February 6, 2025 • 42 mins
Centered on Health 2-6-25 - Shoulder replacement surgery - are you a candidate? with Dr. Kris Abeln
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
It's now time for Centered on Health with Baptis's Help
on US Radio. Wait fortys now here's doctor Jeff Tell.
Speaker 2 (00:10):
Well, good evening, everybody, and welcome to tonight's episode of
Centered on Health with Baptists Health here on news radio
eight forty whas. I'm your host, doctor Jeff Covlin, and
we're joined as always by our producer Mistor Jim Fenn.
Tonight we are going to talk about whether you might
be a candidate for shoulder replacement surgery. We're going to
(00:33):
talk a little bit about shoulder surgery with doctor Chris Ablin.
Doctor Abelin is an orthopedic surgeon with the Baptist's Hospital
Medical Group, specializers in sports medicine, talking about shoulder surgery
and other things that he does. He has practices in
New Albany, Indiana. He did his medical school at the
University of Louisville and sports medicine fellowship with the Santa
(00:55):
Monica Orthopedic Group. Doctor Abelin, thanks for joining us on
Centered on Health.
Speaker 1 (01:02):
Great appreciate having me and looking forward to the discussion.
Speaker 2 (01:05):
Yes, we're very you know, shoulder, We're going to get
to that. That's a that's a big topic. So I
know there's gonna be a lot of listeners who are
going to learn a lot from you tonight, but I
wanted to just start maybe introducing you to our audience
and maybe tell us a little bit about, you know,
what made you want to be a doctor and an
orthopedic sursion in particular.
Speaker 1 (01:27):
Sure, I think that's always a great h starting point.
I probably started on the complete opposite end of medicine
and healthcare. I was a mcconough scholar University of Louisville,
and that's a heavily uh political science, sort of law
school based training program, and uh so kind of you know,
(01:47):
was really exposed to that with into history and things
like that, so sort of really not even really thinking
about medicine and college, but took kind of a general
first couple of years of all kinds of classes and
just really felt like I enjoyed the science part of
the curriculum in college and undergraduates, so decided to major
in biology to focus on that, and you know, was
(02:10):
exposed as some of the fields through internships the mcconough's
Center offered, and didn't really love that career path either,
so I started to think about, you know, using this
science you know degree for something, and you know, medicine
was kind of a very common thing for some of
my classmates in the you know, biology programs. So I
(02:32):
continued to be interested in fascinated with that, and I
think ultimately decided that medicine was where I wanted to
be in And uh, that was kind of step one.
And you know that you get in the medical school
and it's kind of the same thing all over again.
You're exposed to really everything, you know, your general medicine, O, B, G,
Y N and mythology really everything, and your basic science
(02:54):
years and your your first year of clinical rotations. And
I was kind of hope and I didn't make a
bad decision because I care for any of the specialties
I was I was exposed to. I didn't really love
primary care. I did level will be. And you know,
then finally what you're able to get some elective time
and check out orthopedics and and really that was just
(03:16):
a revelation. I really it clicked. And so you know,
that was later on in medical school and you know,
identify that as really what I enjoyed about medicine.
Speaker 2 (03:25):
And so, you know, Chris, I'm fascinated at by wearing
that because when I look at you, know what you've done,
and you do so much with sports teams and things
like that. I just I was wondering, you know, did
you have a sports injury as a kid, and that's
what made you interested in in orthopedics. So I find
you the journey you're describing us pretty fascinating. I have
(03:46):
to say, well, but tell us about what it's like
to be be doing what you're doing. What's a what's
a week like for you? What kind of things? I
know we're talking about shoulders, but in general, what kinds
of things do you treat on a data day?
Speaker 1 (04:02):
That's great, It really depends on I'm over in southern Indiana.
School started today, so it really depends on the time
of year. A lot of my schedule. So as at
school and high school sports and even college sports start up,
my schedule dramatically changes. So, you know, unfortunately, athletics is
fantastic and youth sports is a great you know endeavor,
(04:23):
really encourage, courage that, but it results in injuries. And
so when those start up, my schedule really, you know,
becomes more unpredictable. You know, injuries will happen. We essentially
offer same day appointments, and you know, we even do
injury clinics on the weekend. We cover high school football
and Friday night. So my schedule in the fall is
it's pretty busy, and I have a great team at
(04:44):
Baptist Floyd that really helps with those coverages. So but
essentially I'm in the office two days a week seeing
those types of injuries and adult patients that you know
are seeing and on a regular orthopedic office upright, two
days a week on those injuries. And then I have
a day where I serve in administrative role for the
(05:05):
health system. So that is my general five days a week,
but again in the fall, it stretches into five and
a half to six for most times because that's our
busy football and basketball seasons.
Speaker 2 (05:17):
So I know that you know, when we start talking
about shoulder injuries and shoulder surgery, you can name almost
any sport where you might use your arm. But is
there one sport in particular where you find as a
sports medicine doctor that you see the most injuries of them.
Speaker 1 (05:36):
From a surgical standpoint, it's football injuries. Those are the
kids that are unfortunately, they're the ones that are suffering
more surgical issues with their football injuries, whether it's dislocations
and fractures of the shoulder fractures are the clavical Football
is far and away the one that drives more of
the surgical injuries. As far as what brings people into
(05:57):
the office with injuries, though it's probably on the other
side of that volleyball and baseball, you know, throwers overhead
where it's almost overused type injuries. Rarely, fortunately, do those
patients and surgery, but they certainly will develop pain and
you know, bad mechanics or other things that will need
to be addressed to, you know, guide them through therapy
(06:19):
and rest and rehab protocols. So it's kind of two
sides of the coin. As far as what brings shoulder
patients in, especially at the young patient level.
Speaker 2 (06:29):
Well, I will definitely make sure my three boys don't
listen to this because they're already now that we didn't
let them play football when they were growing up. But
we've made it through those those sports hears. So you know,
one of the things I've learned is, you know, you
don't and I know most people know this, but you
don't really realize how important something is until it's not
(06:51):
not working anymore. And so we're talking a little bit
about the shoulder and to understand kind of what you
do with it, can you give us a little climber
about the shoulder and what are we actually talking about?
Anatomically when we talk about the shoulder.
Speaker 1 (07:08):
The shoulder is a fascinating joint. I mean, it's it's
really designed to provide the most range of motion of
any joint in our body. And you know, with that,
it's probably the most complicated joint in any human vice,
I think, especially surgically. I think most of us agree
on that. So you know, the foundation of any joint
is two surfaces, you know, essentially moving together. And in
(07:32):
general that's a piece of the shoulder blade called the glenoid,
sort of like a golf ball and a golf tea
analogy that the glenoid would be the tea and the
humorous essentially forms the ball. So if you're a golfer,
you know how easy is to have the ball fall
off the tee. So there's a lot of things that
help support that in the shoulder, whether it's muscles like
(07:54):
a rotator, cuff structures, soft tissue structures like the labrim
and the caps that's around the joint, and the carlage
that lines the joint. So there are so many structures
that go into giving a shoulder excellent function, but unfortunately
at the same time can then be injured, resulting in
(08:15):
problems with function.
Speaker 2 (08:18):
And so what are the structures around the joint that
could get injured, what other like the holding it all together,
like ligaments, and what are the differences in those things.
Speaker 1 (08:31):
It's really I think the best way to think about
shoulder injuries is it's very age dependent. So you're young
and dumb patients you know, or you know athletic injuries,
they are more likely going to suffer traumatic injuries. So
those are your fractures, those are your dislocations. So a
fracture would involve, you know, breaking of the bone, which
(08:52):
a lot of times wu'lt need surgery. But other times,
you know, you'll have injuries that are put together with
plate and screws to fix those type injuries. Dislocations will
often result in soft tissue damage. Most people have heard
of the labor that it's sort of like a ring
of tissue so to speak, that would be around the
tee and that provides a lot of stability to the joint.
(09:14):
It can be injured in dislocation. Some of it is
injured with overhead throwing, and that is a soft tissue
repair that's very common in young athletes. So prectures location
type injuries, those are we're going to probably be encountering
in our teenage in twenty and thirty year olds. You know. Then,
this most common structure and arguably the most common injury
(09:35):
that will bring patients into our office for shorter pain
is the rotator cuff. That's a group of four muscles.
The cuff itself is the tendon that attaches to the bone.
Speaker 2 (09:46):
Chris, I'm gonna plug you right there because I want
to hear about this rotator cuff. So we all hear
a lot about that. So let's take a quick break
and when we come back, we'll start with a rotator
cuffs and you can tell us all about it. So
you are listening to Center on Health with Baptist.
