Physical Therapy
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Patient Perspective
Interview with Jeremy McVay – Physical Therapist for University Rehabilitation, Providence RI, 02912.
Conducted 4/29/04 by Matthew Whitson.
MW : Jeremy, could you first give us some background information regarding your education and position at University Rehabilitation?
JM : I am a Physical therapist. I went to college at King College in Bristol Tennessee. I got my masters from East Carolina University in Greensboro, North Carolina, in Physical Therapy. I am currently enrolled in a Doctoral of Physical Therapy program at Simmons College in Boston, and should finish within the next few months. I have been at University Rehabilitation for a year and one month. I have worked with other orthopedic surgeons for another year and a half. Before that, I was in different clinical rotations at many different hospitals.
MW : Now how often do you actually deal with Rotator Cuff Injuries or Shoulder replacement?
JM : I deal with Rotator Cuff Injuries everyday, and Shoulder replacements, I have dealt with 3 full shoulder replacements and one hemi-arthroplasty, which is kind of a half of shoulder replacement where they replace the ball of the shoulder, but not the socket.
MW : Who has gotten these injuries the most?
JM : The shoulder replacements were mostly elderly patients with severe osteoarthritis. I have dealt with many athletes with rotator cuff injuries, including basketball players, swimmers, baseball players, most over head athletes, football players, I think I've seen lacrosse. I've seen crew… tennis, squash players.
MW : For a Rotator Cuff injury, what is the standard recovery time until athletes can be back in action?
JM : That is a good question, and it depends on what is causing the injury. For a typical tendonitis, for an athlete that can be 2-6 weeks; for a partial rotator cuff tear, usually around six weeks. For a full rotator cuff tear, and surgery is used to repair, then you are talking probably four to six months to return to full athletics.
MW : If we focus on the full rotator cuff repair, what is the standard program that you go through with these individuals to bring them back to full speed?
JM : That is a very complicated question, and it varies with the surgeon. Most surgeons have protocols of their exercises or their precautions for the patient. For the most part, you start with very simple exercises trying to get the shoulder moving the first two weeks after surgery. You want to keep the shoulder moving and keep the muscles from tightening in the shoulder, and keeping the scar tissues from tightening around the shoulder. Then after the first two weeks, you are working on increasing that range of motion, even more using other methods. And then after the first four to six weeks, depending upon the surgeon, you are doing more strengthening activities, and then you slowly build up the strength until you start doing sports related activities, such as going through – for a baseball player for example, through the throwing motion; slowly and slowly building up their muscle resistance. There are throwing programs that you may do after the standard rehabilitation. A lot of it depends upon the surgeon. Some surgeons are extremely cautious and some surgeons are more aggressive. The surgeons dealing with athletes tend to be more aggressive. Most athletes, I'm seeing them the first or second day after surgery.
MW : Have seen a difference in the recovery depending on when you start the rehabilitation?
JM : It's probably a ten fold increase. If you start early, it goes so much faster. The difference is incredible. The problem is, once someone isn't moving the shoulder around, all the connective tissue and the scar tissue tend to bind down. And it's more and more difficult to stretch out the shoulder, get it moving again. And it's much more painful for the patient.
MW : What is the overall impact that this surgery has on the patient for their day to day life?
JM : You can drive or use your arm at all for the first six weeks. You can't lift your arm above shoulder for the first one, maybe two months. It severely limits what you can do with that arm, especially if it's your dominant arm. It makes brushing your teeth, or getting dressed difficult.
MW : What about for athletics?
JM : When the muscle has been torn and it has been repaired, it usually never gets back to one hundred percent of what it was before. It depends on how who you are and how hard their training. With the athletic population, I find that they get 90-95 percent of what they were able to do before. But a lot of it depends on the extent of the tear and the skill of the surgeon plays a big part in it too. If you have a surgeon that is using old techniques or isn't extremely skilled, then the patient is going to do extremely different than if someone has an extremely skilled or that is using new techniques.
MW : What would be the major setback that an athlete would encounter trying to get back to that 90-95 percent performance level?
JM : Major setbacks would include if the person can't tolerate the pain very well. Shoulder surgery/recovery is one of the most painful there is; probably is the most painful there is in terms of joint replacement and some people can't tolerate it very well. Usually athletes don't fall in that category. They are usually the ones that push the hardest, and are trying to get back the hardest because it is a huge part of their life. Rather than just using their arm, this is what they do for their living or for their pleasure – this is a really important thing for them. Other setbacks could be… there have been instances where the rotator cuff can tear again if you push to hard, or if they do something with their shoulder when they are not supposed to. For instance, I was at a lecture last week in which I heard a local orthopedist surgeon give a talk about the total shoulder replacement. And the only total shoulder replacement that he had where the muscle broke loose was where the patient mowed the lawn two weeks after surgery. Those would be huge setbacks, or even something where they would have to go back in and do surgery again.
MW : Let's turn over to the full shoulder replacement. What activities do you do with the full shoulder replacement, and how do these differ from the exercises for rotator cuff repair?
JM : The total shoulder replacement, you usually don't get a hundred percent of the range of the motion. If your expectation after rotator cuff surgery is to get 170 or 180 degrees of motion, with 180 degrees being normal. After total shoulder replacement, you are looking to get 145 degrees of active range of motion. So what you are expecting to see after surgery is a lot less. The difference in the rehabilitation with the total should replacement, a lot of times you have to be more careful with the range of motion so you can't push them quite as hard. But a lot of times it takes longer for them to come back as well because the shoulder is not moving exactly as it was designed to. I have seen someone get 170 degrees range of motion, and another that only got ninety degrees range of motion.
MW : Could an athlete ever go back to their sport after full shoulder replacement?
JM : At this point in time, the technology for a full shoulder replacement is not at the point where an overhead throwing athlete, lets say a baseball pitcher, could not go back and excel at his sport. In the future that may be possible as the replacement pieces get better and better. Over the last forty years there has been an incredible difference in total shoulder replacements and how well they have done. But at this point in time, the technology is not there. In terms of an athlete, lets say a hockey player, a sport in which the plane of motion, or where the elbow does not need to go above the shoulder quite as often, they may be able to return to athletics. It depends on the surgeon, and how strong the surgeon thinks the replacement is. One of the problems with total shoulder replacement is the part that is in the inside where the ball rests can break loose. So if you are playing a sport that runs that risk, the replacement can break lose.
MW : My last question for you is this, what else do you think that people should know about recovering from a rotator cuff injury or a shoulder replacement injury?
JM : I think that a lot of time people are scared of rotator cuff surgery, because they are uncertain about it or scared that it will hurt worse or not work. I think that if you are with a good surgeon, most of the times it comes out well. I think that with the athletic population, they need to know that when you get cortisone shots will weaken the tissues inside and while they may hide the pain for a while, the cortisone shots, even just a few, will weaken the tissues. That is something that sports doctors won't tell you. That is probably the most important thing for athletes with rotator cuff repair. In terms of shoulder replacement, I think for the athlete it is uncommon and in the very extreme cases. This would happen not so much in athletics, but in something more intense like a car crash.
-- End of interview.
Created by: Blair Smith, Connie Lee, Daniel Solomon, Matthew Whitson and Stephanie Chang
Date last modified: 5/2/2004