine the best hospital location for their surgery. She performs surgeries at the following hospitals.

  • OU Medical Center Edmond, located at 1 South Bryant in Edmond. The specialized joint replacement ward has large rooms with pullout couches to accommodate family members or friends who wish to stay with the patient.
  • Southwest Medical Center, located at 5602 SW Lee Boulevard in Lawton. Dr. Nolan also offers clinic hours every other week in Lawton to see patients from southern Oklahoma and north Texas.
  • Surgery Center of Oklahoma, located at 9500 N. Broadway in Oklahoma City. SCO is an outpatient surgical facility that provides an upfront cost listed on their website for all procedures. Only outpatient procedures may be performed here, so patients must be healthy enough for a quick recovery. Patients who are having a procedure covered by most government insurance carriers (i.e., Medicare, Tricare) are not eligible to have their procedure done at SCO.
  • Mercy Hospital, located at 4300 W. Memorial Road in Oklahoma City. Dr. Nolan does not perform many surgeries at Mercy, but it is an option for patients who live in the area or whose primary care doctors are based at Mercy.
  • Mercy Edmond I-35, located at 2017 W. I-35 Frontage Road, is a nice, efficient, newer facility for outpatient procedures only. This facility does not do any joint replacement procedures. Patients using Tricare are not eligible to use this facility.
  • AllianceHealth Midwest, located at 2825 Parklawn Drive in Midwest City. Dr. Nolan does not perform many surgeries at this location either, but it is an option for Midwest City patients or those who prefer this hospital.

Dr. Nolan no longer goes to the VA hospital. However, she is happy to see VA patients at her clinic in Midtown or at the new Lawton location and can perform surgeries for them at one of the hospitals listed above. VA patients may continue to go to the VA for their other benefits, such as physical or occupational therapy, and use the outpatient pharmacy there.

Preparing for surgery: pre-op blood work

It’s important to be as healthy as possible at the time of surgery, which is why a pre-operative appointment for blood work is a standard practice. Some blood tests prior to surgery are routine for all patients, while others may only be done if the patient has a history of certain medical conditions.

Your surgeon will go over your medical history with you during your appointment, but you may also need to see an anesthesiologist at the hospital’s pre-op clinic prior to surgery. Your pre-op blood work is most commonly done at this time, typically a few days to a week before surgery. At that time, you should also receive any special instructions about stopping certain medications, which medications to take on the day of surgery, any special skin prep solution to use, and not eating or drinking prior to surgery.

Here’s an overview of the most common pre-op tests we order.

Complete Blood Count (CBC) Panel

A CBC panel is done for all scheduled, non-emergency surgeries and checks four main components.

  • White blood cells, which are your infection-fighting cells. If the count is high, that typically means there’s an infection in your body somewhere. That could mean a urinary tract infection, skin infection, or abscessed tooth, for example. Sometimes the patient isn’t even aware of the infection. If there is an infection, you’ll be treated with antibiotics to clear up the infection prior to surgery.
  • Hemoglobin and hematocrit are two separate measures of your red blood cells. Hemoglobin carries oxygen to your tissues, which is important for healing, so it’s important to have a normal level prior to surgery. Hematocrit measures the volume of red blood cells compared to total blood volume. Low hemoglobin and hematocrit typically means a patient has anemia, often due to an iron deficiency. Some blood loss occurs in any surgery, so it’s important for a patient to start with adequate blood levels. If your pre-op blood work shows anemia, you may be prescribed iron pills or other medications to help increase red blood cells before surgery.
  • Platelets are important for clotting. Any wound, including a surgical incision, needs adequate platelets to form a clot and heal the wound. If platelets are too low, a platelet transfusion can be done to increase the level prior to surgery to ensure appropriate clotting. Sometimes high platelets can be another sign of infection somewhere in the body, and low platelets often indicate liver problems, such as hepatitis or cirrhosis.

Complete Metabolic Panel (CMP)

Also known as a “chemistry” or “chem panel,” the CMP includes what most people think of as electrolytes, including sodium, potassium, calcium, and many others. These different electrolytes have different roles in the body, and an imbalance can indicate that something is going on somewhere in the body. If an electrolyte is too low, it can usually be replaced. If it’s too high, an electrolyte with an opposing function is often given to help balance the body.