Speaker 1 (10:00):
Help here on news radio A forty Wahas.
Speaker 2 (10:03):
I'm your host, doctor Jeff Publin. We're talking tonight the
doctor Chris Abelin, orthopedic surgeon, about shoulder replacement, surgery, shoulder
injury and all things orthopedic. We'll be right back. Welcome
back to Centered on Health with Baptist Help here on
(10:25):
news radio eight forty whas. I'm your host, doctor Jeff Publin,
And tonight we're talking with doctor Chris Abelin, who's an
orthopedic surgeon with the Baptist Hospital Medical Group and talking
to us tonight about shoulder injuries and shoulder replacement surgery.
And we're still kind of learning with him about the
anatomy because I know once we understand this anatomy, we'll
(10:47):
kind of be able to understand what he's helping us
understand about how to fix things. So you started right
before the break telling us about this the rotator cuff.
And I know we've all used that phrase before, but
I how many of us know what we're actually saying.
So tell us what the rotator cuff is and how
that relates to the kinds of injuries that you see.
Speaker 1 (11:09):
Sure, the rotator cuff is a group of four muscles.
There's several different purposes in the shoulder. Certainly most muscles
we know are familiar with how we move and function.
The rotator cuff has some lifting and motion responsibilities in
the shoulder. It also imparts a lot of stability in
the shoulder to sort of center the joint, to keep
(11:30):
it on track so that the other muscles around the
shoulder can actually do their job. So you know, it
means in twenties and thirties, as most tissues in our body,
they're very healthy with good blood supply, but the rotator cuff, unfortunately,
is one of the tissues in our body that's very
affected by age. So you know, into our late forties
(11:51):
and fifties and sixties, that is when you know, I'll
start to have patients come in complain of shoulder pain,
and that's overwhelmingly what we'll usually identify as the source
of their problem, sorry, the source of their pain. So
history is very common. Some of the same things you'll
have this often bothers. Patients at night, I'll certainly almost
(12:13):
always complain of difficulty overhead reaching, those types of things,
but especially night pain seems to be a very common
problem that rotator cuff tears will cause. And so you know,
we'll use that history, we'll examine the patient, we'll move
their arm around, we'll know, we'll ask them to perform
some strength testing, and then we'll have a pretty good idea,
(12:37):
you know, if that's the case they'or not so. And
then after that testing is often done, and by far
most common, it's going to be an MRI era magnetic
as an imaging where we sit you down for forty
five minutes or an hour and we're able to look
in without radiation fortunately to look at the soft tissues
(12:57):
in the shoulder. We'll see everything, but smarily, the road
to itself is what we're looking at in those tests.
Speaker 2 (13:03):
So I'm going to show my uh, my naivete here.
But you know, we've all seen the movies where you know,
somebody dislocates their shoulder and they just jam it across,
you know, another object to pop it back in place,
Like what is a dislocated shoulder? And is that appropriate
to try and put it back in? Or or how
(13:24):
does somebody know when they should go see you acutely
or something that can wait?
Speaker 1 (13:28):
I guess sure. So yeah, Hollywood definitely paints a picture
of these type of injuries, whether it's the sports injuries
or you know, lethal weapons.
Speaker 2 (13:37):
So but.
Speaker 1 (13:40):
Yeah, there you go exactly. So uh, you know, back
to the golf ball on the golf tea analogy. So
I dislook at his shoulders, essentially when the ball is
thrown off the tee and you know, I I typically
you know, most of times that will result in patients
often have to be making the emergency room. It's you know,
(14:02):
it's it is sometimes possible for patients to relax and
spontaneous to reduce the shoulder, and they can have so
many pool on it. A lot of times our athletes
are around athletic trainers on the field and they can
be helpful in those types of valuations. But most commonly,
especially if it's the first time, you're going to probably
need to go to the emergency room to have the
joint reduced. And that's that's an urgent type of situation.
(14:28):
As patients to have multiple dislocations and other situations, there
are times when they learn how to relocate their shoulder
and things of that nature, but that's not typically advised
for a first time dislocation in my opinions.
Speaker 2 (14:41):
And what about We've talked a lot about people coming
to you from sports injuries, and I know, you know
it's a big part of this, but what about other
causes of joint shoulder and specifically pain is lot like
for people who are older, are the brightest cause problems there?
(15:02):
Or overuse injury? What are the some of the non
sort of trauma things that lead people to see you
for a shoulder problem.
Speaker 1 (15:13):
Correct, And that's kind of the third group I break
it down into. So you have your your younger athletic population,
you have your sort of working slash middle aged population,
and then I mean, I think you have your retired
and beyond patients. And so they're going to be suffering
from a different spectrum. They certainly still have rotator cuff tears,
(15:33):
they have a different set of fractures that are more
common because of the fragility fractures, So osteoporosis or bertile
bones can cause a certain elevating risk of fractures even
with minimal trauma. But then far and away you're talking
about the wearing out of the joints or osteothritis or
the general joint disease. And so that's when this car
(15:56):
lout of any joint. In this case, the choulder starts
to in and break down. And in advanced stages, you
know the phrase bone on bone can develop and so
can have very very similar symptoms. Is rotator cup tairs
out of them will come in not knowing which one
it is. X rays are very helpful, whereas you know,
(16:17):
we rely on the rise for soft tissue injuries like
strip cup tears or locations. In this situation, X rays
are by far and away the most helpful.
Speaker 2 (16:26):
Test, just plain X rays.
Speaker 1 (16:30):
Yes, So I think that's a really important starting point
for somebody, you know, who's even in their sixties or
seventies with eight traumatic shoulder pain. Certainly an examination both
medicine is fantastic. It's you know, we have phenomenal procedures
and drugs and therapeutics that are expensive and very worthwhile.
(16:53):
But for our management, and I wish whether it's the order,
whether it's whether it's the hip, there really is nothing
still better than a exam and a plane extra.
Speaker 2 (17:05):
And tell us about that. So somebody comes into your
office and you're doing a physical exam on them. What
are what kinds of things are you looking for that
might help you decide this is something that I might
send to physical therapy, which we'll talk about later, or
some other non invasive treatment. What's the thing where you're
(17:27):
looking at the patient examining them that you say, okay,
this this.
Speaker 1 (17:30):
Person, well I think certainly, the I think separate out
the traumatic ones, which are pretty straightforward, you know, so
the a traumatic hurting, nothing's working. I've taken talent, I've
taken a leave, I've used guys.
Speaker 2 (17:52):
You know that.
Speaker 1 (17:52):
I think that's the one where patients are more eager,
well what it'll do. So night pain, night pain is
very it's it's something that's for me a red flag. Unfortunately,
you know, nothing that just bothers you during the day
when you're at the gym or you know, putting your
coat on occasionally, but it goes away and you sleep.
It's usually non surgical. If you ask for once of them.
(18:14):
That's that's my mentor taught me. If you ask them,
if it bothers you at night, that unfortunately, for me,
is something that leads me to believe it's more likely
than that we have a surgical problem. So yeah, it's
and and the time and again I really finded that
to be through and it's you know, just a it's
(18:35):
a weird dynamic for shoulder pathology. So you know, I'll
listen to the history. I'll certainly examine them. I want
to know, you know what they don't the araby have
they had an injection of a like steroid shot. How
long has it been bothering them? And then you well,
you know, I think it's a specialist. Whats come to me?
(18:59):
Having done medication oftimes had an injection? Then it might
have been the physical therapy for their primary here doctors.
So they've exhausted most of the time what I have
to offer them as a conservative doctor. If they haven't,
I certainly will bring that up. So, which is the
very big part of my evaluation, because many patients have
been having systems for a great amount of time, they've
(19:20):
failed conservator treatment. So I want to be able to
tell them what are your options, and don't memori will
help me answer the question frankly to say, okay, maybe
we didn't think about this conservative option or you know,
this is why it didn't work, and this is how
we're going to fix it.
Speaker 2 (19:38):
Well, we are going to talk about how you do that.
So if you're out there you're listening, you've got solder
problems and it bothers you at night, please listen to
what we're hearing tonight. So I want to remind you
you're listening to Centered on Health with Baptist Help here
on news Radio eight forty whas I'm your host. Doctors
have problem. We're talking with doctor Chris Ablin tonight about
(19:58):
solder replacement surgery injury orthopedic surgeon with about the Talkabial
Medical Group. We'll be like that. Welcome back to Center
on Health with Baptist Health here on news radio eight
forty w h AI, I'm your host, doctor Jeff Publin,
(20:21):
And tonight we're talking to doctor Chris Ablin, orthopedic surgeon
with the Doctor Hospital Medical Group, about soldier replacement surgery
and maybe if you're a good candidate or not so.
