Sunday, October 18, 2015

Ream and run: doctor-patient dialogue during recovery

This is the type of dialogue that is typical after the ream and run.


(To the patient, a surgeon) 
In answer to your questions
(1) it is very important that you bring along your overhead strengthening very carefully in that there is a risk of injuring your rotator cuff.
Make sure each exercise can be repeated comfortably at least 20 times.
(2) same rule for pushups. Start with table pushups then push ups from the knees etc. Do not cause any discomfort that lasts more than 30 minutes afterwards.
Best wishes


Oct 2015

(From the patient)

I wanted to check in as I’m coming up on one year since the surgery. 
I won’t be able to make it up to see you just yet - my schedule is just too busy right now - but I do want to have one more visit/check-up with you, and will schedule in the new year.
I’ll get the 1 year X-rays, and get those  sent up or emailed to you.

Overall, I think I’m doing great!   My SST score on the 1 year survey was 11 !!
I’ve  never had any of that pain (in the antero-medial aspect  of the shoulder) again.  My range of motion has remained just about equal to my right shoulder, with the exception of the posterior capsule stretches. (It’s slowly getting better every month, but not equal to other shoulder.) 
I’m back operating at full strength, able to do all of my surgeries - even the bigger open cases -  pain free!

Just a couple of questions for now:
1. Is it Ok to start doing overhead strengthening exercises for my shoulder?  
While I’ve been gradually increasing the weight lifted during the incline presses, I have not yet done any overhead lifting (e.g., military press type exercise). I’m not looking to lift any heavy weight, but just want to get some strength back in my shoulder.

2. Is there any exercise or movement I should avoid?At this point, is there any exercise or movement I should avoid? 
For example, I would like to be able to do push-ups again, but still have some pain in the shoulder when I’ve tried to do a push-up. I go back and try again every month or so, and I have less pain every time I try, but I do not want to do anything “bad”  that may affect the longevity of my new shoulder.

I want to thank you again for the great work you did, as well as all your kind help and guidance through the recovery process! I’ve been incredibly happy with the results so far, and expect that things will continue to get better during this second year!

All the best.

(From the patient)
July 2015 . 
I am definitely feeling better - my pain in the anteromedial shoulder went away after 4 or 5 days. 
Have been doing my daily stretching, and I continue to do the strengthening exercises without problem.

I haven’t gone back to try swimming yet - I’m debating when I should try that again. 
It seems unlikely I was aggravating the subscap with swimming, as I had been swimming 1-2x/week for 3 months prior, without a problem. So I really think it was the  external rotation stretching I was doing.

I  have attached the Xrays (it’s a little complicated to try to get a CD and send it up to you, so let me know if you can see them OK as an attachment to this email.  I’m happy to bring a CD in October/November when I come back for my 1 year appt).

Happy 4th of July !


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