Coagulation Labs

Coagulation labs include PT and PTT/INR and measure your body’s ability to stop bleeding. These make sure you don’t have an unusually high bleeding tendency. If you take blood thinners for another medical condition, it’s important to discuss that with your doctor well in advance of your surgery. Common blood thinners include Coumadin, Warfarin, Eliquis, Pradaxa, and Xarelto. It’s generally recommended to stop taking blood thinners prior to surgery, but the specific type of medication and the condition it’s treating will impact how long before surgery you’re asked to stop taking it.

Urinalysis

A urinalysis is another test used to look at possible infection, as you do not want to undergo surgery with an infection present. If an infection is already present in your body, that bacteria will travel to the surgical site as well.

Hemoglobin A1C

This test measures glucose levels over the past several weeks and helps determine whether a person’s diabetes is well controlled. Typically, A1C should be lower than 8 prior to a scheduled surgery. Uncontrolled diabetes can increase the risk of infection and complicate the wound healing process. It’s not unusual in pre-op blood work to identify someone who is diabetic and didn’t know it. If the A1C is too high, a patient will be referred back to their primary care physician to help control the diabetes before surgery.

Chest X-Ray

Many hospitals require a chest x-ray prior to surgery to scan for public health issues like tuberculosis (TB). In older patients, the chest x-ray can also be used to show possible pneumonia, collapsed air sacs in the lungs, an enlarged heart, or hardening of the arteries, all of which can increase anesthetic risk.

EKG

An EKG, or electrocardiogram, measures the electrical activity of your heart. It’s typically done for patients over the age of 35 unless younger patients have a cardiac history or another reason to require an EKG. The test can help ensure there are no underlying cardiac issues, such as an abnormal heart rhythm or a prior heart attack the patient didn’t know about. If the EKG shows anything of concern, the patient may be referred back to their primary care physician and/or a cardiologist prior to surgery.

If you have questions about the pre-op process or want to discuss whether an existing medical condition affects your ability to have surgery, contact the Oklahoma Shoulder Center today for a consultation appointment.

Stemless implants for shoulder replacement

There’s a new option in the world of shoulder replacement implants. While stemless implants have been available in Europe for about ten years, that technology has finally made its way to the US. New implants take many years to get to market due to the testing required as part of the FDA testing process. Now that the implants are fully approved, they will soon be widely available.

In a typical shoulder replacement, the implant has a stem that extends down the center of the humerus (upper arm bone), which is hollow. That stem is adhered to the bone to help hold the replacement joint in place.

For many years, a cap or resurfacing device has been available for certain uses, but the caps were not well fixed to the bone. Thus, they could become loose over time and eventually need to be replaced with a traditional stemmed implant.

The new stemless implants do include fixation but without the stem reaching down the bone. The traditional stemmed implants will still be used for most shoulder replacements, but the stemless implants offer a new option for specific situations where they might offer an advantage over the traditional stemmed implant.

Potential need for future revisions

One of the biggest anticipated benefits of stemless implants is for younger patients who need a shoulder replacement because of the increased risk that they may need a revision surgery in the future. For patients under the age of 50 who undergo a shoulder replacement, it’s more likely that the implanted device won’t last their lifetime than in patients who are 65 or better at the time of the first replacement surgery.

Removing traditional stemmed implants can be a challenge and may result in fractures to the bone. The younger a patient is at the time of shoulder replacement, the more likely they will need a revision later, and stemless implants make revisions much easier if one is needed.

Past injury or fracture of the humerus

When patients have previously injured their humerus, it can create a deformity in the top of the bone and cause difficulty with placing a stemmed implant. Since stemless implants don’t reach as far into the humerus bone, it may be an option for patients with a prior fracture or other injury affecting the humerus.

Prior joint replacements

Some patients, for example patients with rheumatoid arthritis, may eventually need both a shoulder and elbow replacement. If both implants involve a stem, there is an area in the middle that is at high risk of fracture, so patients with a prior elbow replacement would be good candidates for a stemless shoulder replacement as well.

Is the new stemless implant right for you? It depends on your specific situation and the quality of your bone, as good bone quality is necessary to support the fixation of the stemless implant. Patients with significant osteoporosis or bone loss are not good candidates for these new implants and will generally be better served by a traditional stemmed implant. The stemless implant won’t replace traditional stemmed options, but rather it offers another option for use in specific situations. The surgical approach, recovery, and rehab are all similar to shoulder replacements using traditional stemmed implants.

If you need a shoulder replacement and fit any of the categories above, contact the Oklahoma Shoulder Center today to see if a stemless implant is right for you.