Right before we went to our our commercial, we were
talking about when to recognize needs for surgery. So now
that we're we're talking about it, Doctor Abelin, if you
(20:43):
could talk to us about what types of surgeries you
do on the shoulder, what are the more common ones,
and what should we know about shoulder surgery?
Speaker 1 (20:55):
Sure, so you know the two most common surgeries. I'll
do our kind of broadly speaking, minimally invasive our arthroscopic options,
that is, using really small incisions, small cameras, and other
instants smaller than even the size of a number two pencil.
And that's predominately to fix the soft tissue problems we discussed,
(21:17):
you know, rotator, cuck tears, laborom tears, those types of
things are how we currently fix soft tissue problems in
the shoulder, and that's outpatient surgery. The surgeries are usually
very short, the recovery can be very long. We're still
doing the same work we did when we're opening shoulder up.
(21:39):
We just fortunately for you know, minimizing infection and bleeding
other complications can do with through little incisions. And then
you know, the other category is open shoulder surgery and
most fractures are still managed that way. But overwhelmingly this
will be when we're talking about replacing the joint, so
shoulder replacement, her shoulder arctoplasty would be done through an
(22:03):
open procedure.
Speaker 2 (22:06):
And part in our lack of understanding, but what are
you actually when we say replacement, what are you actually replacing?
What are the parts of the shoulder that are replaced,
and what are you replacing them?
Speaker 1 (22:19):
More sure? So you know, I'm not even a golfer,
but I'm going to keep us an analogy because I
think it's a good visual But so yeah, so you know,
in in a an auarthritic joint. In this case, the
the socket or the tee and the ball or the
humorous the hum more head the carlage wears down, and
so when you replace a joint, it's actually patients are
(22:44):
always fascinated just how little bone we actually remove. We
have to really just take a very small like you
just take a small wafer sort of like a vanilla
wafer type shape of bone off of the humorous maybe
the diameter of a line or so to be honest.
So it's a very small piece of bone. That's really
(23:04):
all that's removed for most shoulder replacements. And then the implants, Yeah,
it's it's so you know, it's and it's even getting
less and less as before with smaller and smaller implants.
So you know, you remove that little piece of bone
that gives us space in the joint now, and in
that space we're then able to put instruments inside the
bone on the humorous side and then really frankly right
(23:26):
on the surface on that socket or tea side, And
so patients, really it's it's very bone preserving. It's you know,
in some ways we can be minimally basically still have
to make a decision but you can minimize you know,
bone loss and things like that with certain newer implants.
So that's a pretty high level conversation to get into,
(23:47):
but it's it's really not a lot of anatomy we're
violating in modern shoulder replacements.
Speaker 2 (23:53):
But are you leaving metal parts in there after you're done?
Is that? Is that still like when people say, I
have hardware, you know, now, are you gonna have a heart?
Are you gonna have hardware in your shoulder after replacement surgery?
Speaker 1 (24:08):
Yes, of course. And so after we're down we remove
a very small amount, but there's a large amount of
metal going and you know for X rays and so
broadly speaking shoulder replacement, I would say there's two types
of shoulder replacements, you know, the gold standard so to speak,
and the first iteration of shoulder replacement be what we
(24:29):
call anatomic shoulder replacement. The parts we put in essentially
match exactly the parts that we took out, and so
you have a round ball where the ball we took
out was, and you have a flat dish where the
socket you know, we kind of resurfaced. And that's the
most common shoulder replacement for patients in their forties and
(24:52):
fifties because it relies on an intact rotator cuff. The
in the last I would say, fifteen years, beginning first
in Europe, is the development of what's called a reverse
total shoulder and that was initially designed to address the
failings of anatomics shoulder replacement patients with no rot Yeah,
(25:16):
so patients without a rotator cuff really were not candidates
for anatomics shoulder replacement because they would fail immediately. And
that's actually the normal one reason why traditional shoulder replacement
will fail. So over the last two decades, so to speak,
reverse shoulder replacement, especially in the United States, rapidly overtaking
(25:41):
shoulder arthroplasty to be the most common type of shoulder
replacement that we put in. It certainly is in.
Speaker 2 (25:47):
My practice, okay, and.
Speaker 1 (25:51):
So the oh go ahead, And so the difference would be,
you know, we're not reversing your arm. You're not going
to look any differently. I get question several times a week.
But essentially yes, So essentially the implants we put in,
which are metal and plastic and both types of shoulder replacements.
Now the ball that we put in actually attaches to
(26:15):
your socket, which is if you recall used to be
the tea. Now the ball is over there and the
t is now attached on your humors which used to
be the ball. And so we have reversed the articulation
of the implant. And the main improvement in that is
it functions very well and can even miraculously restore patients
(26:38):
who do not have a rotator cuff problem because it
essentially restores the main job of the rotator cuff, which
is centering the joint. So then your other muscles like
your deltoid, your shoulder blade, and you know, other muscles
in the shoulder area can then do their job because
you've replaced the function of the rotator cup. I think
(26:58):
that's the best way to describe it.
Speaker 2 (27:02):
And what you talked earlier about, you know, some of
the things that lead you to thinking somebody might be
a good candidate for surgery. Are there conditions and what
are they where somebody would not be a good candidate
to have a shoulder savory.
Speaker 1 (27:19):
Sure? I mean for shoulder replacement, you know, the absolute
criteria are active ongoing infection and the shoulder which is
a very rare indication. So an active ongoing infection. There
are some patients that have had injuries to the nerves
to the shoulder, whether it's paralysis or some other nerve
(27:40):
injury where they have lost function of certain muscles in
the shoulder area, and that unfortunately is contraindicated. You know,
those are probably the two most black and white contra
indications off the top of my head. And then you
have some other relative indicate. You have some other relative indications.
You know, all of these implants require us to have
(28:01):
some sort of fixation to bone. So you know, if
patients may have had prior surgery injuries or just really
bad arthritis where the bone quality and volume of bone
we have to work with presents a problem. And so
that's a conversation. I might have a couple of times
a year where I just don't feel like it's safe
because of that. And then and then really medical issues.
(28:24):
You know, all of these surgeries require an as dollars
to put the patient to sleep. Already, the stress of surgery,
the blood loss, you know, the recovery period, so your
heart and lung function has to be adequate. It's really
important to have your diabetes under control. One of the
devastating complications from putting a foreign body into your body's infection,
(28:47):
things like diabetes can really raise that risk smoking, So
it's it's really important for patients to optimize that, and
I think it's worth the surgeons we, I think are
seeing more of that. They make its way into our
literature and then filter its way into most of our practices.
Speaker 2 (29:08):
And how long does the surgery normally take.
Speaker 1 (29:12):
For a first time, you know, what we call a
primary shoulder replacement, they've never had another shoulder replacement. I
would say we've good numbers forty five minutes to an
hour for patients in my care. So certainly there are
some tougher ones that come up now and again, but
of course that would be essentially the yeah, there were
(29:32):
that would probably be the bulk of the expectations when
a patient asked me that question, And so you know,
we would anticipate trying to get their surgery done within
an hour. And that's not because we were sort of rush,
but you know, the longer the skin and tissues are
open exposed to air, there's a risk of infection that
goes up. There's more an aestesia involves, there's naga vomiting,
(29:53):
and there's you know, elevated cardio pulmonary Resklant being under
aesthesia with blood box. So you know, there's a fine
line between you point too fast but also not taking
too long that I think is an optimal thing to
shoot for, So you know, and I think that, Yeah, well.
Speaker 2 (30:14):
Let's take our final break here and we're going to
come back and finish up our conversation with doctor Chris
Ablin about solder replacement surgery. He is an orthopedic surgeon
with the Baptors Hospital Medical Group. This is Centered on Health.
I'm doctor Jeff Publin here on news radio eight forty WHAS.
We'll be right back. Welcome back to Centered on Health
(30:42):
with Baptist Health here on news radio eight forty w
h AS. I'm your host, doctor Jeff Peblin, and we're
talking tonight to doctor Chris Ablin, orthopedic surgeon with the
Baptor's Hospital Medical Group, about solder replacement surgery and shoulder surgery.
I want to remind everybody to download the iHeartRadio app.
