When is it better to recover from surgery at home?
Dr. Reuben Gobezie discusses the reason more doctors are treating joint replacement surgeries as outpatient.
Driving Shoulder Research Forward
Scientific research plays a huge role in the care we provide to patients. It’s extremely important to me to stay at the forefront of best practices in shoulder research. Unfortunately, most orthopedic surgeons do not have the capacity to stay involved in research or the ongoing study of their patient outcomes. But at the Cleveland Shoulder Institute, I am extremely fortunate to have a research department in place to study patient outcomes and develop best practice protocols based on the most recent data findings. We regularly contribute our studies to academic journals and present our findings around the world.
Being an independent practice has allowed us to study exactly what we think is best not only for our patients, but for the orthopedic, healthcare and surgical fields in general. The work I do in collaboration with Yousef Shishani, MD, Research Fellow and Stacey Jones, Research Assistant, has led to continuous improvement of our patient outcomes.
Before the patient’s appointment is even scheduled, our team of medical doctors, researchers, physician and medical assistants are working closely together to provide the optimal patient experience. Research and medicine work hand in hand at the Cleveland Shoulder Institute, and it is having an impact not only on our patients, but for those who study our findings as well.
I have always considered myself a scientist as well as a medical doctor, and throughout my career I have been honored to work with world renowned physicians and researchers. During my residency and fellowship years I had the unique opportunity to study with pioneers in the field from in the US and Europe including Gilles Walch, Laurent Lafosse and JP Warner.
Tracking Patient Outcomes
Since the Institute was founded, each patient’s recovery has been tracked and followed to better understand what elements of a treatment served to improve patient outcomes. Some patients have been studied as long as 15 years. We interview our patients to intimately study the efficacy of our procedures and employ what we learn for the patient benefit. This gives us a unique opportunity to ask the right questions that ultimately lead to improvements in patient care, as well as provide ongoing follow up care.
Our internationally-respected research team is continuously active in bringing new, investigative topics in general shoulder research, surgical implant design and treatment modalities to the table. And, we are proud to say, many of our shoulder practice fellows have gone on to have successful practices of their own.
In 2015, our team received the most prestigious international research award in shoulder surgery, the Charles S. Neer Award from the American Shoulder and Elbow Surgeons, the most prestigious subspecialty group in orthopedic surgery comprised of the top shoulder surgeons from around the world. The research team received the award for completing a study demonstrating that tranexamic acid, a drug applied topically during surgery, can be used during shoulder replacements to significantly reduce blood loss from this procedure in a double-blind prospective randomized trial.
This study helped our Institute change how we care for patients in the operating room, demonstrating that tranexamic acid can be used successfully to decrease post-operative complications. The insight gained from this research supported the shoulder community’s march toward less invasive methods for performing shoulder replacements.
For more than a decade, our practice has been focused on the development and ongoing improvement of minimally invasive shoulder replacements. Our work has helped develop a novel technique for minimally invasive rotator cuff repair, sparing the patient from total shoulder replacement. We also developed the technique for the first all arthroscopic shoulder replacement using cartilage grafts.
The improvements and innovations our team has developed have enabled me to become one of the largest volume total shoulder replacement surgeons in the country, and the highest volume outpatient shoulder surgeons in the United States.
Our published research can be found here.
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The Cleveland Shoulder Institute treats patients with all types of shoulder and elbow disorders resulting from traumatic injuries, arthritis, instabilities, rotator cuff and sports-related injuries. Led by internationally recognized Orthopedic Surgeon Reuben Gobezie, MD, the institute provides both surgical and non-operative treatments.
Dr. Gobezie is founder/director of The Cleveland Shoulder Institute and Regen Orthopedics. For more information, visit clevelandshoulder.com or regenorthopedics.com.
How can stem cells stop pain?
Innovations in regenerative medicine are changing the game in orthopedics
Regenerative medicine is breaking new ground every day. In orthopedics, we are now able to use your own adult stem cells to stop pain, heal injuries and even regenerate lost cartilage. The Cleveland Shoulder Institute offers this non-surgical option through our Regen Orthopedics practice. Not just for shoulder pain, the procedure has been especially helpful to patients with knee arthritis. Some of our patients have been able to stop taking pain medicine or have been able to avoid a joint replacement following a Regen procedure.
