Can I go hunting after a shoulder replacement?

When working with patients who need a total shoulder replacement or reverse shoulder replacement, many patients ask if they will be able to hunt following their surgery. Other patients ask about returning to golf or other physically active hobbies. Still others have more questions about their ability to continue in a job that requires physical labor. Not many patients ask us whether they can return to riding a motorcycle, although we have an answer for that as well.

So what activities can you do (and not do) after a shoulder replacement?

When it comes to hunting, we advise patients to proceed with caution following their surgery but that they can still hunt. Certain types of guns can have a pretty decent kick, and the shoulder takes most of that impact. At this point in time, there’s no specific research to measure how that impact affects a replacement shoulder joint over time though. Dr. Nolan hopes to do a future study on the impact of hunting on shoulder replacement to fill that research gap, but for now, we simply don’t know what the impact is.

In the absence of research showing negative impact on shoulder implants, there’s no specific reason to avoid hunting once fully healed from surgery. Dr. Nolan has seen many patients who returned to hunting following their shoulder surgery, and these patients have not developed any implant-related issues over time.

Potential risk doesn’t just come from shotguns, as some handguns still kick and create pressure on the shoulder. Yet some professions, such as police officers, must regularly pass shooting qualifications and meet certain physical standards to continue in their job.

Other jobs that could be impacted by a shoulder replacement include those that require heavy lifting, especially overhead lifting. Some patients with physically demanding jobs choose to take a non-operative treatment approach to manage shoulder pain until they reach retirement age and can pursue replacement. Others who can’t avoid shoulder replacement any longer may need to change positions or request accommodations following surgery.

For golfers, there are no restrictions on returning to regular activity once fully recovered from surgery. However, most patients can expect full recovery to take about six months. There’s no research addressing whether tennis has an impact on replacement shoulder joints. If you played tennis prior to your surgery, you are likely fine to return to playing after recovery. But if you are picking up a new sport after surgery, it’s best to stick with lower impact sports overall that put less stress on your shoulder.

One category of activities we advise against following shoulder replacement surgery is any hobby or activity that could result in falling, such as riding a motorcycle, horseback riding, skiing, or even climbing ladders. Any fall can result in a significant injury, such as dislocating the shoulder, fracturing the area around the implant, or even breaking the implant. Revision surgeries to repair a damaged joint that has already been replaced are harder on the patient than the original surgery, and the outcomes are often not as good as the primary surgery. Thus, we advise people to avoid any activities that could result in a fall or accident that may cause damage to the shoulder.

Ultimately, all joint replacements surgeries are designed to help the individual with activities of daily living, or ADLs. More research is needed to determine how well joint replacements hold up to higher levels of activity over time, but until that research can be completed, remaining active while exercising reasonable caution is the best approach.

Restoring Shoulder Motion Through Tendon Transfer

Tendon transfers can be a great option for many patients who have significant injury to the rotator cuff but may want to avoid reverse shoulder replacement. Tendon transfers may be less invasive than replacement surgery and are a permanent repair with fewer restrictions on future activity. There is also less risk of additional surgeries in the future, such as with patients who undergo joint replacement at a young age.

Tendon transfers can help restore motion to the shoulder, but they don’t resolve any pain associated with arthritis. Thus, tendon transfers are typically done for patients with minimal or no arthritis. For patients with arthritis and an irreparable rotator cuff tear, reverse shoulder replacement surgery is usually the better option.

Here we review three major tendon transfers for the shoulder: latissimus dorsi, pectoralis major, and lower trapezius. In these procedures, the tendon is detached from its regular location and moved to a new location, which changes the force vector to allow it to move the shoulder in a different way. Tendon transfers can be particularly useful for patients who are younger or have a job that requires heavy labor and hope to avoid reverse shoulder replacement.

In some cases, a tendon transfer is done along with a shoulder replacement surgery. For example, a latissimus dorsi tendon transfer can be done alongside or in combination with teres major transfer (called a modified L’Episcopo procedure) while doing a reverse shoulder replacement in a patient with profound weakness that limits external rotation.

