Home-improvement enthusiast gets her mobility back
In late summer 2003, Joyce Clarke was finishing a home-improvement marathon when she felt pain in her right shoulder. Through the fall, the pain worsened, and after a couple of outings with the snow blower in December, the only sensation in Clarke's right arm was a continual throbbing ache that left her unable to sleep.
"I had a feeling I'd torn something," says Clarke, 47, a registered nurse, whose work in Surgical Day Care and the Post-Anesthetic Care Unit at Melrose-Wakefield Hospital (MWH) includes pushing stretchers and lifting patients. "It was difficult to raise my arm above shoulder level."
Repairing cartilage damage caused by repetitive motionOnce she accepted that the injury was not going to heal by itself, Clarke says she turned to Christian Andersen, MD, an orthopedic surgeon who practices at both Lawrence Memorial Hospital of Medford (LMH) and MWH.
Dr. Andersen began by looking for clues in the history of Clarke's injury, the mechanism of the injury and the timeline of her symptoms. After a careful examination of her shoulder that reproduced the snapping and pain that Clarke had been experiencing, Dr. Andersen diagnosed her with a superior labral anterior-posterior (SLAP) tear.
SLAP tears occur when there is damage to the cartilage at the top of the shoulder, where the bicep tendon is attached. The injury is often caused by repetitive overhead motions, such as a long session of ceiling painting in Clarke's case.
Unlike many shoulder injuries, SLAP tears can be very difficult to diagnose. X-rays can rule out problems with bones but they cannot identify soft-tissue injuries such as SLAP tears. And because SLAP tears are often only detectable when the arm is in the position in which pain is experienced, even MRIs can fail to reveal them, says Dr. Andersen, who has performed more than 1,500 shoulder surgeries over the last 14 years.
Complex microsurgery available locallyDr. Andersen specializes in arthroscopic surgery, which he likens to "tying your shoes using a drinking straw, while looking in the rear view mirror." The arthroscope, he explains, is a pencil-sized, fiber-optic video probe that can be inserted into the joint through a small incision. This allows the surgeon to view images of the joint on a TV monitor, while using small probes inserted through narrow tubes to evaluate the joint and repair, reconstruct or remove damaged tissue.
The beauty of the technique, says Dr. Andersen, is that "you can sneak into small spaces without disturbing other tissue and organs to get there." He notes that MWH and LMH use arthroscopic techniques not only for diagnosis but also for complex surgeries - a level of surgical sophistication not seen in most community hospitals.
During Clarke's surgery, she received a scalene block to numb her shoulder nerves during and after the outpatient procedure. The nerve block, explains Dr. Andersen, reduces the need for anesthesia during the operation, which usually takes between 45 minutes and two hours, and extends pain relief - frequently up to 24 hours following the surgery.
Rehabilitation bolsters a painless healing processImmediately after surgery, Clarke was pleasantly surprised to feel almost no pain - just some stiffness in the shoulder. She used an ice cuff for several days to provide continuous cold therapy. At one week and one month follow-up consultations, Dr. Andersen was "very pleased" with the degree of mobility Clarke had recovered, and he recommended a course of physical therapy to strengthen and stretch the joint.
So under the guidance of MWH physical therapists, Clarke has been arm bicycling and doing upper-body push-ups. Ten weeks after her operation, Clarke says, "I'm back at work - and painting ceilings again at home."