How does it work?
Regenerative treatments work by activating the body’s natural healing process to stimulate tissue regeneration and activate healing. These simple procedures take healthy, regenerative cells from either your fat tissues or bone marrow from the hip area, where they are more concentrated, and injects them into the injured area of the body. This activates your body’s own adult stem cells and blood platelets to reduce inflammation, stimulate healing and speed repair for bone, muscle, joint, soft tissue and nerve injuries.
Unlike cortisone injections, regenerative procedures can repair the injured area, rather than simply blocking the pain. The treatment is outpatient and takes just a couple hours. As the stem cells begin to do the work in your body, most patients report an improvement in pain and function within a few weeks and continue to improve for several months as the healing process continues. Ultimately, pain relief can last for several years.
Can anyone have this procedure?
Regenerative medicine is an alternative for those who have been recently injured or who have chronic pain, as well as those who are looking to avoid surgery, prolong the need for surgery, or who just may not be a candidate for surgery. Some patients consider it to avoid ongoing steroid treatments. There are rarely age limits to these procedures. The physician will decide at the initial consultation if you are a candidate.
In most cases, these therapies are helping patients who have failed conventional treatments such as anti-inflammatory medications, cortisone injections, physical therapy, surgery and rest. The first step, is to find out if you are a candidate. We start with a consultation to evaluate the injury and explore individualized treatment plans for each patient. The initial consultation is covered by insurance. The success rates of the regenerative procedures depend on many factors and will be discussed once the doctor has reviewed your individual condition.
Visit Regenorthopedics.com for more information or call us to set up a consultation at 844-786-2355.
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The Cleveland Shoulder Institute treats patients with all types of shoulder and elbow disorders resulting from traumatic injuries, arthritis, instabilities, rotator cuff and sports-related injuries. Led by internationally recognized Orthopedic Surgeon Reuben Gobezie, MD, the institute provides both surgical and non-operative treatments.
Dr. Gobezie is one of the country’s top specialists in advanced arthroscopic and open surgical techniques to restore damaged joints, ligaments and bones. He is also one of the most experienced and highest volume shoulder surgeons in the country. A number of studies have shown that surgical volume, the number of surgeries a surgeon performs each year, is a strong predictor of patient outcome. The more surgeries that a doctor and his surgical team performs, the better the results for patients.
Dr. Gobezie is founder/director of Cleveland Shoulder Institute and Regen Orthopedics.
Feeling the pain of shoulder impingement syndrome
Shoulder impingement syndrome can best be described as a recurring ache/pain on the outside upper part of your shoulder when you raise your arm to shoulder height
Sometimes referred to as swimmer’s shoulder, this syndrome is common with people who perform repetitive arm rotations when exercising or working. These types of repetitive stress injuries are also common in those with assembly line jobs.
Impingement syndrome occurs due to pinching and inflammation of the rotator cuff tendon and bursa in the space below the acromion (see photo). The pain is worse when the arm is raised away from the body. It is a very common condition that, if diagnosed early, can be treated very effectively.
Impingement usually occurs from repetitive and chronic compression of the rotator cuff tendons in the subacromial space. These tendons help hold your arm in place, provide shoulder stability and enable movement.
Damage to any one of the four rotator cuff muscles could result in inflammation and swelling and general pain in shoulder, or cause shoulder impingement. Rotator cuff tears and impingement problems can exist separately or together. It is possible that rotator cuff tears are the result of impingement syndrome and age-related changes within the rotator cuff tendons.
Additionally, aging patients may develop arthritis which can cause bone spurs (boney growths formed on a normal bone) these further narrow the space below the acromion causing impingement (see photo). Again, this is common in older patients who participated in sports such as swimming, tennis, racquetball, baseball or work activities that require overhead positions.
Exhibit 2
Unlike some rotator cuff tears, impingement symptoms are marked by pain. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse, for example, will hurt. Overhead motions tend to increase the pain drastically. The discomfort usually increases at night due to the amount of inflammation that builds during the day.