A latissimus dorsi transfer is used in patients whose rotator cuff tear is irreparable and located in the posterosuperior position of the rotator cuff, which results in pain and weakness in external rotation. One quick test for this type of injury is the hornblower sign, during which the arm is lifted with the elbow at 90 degrees and the hand pointed up. If the hand falls in the fashion of a hornblower, that can signal that the part of the rotator cuff responsible for external rotation is too weak and the patient might be a candidate for tendon transfer.

The latissimus dorsi transfer was first developed by Dr. Christian Gerber in Switzerland, whom Dr. Betsy Nolan studied under during her first shoulder and elbow fellowship. The procedure requires incisions in the front and back of the shoulder and generally requires three to six months of specialized physical therapy afterward to train the muscles to work in a new way.  

A lower trapezius tendon transfer can be done arthroscopically but works similarly to a latissiumus dorsi transfer. Both eliminate the restrictions required with joint replacement.

The pectoralis major transfer treats a different type of rotator cuff tear, a tear of the subscapularis tendon in the front. The procedure helps restore internal rotation to the shoulder, which impacts daily activities like tucking in a shirt or getting a wallet out of a back pocket. If the tendon can be repaired, then a primary repair is done. In patients whose subscapularis tendon is not repairable, a pectoralis major tendon transfer may be an option.

It is common that a surgeon may offer some, but not all, of these treatment options, depending on their skill set. If you have an irreparable rotator cuff tear and want to be able to consider all of your treatment options, contact us today at the Oklahoma Shoulder Center to schedule a consultation.  

Women in Orthopaedics: Dr. Jacquelin Perry

According to a 2014 survey by the American Academy of Orthopaedic Surgeons, women represent only 6.1% of practicing, while medical school enrollment tends to be evenly split between men and women.

Orthopaedic surgery is not a required rotation at most medical schools, and therefore exposure to the field before a career path is chosen is limited. The Perry Initiative seeks to provide early exposure to the field in order to build the pipeline of future female leaders in orthopaedic surgery and engineering.  

Its namesake Dr. Jacquelin Perry, a significant pioneer for women in orthopaedics, was among the first women to practice orthopaedic surgery in the United States. Her career in orthopaedics spanned more than 60 years, and she continued to practice part time until her death in 2013 at the age of 94. Prior to attending medical school, she was a physical therapist in the Army.

She was a professor of surgery at the University of Southern California medical school from the early 1970s to late 1990s, where Dr. Betsy Nolan completed her residency. Dr. Nolan remembers Dr. Perry as sharp, detail-oriented, committed to her work and her patients, and a mentor to both women and men in orthopaedics.

Dr. Perry’s work focused on treating post-polio syndrome patients through gait analysis and spinal surgery to restore mobility. Even when she retired from surgery, she continued to treat patients at her specialized gait analysis clinic. Together with Dr. Vernon Nickel, she developed the halo, a metal ring attached to the skull that is still used today to immobilize the neck and spine.

The Perry Outreach Program offered through The Perry Initiative offers hands-on programs for women in high school, college, and medical school. Their dual focus on orthpaedics and engineering recognizes that a strong partnership between the two fields is critical for the future development of orthopaedic implants and other solutions for patient needs.

For more information about The Perry Initiative and their programs, visit their website.

Reverse Total Shoulder Replacements

In a reverse total shoulder replacement, the normal anatomic configuration of the shoulder is reversed to put the ball where the socket was and socket where the ball was. These procedures are most often done for patients whose rotator cuffs are damaged beyond repair and/or are unable lift their arm overhead due to rotator cuff deficiency. Reversing the ball and socket changes the center of rotation for the shoulder, which allows the deltoid muscle to play a bigger role in moving the arm.

The Food and Drug Administration (FDA) approved the procedure in the United States in 2004, although it had been used in Europe for approximately 20 years prior. When Dr. Betsy Nolan completed her shoulder and elbow fellowship in Switzerland under Dr. Christian Gerber, her training included hundreds of reverse total shoulder replacements with one of the early adopters and design surgeons for the reverse (also called inverse) shoulder replacement.