It is free, it's easy to use. You can listen
(31:02):
to all of the night's show or any of our
other content if you want to relisten to it or
you haven't heard it, so make sure you download that app. So,
doctor Alin, we did have a question that got submitted
that I wanted to just get your thoughts on, and
one of our listeners sent in a question about what
does it mean to have a frozen shoulder?
Speaker 1 (31:27):
Sure, that's that's a very common thing. We haven't brought
up yet actually, and a frozen shoulder actually is one
of the more painful things I'll see. It's oddly enough,
sometimes even more painful than somebody that comes in with
a fractured shoulder. So it's an important topic to cover.
So all of our joints are essentially surrounded by a
(31:47):
tissue called the capsule, and in the shoulder, for some reason,
the shoulder is very uniquely, it's very unique and that
it can often get inflamed. And so when a tissue
is inflamed, we call it an idea. And so frozen
shoulder or adhesive you know, capsulitis meaning inflamed, an inflamed
(32:07):
joint that's also adhaest or stiff, is what this patient's
talking about. And so you know, the hallmark of it
is is a pretty dramatic loss of range of motion
and it's a it's a it's a condition which is
very common we see it more frequently, especially in patients
that have indocrine disorders like thyroid or diabetes. Female gender
(32:30):
with their hormonal fluctuations, so that the shoulder capsule is
uniquely sensitive to the endocurrenent dysfunction, and so those are
the risk factors can often lead to it. It's not
always required, but the hallmark is, you know, a non
arthritic X ray. Their joint spaces are fine, they don't
have arthritis. Most commonly, they don't even have a rotator
(32:51):
cuff tear. But the shoulder is very inflamed and it
becomes very sore, and then you know, a natural response
is to kind of baby it and not move it. Well,
then the shoulder doesn't like that. It gets more stiff
and it kind of snowballs on itself. So you know,
when we look at this, it has a range of
options and it can be pretty severe. It's often it
(33:14):
is often what we call self limiting condition. We can
often see it resolve for most patients with gentle medication
over the counters ice gentle stretching, but for some patients
this can last a year or two and that's just
really not something that most of us want to tolerate,
so we can. Yeah, so you know, Fortunately it does
(33:36):
respond very well to cort unquoe steroid injections, which are
done in the office. Home exercises in therapy can often help,
and that's usually the hallmark. Conservative treatment is by far
and away the most common thing I'll recommend and perform
from my patients. There are some refractory or more severe
cases which we can offer procedural options for. I say
(34:00):
procedure because some of them do not involve actually making decisions,
but we can manipulate the joint while you're under some sedation,
and that's called a shoulder manipulation, where we can sort
of rupture through those adhesions safely and most importantly comfortably
because you're asleep. Surgery, surgery or invasive procedures is very
(34:20):
rarely done for this. I might do that once or
twice a year.
Speaker 2 (34:24):
And when patients do ultimately need surgery. You know, we're
seeing so much advancement between in patient surgery and outpatient surgery,
and can you give us a little bit of where's
the landscape today for shoulder surgery and what why is
it so important to be able to do those outpatient procedures?
(34:46):
Instead of impatient when you're able to do so.
Speaker 1 (34:51):
So, you know, all of the othoscopic surgeries we've spoken about,
ninety nine point nine percent of them are going to
be outpatient unless there's just some unusual medical or social issues.
So you're really talking about the event of outpatient joint replacements,
and it's really fascinating kind of I think what has
(35:13):
driven that, you know, I think most importantly, being able
to safely do them is really the paramount thing. You know,
being able to safely put patients to sleep, wake them up,
do the surgery with minimum bavas, and most importantly, being
able to control their pain. If we weren't able to
do that, I don't think any of these other factors
(35:35):
would have pushed us to this point. But you know,
as we developed better anesthesis strategies with less nag and vomiting,
so called regional anesthesia, where we can essentially numb a nerve,
which can provide you know, almost a day of pain relief,
can make this you know, you get the you get
the patients through the really most painful part of the surgery.
So as we started to see that be possible, we then,
(36:00):
you know, other factors started to drive it. And you know,
I think patient choice, patient preference. Patients want to be home.
You know, I work in a hospital, and I don't
always want to be in a hospital. You know, our patients,
our patients were asking for this, and so I mean
think that was one driver pairs, you know, when you
(36:23):
know we live in a humanititown. You know, some of
the insurance providers started to say, well, you know it's
expensive to keep a patient every night, do we actually
need to do that? And they started to affect reimbursement
or hip and knee replacements, shoulder replacements quickly followed, where
you're really incentivized to really do these as not patient
(36:45):
in the right population. I think, interesting enough, we blame
this for a lot of things in our current society.
But COVID hospitals were full, hospitals shut down. The left
of surgeries, and you know, I think for patients who
unfortunately still had these arthritis wasn't fared during COVID. Patients
(37:07):
still needed surgery, right, and so we had to get
we had to get creative, you know, and you know,
we had to get creative about resource utilization and taking
a bed up for a joint replacement patient. Who was
healthy enough to go home and didn't make sense when
we were struggling to provide the care during the pandemic,
and I think you saw a really huge uptick and
(37:29):
and us kind of saying, hey, let's let's rethink this.
And I think that was an interesting dynamic as well
in the recent history. So you know, between improved surgical
technique and a techniques patient preference, pay preference, and then
kind of a nudge with the pandemic, I think you've seen.
I think it's really taken off to its probably in
(37:51):
some centers more common to have your joint replacement as
an outpatient, that is an impatient now and that self
is certainly moving that way.
Speaker 2 (38:00):
You know, whatever those drivers are, which you really laid
out so beautifully for us, it's still amazing to think
that you can have this kind of surgery and be
done as an outation. So just unbelievable progress. So in
the last couple of minutes that we have, and with
all due respect to you as a surgeon, one of
our goals is to keep people out of the operating
(38:22):
room when we can, so you know, there's a lot
of things out there that people are doing that might
help people before they have to go under surgery for
their shoulders. So one of the things that I think
in the sports medicine world you might be familiar with
this is the platelet with plasma and I think people
(38:43):
are really fascinated by that. CO do you do that?
And if you do, can you tell us a little
bit about what it is and what you've seem with it?
Speaker 1 (38:53):
Yes, I do. I will utilize that in our office
and certainly also as an adjuncture and surgery. So you know,
platelet rich plasma or we'll hear their abbreviation PRP. Got
it start in some other fields of medicine, plastic surgery,
cardiothoracic surgery, looking at wound healing and things of that nature.
(39:15):
They started to look at ways to sort of rev
up our body's responses to injury and healing. And one
of those tissues that revs up in response to injury
is platelets, our platelets, and so it's one of the
cells of our blood and when stimulated they release growth factors,
and so if we could sort of modulate them, it
(39:38):
was felt that we could increase our bodies healing response
by concentrating growth factors. You know, five tenfold from what
our body normally does. And that's really kind of the
heart of what led to the discussion of PRP and
really why it works. So you know what this means
is we you know, if you have this procedure done.
(40:00):
Most of the time, patients are going to do this
in their surgeon's office. You'll have a blood draw, just
like when you get your cholesterol checked, and then you'll
put it in a machine or a centrifuge which spins it.
That spinning process will separate the components of the blood
and we can get the platelets concentrated into a syringe.
And if we then reinjected into the area in this
(40:21):
case the shoulder, we feel like there can be a
response for at the very least inflammation control. So there's
many studies and some of them are not conclusive. How
does PRP work? And you know, I think you I
think in general you would say probably the most basis level,
(40:41):
it modulates inflammation. So it's a pain control. And so
for nonstructural injuries, things that are not big enough toned surgery,
or a patient doesn't want surgery, you might just help
the inflammation in your body and get pin just like
taking you know a steroid shot without some of the
side effects of steroid shots.
Speaker 2 (40:58):
Well, I think to have you back. I think because
we are unfortunately out of time, but I want to
have you back and we're going to talk all about
this stuff. Thank you so much, doctor Ablin for joining
us tonight. That will do it for another segment of
centered on Help with Doctor's Health. I'm your host, doctor
Jeff Colin. I want to thank our guest, doctor Chris
(41:19):
Abelin for sharing with us all about shoulder surgery. We
were just getting into some of these other techniques, so
we're just going to have to have you back. I
hope everybody has a great week and a great weekend
and join us every Thursday night and were another on today.
This program is for informational purposes only. It should not
be relied upon as medical advice. The content of this
(41:41):
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. The show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may have related to your personal health or
regarding specific medical conditions.
Speaker 1 (42:01):
To find a Baptist health provider. Please visit baptistealth dot
com
It's now time for Centered on Health with Baptis's Help
on US Radio. Wait fortys now here's doctor Jeff Tell.
