All the Right Notes: Shoulder replacement surgery restores pianist’s quality of life

(October 3, 2013) Barbara Donne endured excruciating osteoarthritis pain in her right shoulder for many months, but when the agony affected her lifelong pastime — piano playing — she knew something had to be done.

Donne, 73, had retired from corporate life but kept up performing at concerts and teaching two dozen piano students. Cortisone injections and other medications, however, stopped making a dent in shoulder pain so bad she would awaken screaming in the night.

“I was compensating so much for the pain, I had absolutely no zip or energy to play the piano,” recalls the mother and grandmother. “It was almost all-consuming to deal with the pain and losing my range of motion, and my arm felt heavy and not responsive. I wasn’t able to live my life fully.”

Not wanting to become addicted to painkillers, the Centreville, VA, resident consulted with Ryan Miyamoto, MD, an orthopedic surgeon and sports medicine specialist at Inova Fair Oaks Hospital, about shoulder replacement surgery. Donne was stunned — and thrilled — to hear Dr. Miyamoto’s promise that the procedure would leave her right shoulder pain-free, and the replacement was done in June 2011.

Growing Trend
Shoulder replacement surgery, in which a plastic and/or metal joint replaces the damaged joint, is becoming more common as the population ages and refinements have been made in the replacement joint, which is designed more compactly than in years past. According to the American Academy of Orthopaedic Surgeons, about 53,000 people undergo shoulder replacement surgery in the United States each year (still a far cry from the 900,000 who have knee or hip replacement surgery). Replacement joints typically last for 15 to 20 years.

“I perform shoulder replacements multiple times every month,” says Dr. Miyamoto. “Even since four or five years ago, I’m seeing a big increase. I think the implants are more surgeon-friendly and are becoming much more anatomic, recreating the size and shape of the human shoulder. With better success rates, more people want it.”

Despite improvements to the implants, minimally invasive surgery for shoulder replacement isn’t an option. However, for many patients only a 4-inch incision on the upper shoulder area is required, and Donne was able to confidently wear a semi-strapless dress to a wedding two months after her surgery.

Smooth Recovery
After an uneventful two-day hospital stay, Donne dealt with typical post-surgical pain for a few weeks, during which time she had her arm in a sling and packed with ice around the clock. Physical therapy to stretch, flex and strengthen the shoulder area began while she was still in the hospital and continued regularly for almost six months.

“What also enhanced my recovery was the physical therapists kneading and massaging the scarred area so the scar tissue didn’t build up. I still rub it there to keep it loose,” Donne explains. “It was a gradual recovery . . . at first I could hardly dress myself, then I could put the dishes back on the shelf from the dishwasher, then I could put on my necklace. Now I don’t think about those things — I just do them.”

True to Dr. Miyamoto’s word, Donne’s right shoulder is now pain-free, and she’s considering the surgery for her left shoulder, which is also arthritic. Donne was able to play piano pieces using only her left hand while recovering and is now back to full-scale performing and teaching.

“It’s given me the stamina I need, and I have all the strength I ever had,” Donne says. “I thought it was a miracle.”

Why Shoulder Replacement?
Your doctor may recommend shoulder replacement surgery for a variety of reasons, especially if nonsurgical treatments such as medications and activity changes no longer help relieve pain. Patients who benefit typically have the following conditions:

– Osteoarthritis of the shoulder joint, an age-related condition where the cartilage that cushions the bones of the shoulder softens and wears away.
– Shoulder fractures, especially when the bone breaks into four or more pieces and would be difficult to repair.
– Avascular necrosis (also called osteonecrosis), which occurs when the blood supply to the bone is disrupted by factors such as chronic steroid use, alcohol abuse or sickle cell disease.

Goals and Benefits of Surgery
Every surgery carries risks, but shoulder replacement surgery can offer several distinct improvements to patients’ quality of life. According to Ryan Miyamoto, MD, an orthopedic surgeon and sports medicine specialist at Inova Fair Oaks Hospital, replacing a damaged shoulder joint with prosthesis typically produces the following benefits:

– Pain Relief: Discomfort from arthritis, broken bones and other conditions necessitating surgery is gone.
– Better Range of Motion: Patients can expect to be able to use their joint normally, bending and flexing in all directions.
– Improved Strength: Patients often report that their shoulder feels as strong as it did before developing the problem that prompted surgery.

Shoulder surgery questions?  Call 703.504.4550 or visit inova.org/shoulderprogram

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Click to see more news and articles from Inova Fair Oaks Hospital in the Summer / Fall 2013 issue of INhealth magazine:  Read more