Dr. Nolan calls the reverse total shoulder replacement the single biggest technological advance in shoulder surgery in her lifetime. The procedure is now done for many patients who previously would have been told that nothing else could be done. While it is a newer procedure than the total anatomic shoulder replacement, it is not a better treatment — the two are simply different procedures used in different situations. In recent years, new convertible implants are available which make it easier to convert an anatomic total shoulder to a reverse total shoulder at a later date, if further injury or passage of time results in new rotator cuff pathology, which requires revision.  

Many patients who need a reverse total shoulder replacement will have pseudo-paralysis of the shoulder that prevents them from lifting their shoulder above 90 degrees. This means they can’t reach the top of their head to wash or groom their hair or their mouth to feed themselves, for example. Not all patients experience shoulder pain, so the issue may be written off as a nerve injury or simply old age, when in fact it’s due to a massive rotator cuff tear that occurred over time. Patients may have adjusted to limited shoulder function on one side, and it’s not until the second shoulder begins bothering them that they seek treatment. A reverse total shoulder replacement is also done for patients with arthritis when the rotator cuff is not intact and for many patients who need a revision (repeat surgery) who have undergone a prior anatomic total shoulder replacement.

Compared to anatomic total shoulder replacement surgery, the reverse total shoulder replacement is similar in terms of size of incision, length of surgery, and timeframe for recovery. The primary difference between the two are precautions to avoid dislocating the joint following surgery. An anatomic shoulder replacement can dislocate in abduction and external rotation (the position of throwing a ball overhead, for example). A reverse total shoulder replacement is most likely to dislocate in adduction and internal rotation, such as if reaching for a wallet in the back pocket.

The goal for any shoulder replacement surgery is to allow the patient to perform activities of daily life. Shoulder replacements are not designed for heavy lifting or competitive athletics, as doctors do not know how long the replacement joints will last with that level of activity. Any patient with a shoulder replacement should avoid activities with a high risk of falling, such as riding a horse, riding a motorcycle, or working on a roof.

If your shoulder motion, strength, or pain limit you from doing your normal daily activities or you have other shoulder or elbow concerns, call the Oklahoma Shoulder Center today at 405.278.8006 to schedule an appointment.

Should I Get a Second Opinion?

At the Oklahoma Shoulder Center, we regularly see patients who want a second opinion regarding their shoulder or elbow problem. Some patients may be hesitant to seek a second opinion because they are unsure of the cost or they don’t want to offend their original surgeon or referring doctor. However, when it comes to surgery, a second opinion can be beneficial whether it confirms the course of treatment or provides an alternative option. For most patients, the cost for a second opinion is simply an office visit co-pay. Here are a few reasons to consider getting a second opinion:

  • You don’t feel completely comfortable with your doctor. Doctors have different personalities, just like patients do. If you don’t feel like a doctor is the right fit for you in terms of personality, find someone who is.
  • You have unanswered questions after your consultation. It’s important to find a doctor who will answer all of your questions prior to surgery and not make you feel rushed.
  • The first doctor you see doesn’t do this procedure very often. Be sure to ask how many procedures like yours the doctor has done in the past year, or when they last did a surgery like yours. It’s also important how much experience the team (nurses, anesthesiologist, and office staff) have with your specific procedure.
  • You wonder if there might be another option besides surgery or other types of surgery that were not offered. A surgeon often won’t recommend a procedure they’re unfamiliar with, but there may be more than one surgical approach to your injury. A shoulder and elbow specialist should be able to explain the full spectrum of nonsurgical and surgical options. For example, some types of rotator cuff tears can be treated with tendon transfer instead of a reverse total shoulder replacement when they cannot be repaired.  

Many patients who come to the Oklahoma Shoulder Center for a second opinion come to us from out of town, either from other places in Oklahoma or from surrounding states. If you are scheduling an appointment from out of town, our staff will be happy to help with recommendations for nearby restaurants and attractions. We also have group rates available at some nearby hotels if you need lodging.