Speaker 2 (00:10):
Well, good evening, everybody, and welcome to tonight's episode of
Centered on Health with Baptists Health here on news radio
eight forty whas. I'm your host, doctor Jeff Covlin, and
we're joined as always by our producer Mistor Jim Fenn.
Tonight we are going to talk about whether you might
be a candidate for shoulder replacement surgery. We're going to
(00:33):
talk a little bit about shoulder surgery with doctor Chris Ablin.
Doctor Abelin is an orthopedic surgeon with the Baptist's Hospital
Medical Group, specializers in sports medicine, talking about shoulder surgery
and other things that he does. He has practices in
New Albany, Indiana. He did his medical school at the
University of Louisville and sports medicine fellowship with the Santa
(00:55):
Monica Orthopedic Group. Doctor Abelin, thanks for joining us on
Centered on Health.
Speaker 1 (01:02):
Great appreciate having me and looking forward to the discussion.
Speaker 2 (01:05):
Yes, we're very you know, shoulder, We're going to get
to that. That's a that's a big topic. So I
know there's gonna be a lot of listeners who are
going to learn a lot from you tonight, but I
wanted to just start maybe introducing you to our audience
and maybe tell us a little bit about, you know,
what made you want to be a doctor and an
orthopedic sursion in particular.
Speaker 1 (01:27):
Sure, I think that's always a great h starting point.
I probably started on the complete opposite end of medicine
and healthcare. I was a mcconough scholar University of Louisville,
and that's a heavily uh political science, sort of law
school based training program, and uh so kind of you know,
(01:47):
was really exposed to that with into history and things
like that, so sort of really not even really thinking
about medicine and college, but took kind of a general
first couple of years of all kinds of classes and
just really felt like I enjoyed the science part of
the curriculum in college and undergraduates, so decided to major
in biology to focus on that, and you know, was
(02:10):
exposed as some of the fields through internships the mcconough's
Center offered, and didn't really love that career path either,
so I started to think about, you know, using this
science you know degree for something, and you know, medicine
was kind of a very common thing for some of
my classmates in the you know, biology programs. So I
(02:32):
continued to be interested in fascinated with that, and I
think ultimately decided that medicine was where I wanted to
be in And uh, that was kind of step one.
And you know that you get in the medical school
and it's kind of the same thing all over again.
You're exposed to really everything, you know, your general medicine, O, B, G,
Y N and mythology really everything, and your basic science
(02:54):
years and your your first year of clinical rotations. And
I was kind of hope and I didn't make a
bad decision because I care for any of the specialties
I was I was exposed to. I didn't really love
primary care. I did level will be. And you know,
then finally what you're able to get some elective time
and check out orthopedics and and really that was just
(03:16):
a revelation. I really it clicked. And so you know,
that was later on in medical school and you know,
identify that as really what I enjoyed about medicine.
Speaker 2 (03:25):
And so, you know, Chris, I'm fascinated at by wearing
that because when I look at you, know what you've done,
and you do so much with sports teams and things
like that. I just I was wondering, you know, did
you have a sports injury as a kid, and that's
what made you interested in in orthopedics. So I find
you the journey you're describing us pretty fascinating. I have
(03:46):
to say, well, but tell us about what it's like
to be be doing what you're doing. What's a what's
a week like for you? What kind of things? I
know we're talking about shoulders, but in general, what kinds
of things do you treat on a data day?
Speaker 1 (04:02):
That's great, It really depends on I'm over in southern Indiana.
School started today, so it really depends on the time
of year. A lot of my schedule. So as at
school and high school sports and even college sports start up,
my schedule dramatically changes. So, you know, unfortunately, athletics is
fantastic and youth sports is a great you know endeavor,
(04:23):
really encourage, courage that, but it results in injuries. And
so when those start up, my schedule really, you know,
becomes more unpredictable. You know, injuries will happen. We essentially
offer same day appointments, and you know, we even do
injury clinics on the weekend. We cover high school football
and Friday night. So my schedule in the fall is
it's pretty busy, and I have a great team at
(04:44):
Baptist Floyd that really helps with those coverages. So but
essentially I'm in the office two days a week seeing
those types of injuries and adult patients that you know
are seeing and on a regular orthopedic office upright, two
days a week on those injuries. And then I have
a day where I serve in administrative role for the
(05:05):
health system. So that is my general five days a week,
but again in the fall, it stretches into five and
a half to six for most times because that's our
busy football and basketball seasons.
Speaker 2 (05:17):
So I know that you know, when we start talking
about shoulder injuries and shoulder surgery, you can name almost
any sport where you might use your arm. But is
there one sport in particular where you find as a
sports medicine doctor that you see the most injuries of them.
Speaker 1 (05:36):
From a surgical standpoint, it's football injuries. Those are the
kids that are unfortunately, they're the ones that are suffering
more surgical issues with their football injuries, whether it's dislocations
and fractures of the shoulder fractures are the clavical Football
is far and away the one that drives more of
the surgical injuries. As far as what brings people into
(05:57):
the office with injuries, though it's probably on the other
side of that volleyball and baseball, you know, throwers overhead
where it's almost overused type injuries. Rarely, fortunately, do those
patients and surgery, but they certainly will develop pain and
you know, bad mechanics or other things that will need
to be addressed to, you know, guide them through therapy
(06:19):
and rest and rehab protocols. So it's kind of two
sides of the coin. As far as what brings shoulder
patients in, especially at the young patient level.
Speaker 2 (06:29):
Well, I will definitely make sure my three boys don't
listen to this because they're already now that we didn't
let them play football when they were growing up. But
we've made it through those those sports hears. So you know,
one of the things I've learned is, you know, you
don't and I know most people know this, but you
don't really realize how important something is until it's not
(06:51):
not working anymore. And so we're talking a little bit
about the shoulder and to understand kind of what you
do with it, can you give us a little climber
about the shoulder and what are we actually talking about?
Anatomically when we talk about the shoulder.
Speaker 1 (07:08):
The shoulder is a fascinating joint. I mean, it's it's
really designed to provide the most range of motion of
any joint in our body. And you know, with that,
it's probably the most complicated joint in any human vice,
I think, especially surgically. I think most of us agree
on that. So you know, the foundation of any joint
is two surfaces, you know, essentially moving together. And in
(07:32):
general that's a piece of the shoulder blade called the glenoid,
sort of like a golf ball and a golf tea
analogy that the glenoid would be the tea and the
humorous essentially forms the ball. So if you're a golfer,
you know how easy is to have the ball fall
off the tee. So there's a lot of things that
help support that in the shoulder, whether it's muscles like
(07:54):
a rotator, cuff structures, soft tissue structures like the labrim
and the caps that's around the joint, and the carlage
that lines the joint. So there are so many structures
that go into giving a shoulder excellent function, but unfortunately
at the same time can then be injured, resulting in
(08:15):
problems with function.
Speaker 2 (08:18):
And so what are the structures around the joint that
could get injured, what other like the holding it all together,
like ligaments, and what are the differences in those things.
Speaker 1 (08:31):
It's really I think the best way to think about
shoulder injuries is it's very age dependent. So you're young
and dumb patients you know, or you know athletic injuries,
they are more likely going to suffer traumatic injuries. So
those are your fractures, those are your dislocations. So a
fracture would involve, you know, breaking of the bone, which
(08:52):
a lot of times wu'lt need surgery. But other times,
you know, you'll have injuries that are put together with
plate and screws to fix those type injuries. Dislocations will
often result in soft tissue damage. Most people have heard
of the labor that it's sort of like a ring
of tissue so to speak, that would be around the
tee and that provides a lot of stability to the joint.
(09:14):
It can be injured in dislocation. Some of it is
injured with overhead throwing, and that is a soft tissue
repair that's very common in young athletes. So prectures location
type injuries, those are we're going to probably be encountering
in our teenage in twenty and thirty year olds. You know. Then,
this most common structure and arguably the most common injury
(09:35):
that will bring patients into our office for shorter pain
is the rotator cuff. That's a group of four muscles.
The cuff itself is the tendon that attaches to the bone.
Speaker 2 (09:46):
Chris, I'm gonna plug you right there because I want
to hear about this rotator cuff. So we all hear
a lot about that. So let's take a quick break
and when we come back, we'll start with a rotator
cuffs and you can tell us all about it. So
you are listening to Center on Health with Baptist.
Speaker 1 (10:00):
Help here on news radio A forty Wahas.