Five questions to ask when choosing a shoulder or elbow surgeon

When it comes time for any surgical treatment, it’s important to find the right doctor for you. In fact, it’s important for non-surgical treatment as well. Every patient should seek out a qualified physician who makes them feel comfortable. Here are a few things to consider when choosing a shoulder or elbow surgeon.

What specialized training do they have?

In the field of orthopaedic surgery, some physicians are generalists and some are specialists. Even among specialists, their training and experience will vary significantly, as there are no specific guidelines around what experience is required for a surgeon to advertise as a specialist.

Physicians who complete a shoulder and elbow fellowship undergo an additional year of training exclusively dedicated to shoulders and elbows, including open and arthroscopic procedures and joint replacement procedures. There are a limited number of fellowship positions available for this ultra-competitive specialty. For a list of ASES (American Shoulder and Elbow Surgeons) endorsed fellowships, please visit http://www.ases-assn.org/?p=physic-fellowships.

Are they an ASES member?

The most qualified shoulder and elbow surgeons will be those who are members of the American Shoulder and Elbow Surgeons (ASES). New members in the organization must be sponsored by two current members and must meet specific requirements, such as completing a recognized shoulder and elbow fellowship, publishing articles in relevant medical journals, presenting at conferences, and other factors that demonstrate the physician’s contributions to the field of shoulder and elbow surgery. You can search the ASES website to find a member in your area. Dr. Nolan is the only surgeon in Oklahoma to be recognized as a member of this elite group.

How many shoulder or elbow surgeries do they perform each year?

There’s research that shows that surgeons who perform a high volume of shoulder replacements each year have a lower rate of complications than surgeons who perform fewer shoulder replacements. A surgeon whose practice is focused mostly on shoulder and elbow surgery will generally perform a higher number of these types of surgeries per year and thus have more experience with the procedures. Also, they generally work with highly specialized staff who have a great deal of experience with these types of procedures.

Do you feel comfortable when meeting with them? Do you feel like they listen?

When meeting with a surgeon to talk about your concerns and questions related to your current issue or upcoming surgery, it’s critically important that you feel comfortable with them. If you’re not comfortable with your doctor, you may be less likely to keep follow-up appointments or even follow their treatment plan. Make sure to find a doctor with whom you feel you can ask all of your questions and who takes the time to address them.

Following your surgery, will you see the surgeon or will post-op care be handled solely by their staff? Are you comfortable with their approach?

Some surgeons choose to use a physician assistant (PA) as part of their patient care team, which could mean that you see a PA for part or all of your post-surgical care. While a PA is a valuable part of the surgical team, it’s important that your surgeon be directly engaged with you both before and after your surgery. If you consult with a surgeon who barely shows up to meet you before surgery and won’t be involved in your post-op care, you might be more comfortable looking for another doctor.

If you are seeking a qualified specialist for shoulder or elbow surgery or want a second opinion, contact the Oklahoma Shoulder Center today to schedule an appointment.

Three types of arthritis that impact the shoulder and elbow

Arthritis is a group of diseases that can cause swelling, pain, stiffness, and decreased range of motion in the joints. It’s the leading cause of disability in the United States, and it can affect people of all ages. Symptoms range from mild to severe and may come and go in some patients. There are many different types of arthritis, but there are three primary categories that impact the shoulder and elbow.

Osteoarthritis

Most of the time when people say arthritis, they mean osteoarthritis. It’s the normal wear and tear type of arthritis that typically affects older adults, although younger people can also have osteoarthritis. It’s a slow process that develops over years, and once it starts, it can’t be reversed.

Many people with osteoarthritis have a strong genetic predisposition. It’s not directly genetic, but it does tend to run in families. This type of arthritis primarily affects the large joints, like the hips, knees, and shoulders. Osteoarthritis of the elbow is not very common, whereas osteoarthritis of the shoulder is.

Osteoarthritis can affect multiple joints at one time. Typically, treatment begins with non-operative approaches to try and preserve the joint as long as possible. That may include cortisone injections, physical therapy, activity modification, use of assistive devices, or anti-inflammatories.

For osteoarthritis of the shoulder, steroid injections can often be effective for a while to decrease the pain and allow for continued function. In other joints, such as the knee, a viscosupplementation to inject lubricating fluid into the joint may be used, but that treatment is not FDA approved for shoulders and research hasn’t shown it to be effective for shoulders.