Whether coming to see us for a second opinion from out of town or locally, here are some important items to bring to your appointment:

    • Previous x-rays, MRIs, or other images, especially any images taken within the past six months. Please bring the actual images as either prints or electronic files, in addition to the written report from the radiologist.   
    • Prior operative reports and implant logs, if you have had a previous surgery. Be sure to request these in advance from your previous physician and bring them with you or ask that they fax them to us in advance. 
    • Any medical records from recent visits to other orthopaedic surgeons.

If you are considering a second opinion about your shoulder or elbow issue, we invite you to contact us at the Oklahoma Shoulder Center. Call 405.278.8006 today to schedule an appointment with Dr. Betsy Nolan.

An Overview of Anatomic Total Shoulder Replacements

There are four basic types of shoulder replacements: hemiarthroplasty (also known as a partial shoulder replacement); resurfacing arthroplasty; traditional, or anatomic, total shoulder replacements; and reverse total shoulder replacements.  Hemiarthroplasty and resurfacing arthroplasty are used in specific, limited circumstances. Reverse shoulder arthroplasty is used mostly in patient with arthritis when the rotator cuff is not intact, patients with massive irreparable rotator cuff tears with pseudo-paralysis (inability to lift the arm above 90 degrees), and many revision and deformity situations. This post will specifically address anatomic total shoulder replacements, with a post about reverse shoulder replacements to come later.

Most shoulder replacements are done when arthritis of some kind — rheumatoid, osteoarthritis, psoriatic, or post-traumatic — causes significant pain or limitations in shoulder function. Before shoulder replacement surgery, Dr. Nolan will usually recommend more conservative treatment options, including activity modification, anti-inflammatory medications or steroid injections, physical therapy, and other non-invasive treatment options. Some patients may not find relief with any of the non-invasive treatments, however, and will then proceed to total shoulder replacement surgery.

The rotator cuff, or the muscles and tendons that keep the ball-and-socket joint between your arm and shoulder blade functioning, must be intact for an anatomic total shoulder replacement to function correctly and to avoid early loosening. The shoulder replacement surgery is typically a one- to two-hour procedure, but it could be longer in some circumstances if there is additional work required, such as bone grafting. During the procedure, a prosthesis is used to replace the head of the humerus bone (ball portion of the ball-and-socket joint) and the socket (glenoid) of the shoulder joint. The ball is typically made of cobalt chrome, while a medical-grade plastic (polyethylene) is used for the glenoid portion. Most total shoulder replacements can be done with an approximately five-inch scar on the front area of the shoulder.

Most patients stay in the hospital for one night following surgery, but some patients may stay longer. Before being discharged from the hospital, you will see a physical therapist to learn how to take your sling on and off and learn tips for getting dressed and doing daily tasks without injuring your shoulder as it heals. Upon going home, you will be able to do things with your hand on the operative arm like talking on your phone and feeding yourself, but may need someone available to help you with getting dressed, showering, cooking, and other daily tasks, typically for a week or two following surgery.

About two weeks after surgery, you will have a post-operative appointment with Dr. Nolan. If everything looks good in terms of the incision healing, most patients will start a three-month course of physical therapy two or three times per week. Some patients may continue physical therapy for up to an additional three months. We can help you locate a physical therapist near home or work so that you can make it to therapy appointments frequently, as regular therapy is essential for full recovery from total shoulder replacement.

Many patients want to know when they can return to work or other activities following surgery. For patients who work desk jobs, we recommend taking a full two weeks off to recover, make sure the incision is healing properly, and get scheduled for physical therapy. You will be in a sling for approximately six weeks after surgery. For patients who work manual labor jobs, additional time off work will likely be required to allow your shoulder to fully heal. For those who do heavy lifting at work, expect to take at least three months off work. Sports activities should generally wait for three to six months after surgery, depending on your progress in physical therapy and the type of activity you want to do. We recommend avoiding contact sports and activities where you risk falling from a height, such as riding a horse or working on roofs indefinitely following shoulder replacement surgery.