Speaker 2 (10:03):
I'm your host, doctor Jeff Publin. We're talking tonight the
doctor Chris Abelin, orthopedic surgeon, about shoulder replacement, surgery, shoulder
injury and all things orthopedic. We'll be right back. Welcome
back to Centered on Health with Baptist Help here on
(10:25):
news radio eight forty whas. I'm your host, doctor Jeff Publin,
And tonight we're talking with doctor Chris Abelin, who's an
orthopedic surgeon with the Baptist Hospital Medical Group and talking
to us tonight about shoulder injuries and shoulder replacement surgery.
And we're still kind of learning with him about the
anatomy because I know once we understand this anatomy, we'll
(10:47):
kind of be able to understand what he's helping us
understand about how to fix things. So you started right
before the break telling us about this the rotator cuff.
And I know we've all used that phrase before, but
I how many of us know what we're actually saying.
So tell us what the rotator cuff is and how
that relates to the kinds of injuries that you see.
Speaker 1 (11:09):
Sure, the rotator cuff is a group of four muscles.
There's several different purposes in the shoulder. Certainly most muscles
we know are familiar with how we move and function.
The rotator cuff has some lifting and motion responsibilities in
the shoulder. It also imparts a lot of stability in
the shoulder to sort of center the joint, to keep
(11:30):
it on track so that the other muscles around the
shoulder can actually do their job. So you know, it
means in twenties and thirties, as most tissues in our body,
they're very healthy with good blood supply, but the rotator cuff, unfortunately,
is one of the tissues in our body that's very
affected by age. So you know, into our late forties
(11:51):
and fifties and sixties, that is when you know, I'll
start to have patients come in complain of shoulder pain,
and that's overwhelmingly what we'll usually identify as the source
of their problem, sorry, the source of their pain. So
history is very common. Some of the same things you'll
have this often bothers. Patients at night, I'll certainly almost
(12:13):
always complain of difficulty overhead reaching, those types of things,
but especially night pain seems to be a very common
problem that rotator cuff tears will cause. And so you know,
we'll use that history, we'll examine the patient, we'll move
their arm around, we'll know, we'll ask them to perform
some strength testing, and then we'll have a pretty good idea,
(12:37):
you know, if that's the case they'or not so. And
then after that testing is often done, and by far
most common, it's going to be an MRI era magnetic
as an imaging where we sit you down for forty
five minutes or an hour and we're able to look
in without radiation fortunately to look at the soft tissues
(12:57):
in the shoulder. We'll see everything, but smarily, the road
to itself is what we're looking at in those tests.
Speaker 2 (13:03):
So I'm going to show my uh, my naivete here.
But you know, we've all seen the movies where you know,
somebody dislocates their shoulder and they just jam it across,
you know, another object to pop it back in place,
Like what is a dislocated shoulder? And is that appropriate
to try and put it back in? Or or how
(13:24):
does somebody know when they should go see you acutely
or something that can wait?
Speaker 1 (13:28):
I guess sure. So yeah, Hollywood definitely paints a picture
of these type of injuries, whether it's the sports injuries
or you know, lethal weapons.
Speaker 2 (13:37):
So but.
Speaker 1 (13:40):
Yeah, there you go exactly. So uh, you know, back
to the golf ball on the golf tea analogy. So
I dislook at his shoulders, essentially when the ball is
thrown off the tee and you know, I I typically
you know, most of times that will result in patients
often have to be making the emergency room. It's you know,
(14:02):
it's it is sometimes possible for patients to relax and
spontaneous to reduce the shoulder, and they can have so
many pool on it. A lot of times our athletes
are around athletic trainers on the field and they can
be helpful in those types of valuations. But most commonly,
especially if it's the first time, you're going to probably
need to go to the emergency room to have the
joint reduced. And that's that's an urgent type of situation.
(14:28):
As patients to have multiple dislocations and other situations, there
are times when they learn how to relocate their shoulder
and things of that nature, but that's not typically advised
for a first time dislocation in my opinions.
Speaker 2 (14:41):
And what about We've talked a lot about people coming
to you from sports injuries, and I know, you know
it's a big part of this, but what about other
causes of joint shoulder and specifically pain is lot like
for people who are older, are the brightest cause problems there?
(15:02):
Or overuse injury? What are the some of the non
sort of trauma things that lead people to see you
for a shoulder problem.
Speaker 1 (15:13):
Correct, And that's kind of the third group I break
it down into. So you have your your younger athletic population,
you have your sort of working slash middle aged population,
and then I mean, I think you have your retired
and beyond patients. And so they're going to be suffering
from a different spectrum. They certainly still have rotator cuff tears,
(15:33):
they have a different set of fractures that are more
common because of the fragility fractures, So osteoporosis or bertile
bones can cause a certain elevating risk of fractures even
with minimal trauma. But then far and away you're talking
about the wearing out of the joints or osteothritis or
the general joint disease. And so that's when this car
(15:56):
lout of any joint. In this case, the choulder starts
to in and break down. And in advanced stages, you
know the phrase bone on bone can develop and so
can have very very similar symptoms. Is rotator cup tairs
out of them will come in not knowing which one
it is. X rays are very helpful, whereas you know,
(16:17):
we rely on the rise for soft tissue injuries like
strip cup tears or locations. In this situation, X rays
are by far and away the most helpful.
Speaker 2 (16:26):
Test, just plain X rays.
Speaker 1 (16:30):
Yes, So I think that's a really important starting point
for somebody, you know, who's even in their sixties or
seventies with eight traumatic shoulder pain. Certainly an examination both
medicine is fantastic. It's you know, we have phenomenal procedures
and drugs and therapeutics that are expensive and very worthwhile.
(16:53):
But for our management, and I wish whether it's the order,
whether it's whether it's the hip, there really is nothing
still better than a exam and a plane extra.
Speaker 2 (17:05):
And tell us about that. So somebody comes into your
office and you're doing a physical exam on them. What
are what kinds of things are you looking for that
might help you decide this is something that I might
send to physical therapy, which we'll talk about later, or
some other non invasive treatment. What's the thing where you're
(17:27):
looking at the patient examining them that you say, okay,
this this.
Speaker 1 (17:30):
Person, well I think certainly, the I think separate out
the traumatic ones, which are pretty straightforward, you know, so
the a traumatic hurting, nothing's working. I've taken talent, I've
taken a leave, I've used guys.
Speaker 2 (17:52):
You know that.
Speaker 1 (17:52):
I think that's the one where patients are more eager,
well what it'll do. So night pain, night pain is
very it's it's something that's for me a red flag. Unfortunately,
you know, nothing that just bothers you during the day
when you're at the gym or you know, putting your
coat on occasionally, but it goes away and you sleep.
It's usually non surgical. If you ask for once of them.
(18:14):
That's that's my mentor taught me. If you ask them,
if it bothers you at night, that unfortunately, for me,
is something that leads me to believe it's more likely
than that we have a surgical problem. So yeah, it's
and and the time and again I really finded that
to be through and it's you know, just a it's
(18:35):
a weird dynamic for shoulder pathology. So you know, I'll
listen to the history. I'll certainly examine them. I want
to know, you know what they don't the araby have
they had an injection of a like steroid shot. How
long has it been bothering them? And then you well,
you know, I think it's a specialist. Whats come to me?
(18:59):
Having done medication oftimes had an injection? Then it might
have been the physical therapy for their primary here doctors.
So they've exhausted most of the time what I have
to offer them as a conservative doctor. If they haven't,
I certainly will bring that up. So, which is the
very big part of my evaluation, because many patients have
been having systems for a great amount of time, they've
(19:20):
failed conservator treatment. So I want to be able to
tell them what are your options, and don't memori will
help me answer the question frankly to say, okay, maybe
we didn't think about this conservative option or you know,
this is why it didn't work, and this is how
we're going to fix it.
Speaker 2 (19:38):
Well, we are going to talk about how you do that.
So if you're out there you're listening, you've got solder
problems and it bothers you at night, please listen to
what we're hearing tonight. So I want to remind you
you're listening to Centered on Health with Baptist Help here
on news Radio eight forty whas I'm your host. Doctors
have problem. We're talking with doctor Chris Ablin tonight about
(19:58):
solder replacement surgery injury orthopedic surgeon with about the Talkabial
Medical Group. We'll be like that. Welcome back to Center
on Health with Baptist Health here on news radio eight
forty w h AI, I'm your host, doctor Jeff Publin,
(20:21):
And tonight we're talking to doctor Chris Ablin, orthopedic surgeon
with the Doctor Hospital Medical Group, about soldier replacement surgery
and maybe if you're a good candidate or not so.
