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Thursday, June 30

Surgery Observation

Today in the OR had a visitor through my surgery observation program, Bob Daft from the Lear Corporation.  I hope Bob had a good experience today.

Thursday, June 23

MissOuri Smelting Technology (MOST) Site Visit

Jim Clements, myself, Lisa Angeles RN

This morning I had the chance visit Missouri Smelting Technology, or MOST, in Troy, MO.  I went with Lisa Angeles, RN case manager for one of my patients.  Jim Clements, the plant manager, did a great job of showing us what they do at MOST.  My sincere thanks to Jim for taking the time to show us around.  Also thanks to Katherine Shaw, the HR director, for setting everything up and allowing us to come out.  It was very helpful in allowing me to assess the physical demands of their work.  It was also just plain impressive.  Thanks again.

Wednesday, June 22

Can't sleep because of your shoulder?

Many shoulder problems cause difficult with sleep at night.  The #1 complaint that I hear in my practice is "I can't get comfortable at night."  In fact, my patients are often dragged in to see me by their spouse because their significant other tosses and turns all night.  Nighttime pain is often the most significant part of a problem with the shoulder.  Other complaints include difficulty with reaching above the head or behind the back, difficulty getting a bra on, or difficulty reaching into a back pocket.  Many times the pain radiates into the arm as well.
What causes nighttime pain?  One word: inflammation.  Inflammation is the root cause of many problems that affect the shoulder while resting.  Inflammation can  result from one of several different underlying problems.  Problems that cause inflammation include rotator cuff tendonitis or tears, "bone spurs", and arthritis in the shoulder.  Frozen shoulder also is the result of inflammation.  Of these, rotator cuff problems are the most common.
What can we do about it?  This time, it's a two word answer: cortisone shot.  Although cortisone injections are not the solution for every patient, they are often very helpful with nighttime pain.  They may completely eliminate the problem, permanently.  In other cases, they may help for weeks or months.  Besides cortisone shots, other treatments for shoulder pain are available.  These include anti-inflammatory medication and physical therapy.  Rarely, surgery may be necessary to correct a significant problem, such as a severely torn rotator cuff tear or large bone spurs which cause friction and rubbing.  For a very small group of patients with arthritis, shoulder replacement may be the best option.
A physical exam, x-rays, and sometimes an MRI are all necessary to establish a diagnosis.  Making an appointment when things have been going on for more than a week or two is often helpful to "nip it in the bud" and prevent the problem from getting worse.  Remember, it is not normal for a shoulder to be painful.

Afterword:  see my post about ultrasound-guided injections for more information!

Tuesday, June 14

Talk at the Missouri Division of Workers' Compensation Annual Meeting

Yesterday I had the pleasure of speaking at the Missouri Division of Workers' Compensation 17th Annual Meeting.  The subject of my talk was "Determining Causation in Rotator Cuff Tears".  The talk was a great chance to discuss the difficult question of what causes a rotator cuff tear.  Sometimes the cause is degenerative--wear and tear--and sometimes traumatic--from an injury.  I was happy to see many administrative law judges in the audience and had a chance to discuss the subject with several of them, including David Zerrer, Carl Mueller, and Tim Wilson.  I met the chief administrative law judge in St. Charles County, Grant Gorman, and have invited him to our practice to discuss issues in the law.