Some individuals are not good candidates for total shoulder replacement surgery, including anyone with an active infection, those who are too weak or ill for anesthesia, diabetics with A1c levels that are not well controlled, individuals who do a lot of heavy lifting that may compromise the implant, and individuals who work at high elevations (such as roofers), and those who are at high risk of falls (such as people with Parkinson’s disease). Heavy lifting and falling from a high elevation or falling shortly after surgery create risk of breaking the implant, breaking the surrounding bones, or injuring the muscles and tendons. If any of those occur, surgery may be required to repair the shoulder, and each additional surgery has a lower success rate. Dr. Nolan will discuss all of these factors with you to determine whether or not you are a good candidate for a total shoulder replacement.

If you are experiencing significant pain or limited function of your shoulder and wonder if you might be a candidate for a total shoulder replacement, call the Oklahoma Shoulder Center today to schedule a consultation appointment.

What to Expect for Outpatient Elbow Surgeries

Dr. Betsy Nolan at the Oklahoma Shoulder Center treats patients with a range of elbow problems through outpatient surgical procedures. This may include the following injuries and procedures:

  • Elbow arthroscopy (scope) procedures. Some examples include procedures to remove loose cartilage or bone fragments, treat tennis elbow, or resolve cartilage defects.
  • Reconstructions for fractures or dislocations.
  • Repair or reconstruction of torn ligaments. One example is ulnar collateral ligament reconstruction (commonly referred to as the Tommy Johns surgery, named after the famous baseball player who was the first to return to play following this procedure).
  • Treatment of nerve entrapments. For example, ulnar nerve transposition can help treat cubital tunnel syndrome.
  • Capsular releases to improve motion in a stiff elbow which has not improved with physical or occupational therapy.

As with any surgical procedure, it is important to follow the guidelines provided by your surgeon and the hospital related to preparing for and recovering from surgery. For outpatient elbow procedures, you will need someone to drive you to the hospital the morning of your procedure and drive you home afterward. It’s also generally a good idea to have someone stay with you the first night that you are home.

The length of time required for an outpatient elbow surgery will vary based on the procedure, but most procedures take around two hours or less. In most cases, elbow surgeries can be completed with a nerve block and sedation, rather than general anesthesia. Your anesthesiologist will discuss the options with you prior to surgery.

The nerve block puts part or all of your arm to sleep, which helps reduce pain both during and after surgery. Patients given a nerve block for surgery generally require less pain meds during and after surgery, and are therefore able to avoid many of the potential side effects of these medications. The nerve block will wear off at different times for different patients, but may last up to 48 hours, so we recommend that patients start taking their pain medicine before the block wears off and especially before going to sleep the night after surgery, in case the block wears off during the night. Once the nerve block wears off, you can determine how much pain medication you need, but it is generally easier to cut back the medication than try to “catch up” to the pain.

Depending on the type of surgery, you may be in a splint or sling or both for a short period. Elbow motion may be restricted, although to varying degrees depending on the type of operation, until your post-operative appointment with Dr. Nolan approximately two weeks after surgery. Some procedures, such as ulnar nerve transportation, don’t require any immobilization, while others may involve a specialized brace that only allows specific movements. Prior to your procedure, Dr. Nolan can discuss specifics for your elbow motion restrictions so that you can better prepare for the time after surgery.

The elbow area does not have much soft tissue padding around it, which means additional precautions may be needed during recovery to avoid movement or potentially bumping the elbow into a hard surface. In the days following surgery, you should not lift anything heavier than a coffee cup until cleared by Dr. Nolan. To reduce potential swelling, elevate your elbow above your heart and ice the elbow area.

Patients can generally remove the dressing on the wound after 48 hours — the easiest removal option is in a shower when the dressing is wet. You can wash with soap and water but avoid any lotions or creams. Also, use caution if out in the sun and keep your scar covered with clothing as sun exposure can cause the scar to spread.