Before you see the doctor
The first course of action is to reduce the swelling and pain. Things you can try at home include:
- Applying ice
- Wearing a compression sleeve
- Discontinuing any activities that may have contributed to overuse of the shoulder
If the shoulder pain doesn’t go away or worsens, see a shoulder specialist. It’s important to properly diagnose your condition to ensure you’re getting the best treatment. A specialist will evaluate your X-ray or MRI and determine a care plan. Non-surgical treatments may include activity modifications, physical therapy and/or a cortisone shot to ease the pain. If there is no improvement in your strength or the injury worsens over time, surgery may be the best option to restore function and alleviate pain. We’re here to help. Call 844-SHOULDR (844-746-8537) to schedule an appointment.
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The Cleveland Shoulder Institute treats patients with all types of shoulder and elbow disorders resulting from traumatic injuries, arthritis, instabilities, rotator cuff and sports-related injuries. Led by internationally recognized Orthopedic Surgeon Reuben Gobezie, MD, the institute provides both surgical and non-operative treatments.
Dr. Gobezie is one of the country’s top specialists in advanced arthroscopic and open surgical techniques to restore damaged joints, ligaments and bones. He is also one of the most experienced and highest volume shoulder surgeons in the country. A number of studies have shown that surgical volume, the number of surgeries a surgeon performs each year, is a strong predictor of patient outcome. The more surgeries that a doctor and his surgical team performs, the better the results for patients.
Dr. Gobezie is founder/director of Cleveland Shoulder Institute as well as Regen Orthopedics.
Postoperative Care for the Shoulder
Many family members have asked us how to best prepare for post operative care of the shoulder. The key thing to remember about any healing process is to respect it. It takes time. The patient should have someone ready to help drive them home from the procedure and help at home for the first few days after surgery.
Controlling pain during the first few days is essential. Most physicians send their patients home with a limited amount of pain medication. These should be taken according to the exact recommendations of the patient’s doctor. The patient should not drive while on pain medication. Be prepared to help with meals and/or run errands as needed.
The most important way to control pain is to properly support the arm. Help the patient adjust the arm sling when they are standing up. Gravity will help, and the arm will hang comfortably. Most doctors recommend wearing the sling when walking around and while sleeping. They will be able to take it off while sitting, resting or showering. You don’t want the sling to be too tight. No pressure should be applied to the surgical sight.
Ice is crucial for recovery and pain relief. Icing the surgical site for 15-20 minutes every few hours is highly recommended. We have had patients purchase in-home ice therapy pumps that can be very helpful with post-operative pain control.
Showering can take place 24 hours after surgery. The patient should not be afraid that dressing him or herself will injure the shoulder. But they may need to avoid certain movements depending on the doctor’s orders. They should be able to provide their own basic care. It will be easiest for patients to wear shirts that button up the front. A necessary task for you to do is to check the surgical site for signs of infection. Complications are rare, but you should report increased drainage or bleeding, redness, fever, swelling or pain at the surgical site to the patient’s doctor.
It might help to have a reclining chair to sleep in or a large pillow to support the whole back while sleeping. Some of my patients keep a small pillow behind their upper arm to lift their elbows forward, but you don’t want the patient to rest their elbow on anything that causes the shoulder to push up.
Make sure the patient starts physical therapy exercises as directed. It is the most important part of the follow up treatment. Chances of a full recovery increase when exercises are done regularly. Offer encouragement, and ask about the specific exercises before the surgery so you can be prepared once they are home.
All normal activities should continue as tolerated. The patient should not smoke, drink any alcohol, make any weighty decisions or sign any legal documents within the first 24 hours after surgery.
Orthopedic Surgeon, Reuben Gobezie, MD, is an internationally recognized leader in the care of shoulder injuries. He treats patients with all types of disorders resulting from traumatic injuries, arthritis, instabilities, rotator cuff and sports-related injuries through the Cleveland Shoulder Institute with locations in Beachwood, Concord and Westlake. Dr. Gobezie is founder/director of The Cleveland Shoulder Institute and Regen Orthopedics. For more information, visit clevelandshoulder.com and regenorthopedics.com.
Reuben Gobezie, MD
Cleveland Shoulder Institute
844-SHOULDR or 844-746-8537
Made by Hand (and Shoulder) – Patient Testimonial
Richard Grell, Hudson, Ohio
Facing the decision to have a total shoulder replacement surgery isn’t easy for anyone. For Richard Grell, the idea was very intimidating. As an expert Windsor chair maker for the last 45 years, Richard is completely reliant on having two strong shoulders to make a living.