As arthritis progresses, an individual may be unable to complete normal daily activities or may be in so much pain that narcotic pain medications are required. At that point, when non-operative treatment is no longer giving sufficient relief, it may be time to talk to your doctor about surgical options, including joint replacement. More than 50,000 shoulder replacements are done each year in the US.

Inflammatory arthritis

There are many types of autoimmune and inflammatory arthritis, including rheumatoid and psoriatic arthritis. In this type of arthritis, the body is attacking its own cells, which causes inflammation, pain, and stiffness. Rheumatoid arthritis (the most common type of inflammatory arthritis) typically attacks the smaller joints, such as the hands and elbow. Shoulders are less commonly impacted by rheumatoid arthritis, although it is possible.

In treating inflammatory arthritis, the goal is to preserve the joints as long as possible, since this type of arthritis can affect patients at a much younger age. Most patients in this category see a rheumatologist for primary treatment with medication. Newer medications developed in the past 10 to 15 years work very well for controlling the disease and helping prevent the need for joint replacement. However, if a patient does have advanced joint destruction from inflammatory arthritis, the treatment options are usually the same as those mentioned above for osteoarthritis.

Post-traumatic arthritis

This type of arthritis is much less common, but it occurs when a fracture line extends into the joint following some sort of trauma, such as a car accident or fall. This results in incongruity of the joint line, which means the surface is uneven and does not glide smoothly against the other side of the joint. Over time, this leads to damage to the cartilage lining on both sides of the joint, and these joints develop end-stage arthritis.

Frequently, this type of arthritis is not very responsive to the conservative managements listed above in the osteoarthritis section, and patients may need surgery for definitive treatment. Also, deformities (abnormal shape of the bone) and/or bone loss from the injury can affect the surgical options, including type of implant, in these patients.

Not long ago, the most common reason for an elbow replacement was rheumatoid arthritis. Due to advancements in the medical management of rheumatoid arthritis, including medications called DMARDs (disease-modifying antirheumatic drugs), post-traumatic arthritis has become the leading reason for elbow replacements.

If you are experiencing shoulder or elbow pain and stiffness and suspect arthritis may be the cause, contact the Oklahoma Shoulder Center today to schedule an appointment.

What is impingement syndrome?

The word “impingement” covers a wide range of scenarios where something is pushing or causing pressure on another thing. In the shoulder, impingement most often refers to subacromial impingement, which affects the rotator cuff tendons beneath the acromion bone.

Impingement can cause persistent pain and affect daily activities. Symptoms are similar to rotator cuff tears, including pain when lifting the arm out to the side or overhead. That can include activities like reaching for a box of tissues behind the seat in the car, drying your hair, or reaching to get a plate out of an overhead cabinet. Impingement usually doesn’t result in weakness like a tear, but movement could be inhibited by pain.

Bone spurs in this area can also create pressure on the tendons and can eventually lead to rotator cuff tears. The shape of the acromion bone can be flat, curved, or hooked. People with more curvature in their acromion have a higher risk of rotator cuff tears as the acromion causes more wear on the rotator cuff over time.

That space around the rotator cuff tendons is relatively narrow, so any amount of inflammation in the shoulder can create pressure on the tendons and cause impingement, even in those individuals with a flat acromion. Sometimes the pain can radiate over the deltoid, but impingement pain usually stops above the elbow. If pain continues below the elbow and down into the hand, the problem likely originates in the neck rather than the shoulder area.

Impingement is usually treated with physical therapy, including specific exercises to strengthen the rotator cuff and scapular stabilizing muscles. For patients whose schedules or travel don’t allow for regular physical therapy appointments, many of the exercises can be done on your own using resistance bands, which can be rolled up and packed in a bag or suitcase.

Another treatment option is a steroid injection, which is a powerful anti-inflammatory that can help reduce swelling and pressure in the area. The steroid can take a few days to take effect, so the injection is typically done along with a local anesthetic that helps reduce the pain until the steroid can reduce the swelling.

Most of the time, surgery isn’t necessary for impingement alone. However, some patients with large bone spurs or those who don’t improve with non-operative treatments like physical therapy, injections, and anti-inflammatory medications may undergo an outpatient arthroscopic surgery. Through several small incisions, the surgeon can flatten the acromion bone, shave off bone spurs, and clean out the thickened bursa to relieve pressure and allow more room for the tendons.

If you are experiencing shoulder pain that affects your daily activity, contact the Oklahoma Shoulder Center today to schedule an appointment.