We encourage patients to call our office with any questions before or after surgery. Give us a call at 405.278.8006. We’re here to help!

Giving Back Through Journal Editing

Since completing her two shoulder and elbow fellowships, Dr. Betsy Nolan has been editing and reviewing submissions for medical journals. The editing and review process is a way to support the profession overall and ensure quality information is shared with other orthopaedic surgeons. It’s also a way to stay informed of the latest developments and new research.

For most journals, the process involves one volunteer editor and two volunteer reviewers for each submission to determine if it fits that specific journal’s topic and audience, if the study design is appropriate for the question, and if the findings significantly add to the existing body of knowledge on that topic. An author who submits an article must include the level of evidence they believe their study represents, but the editors or reviewers may change the level of evidence rating. Most journals have a statistical reviewer, too, that focuses on the statistical analysis of the data rather than the clinical relevance of the research.

On the clinical side, Dr. Nolan values the opportunity to know what new approaches are being explored for treating shoulder and elbow concerns. From a research side, the process often sparks new questions about other areas to be studied or new technologies and techniques to incorporate into a future research study. It also helps her ensure that her own research is designed to meet the rigorous standards required for being published in a medical journal.

Dr. Nolan currently serves as Associate Editor for Continuing Medical Education for the Journal of Bone and Joint Surgery, Assistant Editor for the Journal of Shoulder and Elbow Arthroplasty, and a reviewer for the Journal of Shoulder and Elbow Surgery and for Clinical Orthopaedics and Related Research. In addition to reviewing shoulder and elbow articles, she also reviews continuing medical education questions and papers that fall in the education category related to training the next generation of orthopaedic surgeons for some of these journals.

Dr. Nolan sees editing and reviewing journal articles as an important opportunity to give back to the orthopaedic surgery community and ensure that quality medical information is published in each of these journals. As with other volunteer editors and reviewers, she sets aside the necessary time to edit or review journal articles and contribute to the sharing of knowledge among the orthopaedic surgery community.

Rotator Cuff Injuries and Treatment

Shoulder Specialist In Oklahoma City

Shoulder Specialist In Oklahoma City

The rotator cuff consists of muscles and tendons that keep the ball-and-socket joint between your arm and shoulder blade functioning correctly and help you lift and rotate your arm. There are four muscles in the rotator cuff — supraspinatus, infraspinatus, teres minor, and subscapularis. There is also a lubricating sac (called the bursa) between the rotator cuff and the acromion, or the bone on top of your shoulder

 

Tendinitis, Impingement, and Bursitis

Shoulder tendinitis occurs when the tendons are irritated or mildly damaged, and bursitis occurs when the bursa becomes inflamed or swollen. With shoulder impingement, the acromion rubs against the bursa or one of the tendons and causes pain or inflammation. Symptoms include pain or swelling in the front or outside part of the shoulder and pain when lifting or lowering your arm.

For many cases of tendinitis, impingement, or bursitis, the first course of treatment may be to rest the shoulder and use non-steroidal anti-inflammatory medications to reduce the inflammation in the shoulder. For some patients, physical therapy may also be recommended. In cases where pain and inflammation cannot be resolved through rest or physical therapy, surgery can help create more space for the rotator cuff by removing inflamed portions of the bursa, part of the acromion, or any bone spurs projecting downward off the acromion.

Rotator Cuff Tears

Another common source of shoulder pain is a rotator cuff tear. The majority of tears occur in the supraspinatus tendon, but a tear can occur in any or all of the four tendons. While this can be a painful injury for many people, it is also possible to have a rotator cuff tear with no symptoms of pain or dysfunction.

Symptoms include pain that occurs in relation to overhead activity or reaching out to the side, such as when putting on a coat or reaching for something above, beside, or behind you. However, pain may also be present when the shoulder is at rest, particularly if you are lying on the affected shoulder. Other symptoms include weakness when lifting or rotating your arm.