The detailed work involved in making these chairs in a traditional manner includes using a variety of specialized tools to cut and grate the wood evenly. The craftsmanship and work involved in the cutting of the timber, then splitting, shaping, steam bending, carving, turning, finishing and painting each piece is incredible. Many have compared this type of detailed and artistic carpentry work to a form of sculpting. Each of Richard’s hand-crafted pieces of furniture is shaped from solid pieces of wood, made straight from the trees and shipped to clients all over the world.
When Richard injured his shoulder doing yardwork, it was immobilized to the point he couldn’t use it at all. He was relieved to learn from his primary care doctor that we had one of the best shoulder surgeons in the country living in Northeast Ohio.
“When I first met Dr. Gobezie, I knew it was a great opportunity to meet someone who was passionate about what they do. He explained everything, and gave me great confidence in what I was about to undergo,” said Richard.
Dr. Gobezie diagnosed Richard’s massive rotator cuff tear and recommended the total reverse shoulder replacement. He knew how important it was for Richard’s shoulder to be back to full mobility as soon as possible. Richard was counting on this.
A reverse total shoulder replacement switches the articulation in the shoulder, a ball is now being implanted on the shoulder socket side, and a new socket is put in place of the native humeral head. The deltoid muscle now acts as the major contributor to the shoulder movement instead of the rotator cuff muscles. Typically, patients are instructed to stay in a sling for one week after surgery but can get out of it to use the arm for their daily living activities. One possible drawback to repairing the shoulder using the reverse procedure is that patients may not be able to reach behind their back as well. However, most of the patients show incredible improvement in the first couple of months and by one year, will have maximum range of motion.
“I had my surgery on a Monday. Tuesday, I went home and started my physical therapy and was back in my shop working on Friday,” said Richard, who was extremely careful and followed Dr. Gobezie’s advice and instruction when he started his physical therapy program.
A year after his surgery Richard received the largest commission he had ever had from the University of New England. The project called for 56 chairs, some set tea and tea tables. “I worked on the commissioned project for seven months straight, only taking off a few days for holidays, and my shoulder never gave me the slightest problem. The wood chips under the bench were like a mountain,” said Richard, who maintained his physical therapy exercises while he was working on the project. It was a great test of his shoulder strength, and he passed with flying colors.
Luckily, staying mentally and physically active helped to set Richard up for success. As everyone ages differently, Richard’s active lifestyle played a pivotal role in his speedy recovery. Richard had always stayed active while working on the farm he and his wife, Gay, purchased from his grandfather.
“I have had friends with shoulder issues; some with surgeries of varying degrees of success with other doctors. My experience with Dr. Gobezie and his staff was so positive I have recommended him and will continue to recommend him highly,” said Richard.
Shoulder pain from Playing Golf
Though golf is considered a moderate risk activity, an in-depth look at golf reveals that overuse and poor technique can result in serious injury. At first glance, the golf swing may appear to be a relatively simple move. However, the swing requires a synchronized effort of muscle strength, timing, and coordination to generate high club-head speeds, often more than 100 mph.
Golf injuries originate either from overuse or from a traumatic origin and primarily affect the elbow, wrist, shoulder and the lumbar area. In regards to shoulder injuries, the lead shoulder, or the left shoulder in the right-handed golfer, is particularly vulnerable to injury. Common shoulder problems affecting golfers include rotator cuff tears, long head of the biceps tendon injuries, shoulder impingement, osteoarthritis, and shoulder joint instability.
Most patients sustaining a golf related shoulder injury will respond to nonsurgical treatment, such as rest and a physical therapy program including: (a) muscular strengthening and flexibility; (b) a pre-game warm-up routine; and (c) the adjustment of an individual’s golf swing to meet their physical capacities and limitations through properly supervised golf lessons.
At the Cleveland Shoulder Institute, we highly encourage the adoption of our “Five Week Interval Golf Program.” This is a structured progressive rehabilitation program aimed at accelerating the return to play golf for our patients who suffered a shoulder injury or after undergoing a shoulder related surgery. This program is comprised of a set of several swings using different clubs performed three days a week, for four weeks. By the fifth week, our patients can enjoy a game of nine holes. For a copy of this golf interval program, visit http://bit.ly/clerehabgolf.