Right before we went to our our commercial, we were
talking about when to recognize needs for surgery. So now
that we're we're talking about it, Doctor Abelin, if you
(20:43):
could talk to us about what types of surgeries you
do on the shoulder, what are the more common ones,
and what should we know about shoulder surgery?
Speaker 1 (20:55):
Sure, so you know the two most common surgeries. I'll
do our kind of broadly speaking, minimally invasive our arthroscopic options,
that is, using really small incisions, small cameras, and other
instants smaller than even the size of a number two pencil.
And that's predominately to fix the soft tissue problems we discussed,
(21:17):
you know, rotator, cuck tears, laborom tears, those types of
things are how we currently fix soft tissue problems in
the shoulder, and that's outpatient surgery. The surgeries are usually
very short, the recovery can be very long. We're still
doing the same work we did when we're opening shoulder up.
(21:39):
We just fortunately for you know, minimizing infection and bleeding
other complications can do with through little incisions. And then
you know, the other category is open shoulder surgery and
most fractures are still managed that way. But overwhelmingly this
will be when we're talking about replacing the joint, so
shoulder replacement, her shoulder arctoplasty would be done through an
(22:03):
open procedure.
Speaker 2 (22:06):
And part in our lack of understanding, but what are
you actually when we say replacement, what are you actually replacing?
What are the parts of the shoulder that are replaced,
and what are you replacing them?
Speaker 1 (22:19):
More sure? So you know, I'm not even a golfer,
but I'm going to keep us an analogy because I
think it's a good visual But so yeah, so you know,
in in a an auarthritic joint. In this case, the
the socket or the tee and the ball or the
humorous the hum more head the carlage wears down, and
so when you replace a joint, it's actually patients are
(22:44):
always fascinated just how little bone we actually remove. We
have to really just take a very small like you
just take a small wafer sort of like a vanilla
wafer type shape of bone off of the humorous maybe
the diameter of a line or so to be honest.
So it's a very small piece of bone. That's really
(23:04):
all that's removed for most shoulder replacements. And then the implants, Yeah,
it's it's so you know, it's and it's even getting
less and less as before with smaller and smaller implants.
So you know, you remove that little piece of bone
that gives us space in the joint now, and in
that space we're then able to put instruments inside the
bone on the humorous side and then really frankly right
(23:26):
on the surface on that socket or tea side, And
so patients, really it's it's very bone preserving. It's you know,
in some ways we can be minimally basically still have
to make a decision but you can minimize you know,
bone loss and things like that with certain newer implants.
So that's a pretty high level conversation to get into,
(23:47):
but it's it's really not a lot of anatomy we're
violating in modern shoulder replacements.
Speaker 2 (23:53):
But are you leaving metal parts in there after you're done?
Is that? Is that still like when people say, I
have hardware, you know, now, are you gonna have a heart?
Are you gonna have hardware in your shoulder after replacement surgery?
Speaker 1 (24:08):
Yes, of course. And so after we're down we remove
a very small amount, but there's a large amount of
metal going and you know for X rays and so
broadly speaking shoulder replacement, I would say there's two types
of shoulder replacements, you know, the gold standard so to speak,
and the first iteration of shoulder replacement be what we
(24:29):
call anatomic shoulder replacement. The parts we put in essentially
match exactly the parts that we took out, and so
you have a round ball where the ball we took
out was, and you have a flat dish where the
socket you know, we kind of resurfaced. And that's the
most common shoulder replacement for patients in their forties and
(24:52):
fifties because it relies on an intact rotator cuff. The
in the last I would say, fifteen years, beginning first
in Europe, is the development of what's called a reverse
total shoulder and that was initially designed to address the
failings of anatomics shoulder replacement patients with no rot Yeah,
(25:16):
so patients without a rotator cuff really were not candidates
for anatomics shoulder replacement because they would fail immediately. And
that's actually the normal one reason why traditional shoulder replacement
will fail. So over the last two decades, so to speak,
reverse shoulder replacement, especially in the United States, rapidly overtaking
(25:41):
shoulder arthroplasty to be the most common type of shoulder
replacement that we put in. It certainly is in.
Speaker 2 (25:47):
My practice, okay, and.
Speaker 1 (25:51):
So the oh go ahead, And so the difference would be,
you know, we're not reversing your arm. You're not going
to look any differently. I get question several times a week.
But essentially yes, So essentially the implants we put in,
which are metal and plastic and both types of shoulder replacements.
Now the ball that we put in actually attaches to
(26:15):
your socket, which is if you recall used to be
the tea. Now the ball is over there and the
t is now attached on your humors which used to
be the ball. And so we have reversed the articulation
of the implant. And the main improvement in that is
it functions very well and can even miraculously restore patients
(26:38):
who do not have a rotator cuff problem because it
essentially restores the main job of the rotator cuff, which
is centering the joint. So then your other muscles like
your deltoid, your shoulder blade, and you know, other muscles
in the shoulder area can then do their job because
you've replaced the function of the rotator cup. I think
(26:58):
that's the best way to describe it.
Speaker 2 (27:02):
And what you talked earlier about, you know, some of
the things that lead you to thinking somebody might be
a good candidate for surgery. Are there conditions and what
are they where somebody would not be a good candidate
to have a shoulder savory.
Speaker 1 (27:19):
Sure? I mean for shoulder replacement, you know, the absolute
criteria are active ongoing infection and the shoulder which is
a very rare indication. So an active ongoing infection. There
are some patients that have had injuries to the nerves
to the shoulder, whether it's paralysis or some other nerve
(27:40):
injury where they have lost function of certain muscles in
the shoulder area, and that unfortunately is contraindicated. You know,
those are probably the two most black and white contra
indications off the top of my head. And then you
have some other relative indicate. You have some other relative indications.
You know, all of these implants require us to have
(28:01):
some sort of fixation to bone. So you know, if
patients may have had prior surgery injuries or just really
bad arthritis where the bone quality and volume of bone
we have to work with presents a problem. And so
that's a conversation. I might have a couple of times
a year where I just don't feel like it's safe
because of that. And then and then really medical issues.
(28:24):
You know, all of these surgeries require an as dollars
to put the patient to sleep. Already, the stress of surgery,
the blood loss, you know, the recovery period, so your
heart and lung function has to be adequate. It's really
important to have your diabetes under control. One of the
devastating complications from putting a foreign body into your body's infection,
(28:47):
things like diabetes can really raise that risk smoking, So
it's it's really important for patients to optimize that, and
I think it's worth the surgeons we, I think are
seeing more of that. They make its way into our
literature and then filter its way into most of our practices.
Speaker 2 (29:08):
And how long does the surgery normally take.
Speaker 1 (29:12):
For a first time, you know, what we call a
primary shoulder replacement, they've never had another shoulder replacement. I
would say we've good numbers forty five minutes to an
hour for patients in my care. So certainly there are
some tougher ones that come up now and again, but
of course that would be essentially the yeah, there were
(29:32):
that would probably be the bulk of the expectations when
a patient asked me that question, And so you know,
we would anticipate trying to get their surgery done within
an hour. And that's not because we were sort of rush,
but you know, the longer the skin and tissues are
open exposed to air, there's a risk of infection that
goes up. There's more an aestesia involves, there's naga vomiting,
(29:53):
and there's you know, elevated cardio pulmonary Resklant being under
aesthesia with blood box. So you know, there's a fine
line between you point too fast but also not taking
too long that I think is an optimal thing to
shoot for, So you know, and I think that, Yeah, well.
Speaker 2 (30:14):
Let's take our final break here and we're going to
come back and finish up our conversation with doctor Chris
Ablin about solder replacement surgery. He is an orthopedic surgeon
with the Baptors Hospital Medical Group. This is Centered on Health.
I'm doctor Jeff Publin here on news radio eight forty WHAS.
We'll be right back. Welcome back to Centered on Health
(30:42):
with Baptist Health here on news radio eight forty w
h AS. I'm your host, doctor Jeff Peblin, and we're
talking tonight to doctor Chris Ablin, orthopedic surgeon with the
Baptor's Hospital Medical Group, about solder replacement surgery and shoulder surgery.
I want to remind everybody to download the iHeartRadio app.
It is free, it's easy to use. You can listen
(31:02):
to all of the night's show or any of our
other content if you want to relisten to it or
you haven't heard it, so make sure you download that app. So,
doctor Alin, we did have a question that got submitted
that I wanted to just get your thoughts on, and
one of our listeners sent in a question about what
does it mean to have a frozen shoulder?