As people age, their risk for rotator cuff tears increase, with the average age of a symptomatic rotator cuff tear being 58 years old. Individuals whose jobs or hobbies involve a lot of overhead activity and those born with certain shapes of the acromion are most at risk for degenerative rotator cuff tears, or a wearing down of the tendon over time. Rotator cuff tears can occur in younger individuals as an acute tear caused by a specific injury or fall, but most rotator cuff tears are not the direct result of a specific trauma.

Treatment for rotator cuff tears may begin similarly to treatment for shoulder tendinitis or bursitis — with rest or activity modification to avoid painful movements or with physical therapy or other exercises to strengthen the muscles around the torn portion of the rotator cuff to compensate. Non-steroidal anti-inflammatory medications or a steroid injection may be prescribed to help reduce inflammation and pain.

One reason that rotator cuff injuries are common and don’t heal well on their own is that blood supply is limited. Blood supply, which is necessary for an area of the body to heal, comes through the bone to the tendons. If the tendon has torn to the point of detaching from the bone, then blood supply is even more limited, which makes it particularly difficult for complete tears to heal as opposed to partial tears.

While some rotator cuff tears can improve with nonsurgical treatment, many rotator cuff tears will ultimately require surgery. Most rotator cuff repairs are outpatient procedures, typically done arthroscopically using a camera and multiple small incisions about the size of the tip of a pen. A small number of more severe rotator cuff tears may require a latissimus dorsi or pectoralis major tendon transfer or a reverse shoulder replacement. On rare occasions, an arthroscopic debridement for pain control with or without biceps tenotomy (releasing the biceps tendon from the shoulder joint) may be performed if the tear cannot be repaired. This is typically reserved for patients who are not interested in or not candidates for larger procedures to resolve the problem.

If you are experiencing pain or limited movement in your shoulder, contact the Oklahoma Shoulder Center today for an appointment to determine the specific cause of your shoulder pain and discuss treatment options.

Celebrating Our First Year

This month, we celebrate the first anniversary of the Oklahoma Shoulder Center. When we first opened last February, we operated on a part-time schedule and then began seeing patients full time in July. So it’s our official anniversary this month, but we may just decide to celebrate again in July to mark one year of full-time patient care. We want to extend a special thank you to our patients and referral partners for trusting us with your care. As we mark this occasion, we also want to highlight a few key features of our practice.

Convenient Location & Hours

We’re conveniently located in Midtown in a stand-alone building with ample parking. Our office is a converted historic home, which creates a welcoming and comfortable atmosphere for patients and guests.  

Because we understand that scheduling can be difficult sometimes, we offer appointments on Saturdays and some evenings. We can also work patients into the schedule quickly when necessary.

Independent Practice & Open Referrals

As an independent orthopaedic surgery practice, we can refer patients to any location for imaging studies, therapy, or other treatment. We’re not restricted to referring only within a specific hospital group—we can refer you directly to the best and most convenient option for you. Since we have many patients who travel from across the state and even neighboring states to see Dr. Betsy Nolan, this flexibility in referring to any therapy clinic is extremely beneficial to our patients.

In most cases, you do not need a primary care referral to see Dr. Nolan and can simply call the Oklahoma Shoulder Center for an appointment. Check with your insurance to be sure, or give us a call to discuss.

Direct Care From a Highly Qualified Surgeon
Dr. Nolan is the only practicing member of American Shoulder and Elbow Surgeons in the state and the only Oklahoma shoulder surgeon that completed two shoulder and elbow fellowships. As a true shoulder and elbow specialist, she is able to provide the highest level of care for any shoulder or elbow problems.

On top of her extensive experience, patients at the Oklahoma Shoulder Center also benefit from access to Dr. Nolan. Every patient sees Dr. Nolan at every appointment. You will meet and discuss your needs with your surgeon directly, as opposed to meeting your surgeon for the first time the day of surgery. We believe strongly in empowering our patients to make the best decision for their health and their life, and we discuss the full range of options with each patient.

Thank you again to our patients, referral partners, and other supporters for joining us on this journey. We look forward to continued partnership with you in serving the shoulder and elbow needs of Oklahomans for years to come.