Golfers who fail to respond to nonsurgical treatment options can often return to competitive golf after appropriate surgical treatment. For more information on shoulder anatomy, disease, surgery and management, please call 844-SHOULDR (844-746-8537).
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Dr. Gobezie is founder/director of Cleveland Shoulder Institute as well as Regen Orthopedics.
Shoulder Pain at Night
One of the most common complaints I hear in my office is that a patient cannot sleep due to shoulder pain. They tell me that no matter what side they try to sleep on, it still hurts. Some patients report stiff or dull pain that becomes worse when they raise their arm or shift from side to side. Other symptoms may include numbness and tingling in your fingers or a muscle spasm.
What’s going on?
The shoulder is one of the most agile joints of the body, allowing movement in all directions. Because of this, it can be more susceptible to injury. Painful conditions may also arise from overuse due to a specific activity or shoulder motion that you make repetitively. Any repetitive shoulder motion can cause an overuse injury, but racket and ball throwing sports are common culprits.
Typically, shoulder pain that gets worse at night may be caused by bursitis, tendinopathy or an injury to the rotator cuff.
Bursitis is an inflammation of the bursa, which is a fluid-filled pad that provides a cushion to the bones of the joint. When injured, fluid in the bursa increases and this swelling can be painful.
Biceps Tendinopathy is usually the result of long term overuse and deterioration of the biceps tendon that connects muscles and bones in the shoulder joint. Tendons may also get less flexible as we age, and more prone to injury. Tendinopathy is often part of the aging process. Biceps tendinopathy can give sharp pains in the arm with certain motions like reaching behind you.
Rotator cuff injuries usually involve a tear in these tendons. The rotator cuff includes four muscles that come together as tendons and connect your humerus bone to the shoulder blade. The cuff provides shoulder stability and enables movement. Damage to any one of the four muscles could result in inflammation, swelling and general pain in shoulder. Rotator cuff tears are a very common problem and may result from a fall or lifting something too heavy, too fast. But most tears occur as the tendons wear down over time.
Before you see the doctor
The first course of action is to reduce the swelling and pain. Things you can try at home include:
- Take anti-inflammatory medications such as ibuprofen, naproxen or acetaminophen
- Sleep in a recliner
- Apply ice or heat
- Wear a compression sleeve
- Discontinue any activities that may have contributed to overuse of the shoulder
If the shoulder pain doesn’t go away or worsens, see an orthopedic specialist. It’s important to see a doctor who specializes in shoulder care to properly diagnose your condition to ensure you’re getting the best treatment. The doctor will evaluate your X-ray or MRI and determine a care plan. Non-surgical treatments may include activity modifications, physical therapy and/or a cortisone shot to ease the pain. Newer treatments involving regenerative medicine may also be an alternative. This is typically the use of your own blood platelets or stem cells to heal the injured area. More information on these types of treatment can be found at our sister practice Regen Orthopedics.
If there is no improvement in your strength or the injury worsens over time, surgery may be the best option to restore function and alleviate pain.
We’re here to help
We would be happy to evaluate your shoulder condition or provide a second opinion. Call 844-SHOULDR (844-746-8537) to schedule an appointment.
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The Cleveland Shoulder Institute treats patients with all types of shoulder and elbow disorders resulting from traumatic injuries, arthritis, instabilities, rotator cuff and sports-related injuries. Led by nationally recognized Orthopedic Surgeon Reuben Gobezie, MD, the institute provides both surgical and non-operative treatments.
Dr. Gobezie is one of the country’s top specialists in advanced arthroscopic and open surgical techniques to restore damaged joints, ligaments and bones. He is also one of the most experienced and highest volume shoulder surgeons in the country. A number of studies have shown that surgical volume, the number of surgeries a surgeon performs each year, is a strong predictor of patient outcome. The more surgeries that a doctor and his surgical team performs, the better the results for patients.
Dr. Gobezie is Founding Director of The Cleveland Shoulder Institute , Regen Orthopedics and PT Genie.