Speaker 1 (31:27):
Sure, that's that's a very common thing. We haven't brought
up yet actually, and a frozen shoulder actually is one
of the more painful things I'll see. It's oddly enough,
sometimes even more painful than somebody that comes in with
a fractured shoulder. So it's an important topic to cover.
So all of our joints are essentially surrounded by a
(31:47):
tissue called the capsule, and in the shoulder, for some reason,
the shoulder is very uniquely, it's very unique and that
it can often get inflamed. And so when a tissue
is inflamed, we call it an idea. And so frozen
shoulder or adhesive you know, capsulitis meaning inflamed, an inflamed
(32:07):
joint that's also adhaest or stiff, is what this patient's
talking about. And so you know, the hallmark of it
is is a pretty dramatic loss of range of motion
and it's a it's a it's a condition which is
very common we see it more frequently, especially in patients
that have indocrine disorders like thyroid or diabetes. Female gender
(32:30):
with their hormonal fluctuations, so that the shoulder capsule is
uniquely sensitive to the endocurrenent dysfunction, and so those are
the risk factors can often lead to it. It's not
always required, but the hallmark is, you know, a non
arthritic X ray. Their joint spaces are fine, they don't
have arthritis. Most commonly, they don't even have a rotator
(32:51):
cuff tear. But the shoulder is very inflamed and it
becomes very sore, and then you know, a natural response
is to kind of baby it and not move it. Well,
then the shoulder doesn't like that. It gets more stiff
and it kind of snowballs on itself. So you know,
when we look at this, it has a range of
options and it can be pretty severe. It's often it
(33:14):
is often what we call self limiting condition. We can
often see it resolve for most patients with gentle medication
over the counters ice gentle stretching, but for some patients
this can last a year or two and that's just
really not something that most of us want to tolerate,
so we can. Yeah, so you know, Fortunately it does
(33:36):
respond very well to cort unquoe steroid injections, which are
done in the office. Home exercises in therapy can often help,
and that's usually the hallmark. Conservative treatment is by far
and away the most common thing I'll recommend and perform
from my patients. There are some refractory or more severe
cases which we can offer procedural options for. I say
(34:00):
procedure because some of them do not involve actually making decisions,
but we can manipulate the joint while you're under some sedation,
and that's called a shoulder manipulation, where we can sort
of rupture through those adhesions safely and most importantly comfortably
because you're asleep. Surgery, surgery or invasive procedures is very
(34:20):
rarely done for this. I might do that once or
twice a year.
Speaker 2 (34:24):
And when patients do ultimately need surgery. You know, we're
seeing so much advancement between in patient surgery and outpatient surgery,
and can you give us a little bit of where's
the landscape today for shoulder surgery and what why is
it so important to be able to do those outpatient procedures?
(34:46):
Instead of impatient when you're able to do so.
Speaker 1 (34:51):
So, you know, all of the othoscopic surgeries we've spoken about,
ninety nine point nine percent of them are going to
be outpatient unless there's just some unusual medical or social issues.
So you're really talking about the event of outpatient joint replacements,
and it's really fascinating kind of I think what has
(35:13):
driven that, you know, I think most importantly, being able
to safely do them is really the paramount thing. You know,
being able to safely put patients to sleep, wake them up,
do the surgery with minimum bavas, and most importantly, being
able to control their pain. If we weren't able to
do that, I don't think any of these other factors
(35:35):
would have pushed us to this point. But you know,
as we developed better anesthesis strategies with less nag and vomiting,
so called regional anesthesia, where we can essentially numb a nerve,
which can provide you know, almost a day of pain relief,
can make this you know, you get the you get
the patients through the really most painful part of the surgery.
So as we started to see that be possible, we then,
(36:00):
you know, other factors started to drive it. And you know,
I think patient choice, patient preference. Patients want to be home.
You know, I work in a hospital, and I don't
always want to be in a hospital. You know, our patients,
our patients were asking for this, and so I mean
think that was one driver pairs, you know, when you
(36:23):
know we live in a humanititown. You know, some of
the insurance providers started to say, well, you know it's
expensive to keep a patient every night, do we actually
need to do that? And they started to affect reimbursement
or hip and knee replacements, shoulder replacements quickly followed, where
you're really incentivized to really do these as not patient
(36:45):
in the right population. I think, interesting enough, we blame
this for a lot of things in our current society.
But COVID hospitals were full, hospitals shut down. The left
of surgeries, and you know, I think for patients who
unfortunately still had these arthritis wasn't fared during COVID. Patients
(37:07):
still needed surgery, right, and so we had to get
we had to get creative, you know, and you know,
we had to get creative about resource utilization and taking
a bed up for a joint replacement patient. Who was
healthy enough to go home and didn't make sense when
we were struggling to provide the care during the pandemic,
and I think you saw a really huge uptick and
(37:29):
and us kind of saying, hey, let's let's rethink this.
And I think that was an interesting dynamic as well
in the recent history. So you know, between improved surgical
technique and a techniques patient preference, pay preference, and then
kind of a nudge with the pandemic, I think you've seen.
I think it's really taken off to its probably in
(37:51):
some centers more common to have your joint replacement as
an outpatient, that is an impatient now and that self
is certainly moving that way.
Speaker 2 (38:00):
You know, whatever those drivers are, which you really laid
out so beautifully for us, it's still amazing to think
that you can have this kind of surgery and be
done as an outation. So just unbelievable progress. So in
the last couple of minutes that we have, and with
all due respect to you as a surgeon, one of
our goals is to keep people out of the operating
(38:22):
room when we can, so you know, there's a lot
of things out there that people are doing that might
help people before they have to go under surgery for
their shoulders. So one of the things that I think
in the sports medicine world you might be familiar with
this is the platelet with plasma and I think people
(38:43):
are really fascinated by that. CO do you do that?
And if you do, can you tell us a little
bit about what it is and what you've seem with it?
Speaker 1 (38:53):
Yes, I do. I will utilize that in our office
and certainly also as an adjuncture and surgery. So you know,
platelet rich plasma or we'll hear their abbreviation PRP. Got
it start in some other fields of medicine, plastic surgery,
cardiothoracic surgery, looking at wound healing and things of that nature.
(39:15):
They started to look at ways to sort of rev
up our body's responses to injury and healing. And one
of those tissues that revs up in response to injury
is platelets, our platelets, and so it's one of the
cells of our blood and when stimulated they release growth factors,
and so if we could sort of modulate them, it
(39:38):
was felt that we could increase our bodies healing response
by concentrating growth factors. You know, five tenfold from what
our body normally does. And that's really kind of the
heart of what led to the discussion of PRP and
really why it works. So you know what this means
is we you know, if you have this procedure done.
(40:00):
Most of the time, patients are going to do this
in their surgeon's office. You'll have a blood draw, just
like when you get your cholesterol checked, and then you'll
put it in a machine or a centrifuge which spins it.
That spinning process will separate the components of the blood
and we can get the platelets concentrated into a syringe.
And if we then reinjected into the area in this
(40:21):
case the shoulder, we feel like there can be a
response for at the very least inflammation control. So there's
many studies and some of them are not conclusive. How
does PRP work? And you know, I think you I
think in general you would say probably the most basis level,
(40:41):
it modulates inflammation. So it's a pain control. And so
for nonstructural injuries, things that are not big enough toned surgery,
or a patient doesn't want surgery, you might just help
the inflammation in your body and get pin just like
taking you know a steroid shot without some of the
side effects of steroid shots.
Speaker 2 (40:58):
Well, I think to have you back. I think because
we are unfortunately out of time, but I want to
have you back and we're going to talk all about
this stuff. Thank you so much, doctor Ablin for joining
us tonight. That will do it for another segment of
centered on Help with Doctor's Health. I'm your host, doctor
Jeff Colin. I want to thank our guest, doctor Chris
(41:19):
Abelin for sharing with us all about shoulder surgery. We
were just getting into some of these other techniques, so
we're just going to have to have you back. I
hope everybody has a great week and a great weekend
and join us every Thursday night and were another on today.
This program is for informational purposes only. It should not
be relied upon as medical advice. The content of this
(41:41):
program is not intended to be a substitute for professional
medical advice, diagnosis, or treatment. The show is not designed
to replace a physician's medical assessment and medical judgment. Always
seek the advice of your physician with any questions or
concerns you may have related to your personal health or
regarding specific medical conditions.
Speaker 1 (42:01):
To find a Baptist health provider. Please visit baptistealth dot
com
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