As a follow up to our post on shoulder replacement surgery from Dr. Michael Cohn, he explains here post surgical recovery, what it is like and what you can expect in terms of pain and healing.  

Dr. Michael Cohn practices at the Orthopedic Center of Palm Beach County.  He is an expert at performing shoulder replacement surgery.  He welcomes second opinion consultations with regards to shoulder replacement surgery and evaluates each individual on a case by cases basis.  

​By Michael A. Cohn, M.D. 

You may undergo a total shoulder replacement, reverse total shoulder replacement, or another variation of shoulder replacement depending on your particular situation.  The surgery typically takes about an hour.   
 
I believe in minimizing postoperative pain as best as possible.  Your operated arm will be numb from the regional anesthesia, which also can provide good pain relief for the next day.  In most cases, a long-acting local anesthetic will be infused at the surgical site before you wake up from anesthesia giving additional pain relief for 24-48 hours after surgery.  An ice pad will also be applied to your shoulder before you wake up to help with pain and swelling. 
 
After surgery, you will be moved into the recovery room where you will stay for approximately one hour.  During this time, you will be monitored until you fully awaken from anesthesia.  If done in the hospital setting, you will be taken to your hospital room.  If your surgery is done as an outpatient, you will be discharged to home with a family member and will be monitored at home that evening by a visiting nurse.
 
After surgery, you will feel some pain that will be managed with medication to make you feel as comfortable as possible.  When you are able to move your hand, begin making a fist and holding it for five seconds.  This small exercise helps to keep your blood circulating and should be done frequently.
 
Your arm will be in a sling for four to six weeks after surgery, aside from physical therapy and home exercise sessions.  This is to protect your shoulder replacement and to allow the soft tissues to heal around your shoulder.
 
Postoperative Concerns
 
Total shoulder replacement is a very successful operation and the 10-year survival rate is about 90 percent.  Most patients end up with extremely functional shoulders and are able to return to the activities of daily living and low impact sports without pain.  Any type of operation can have complications, although they are very rare. Complications of shoulder replacement surgery may include infection, bleeding, shoulder instability, tearing of the rotator cuff, fracture and loosening of the prosthesis.  Most of these concerns can be minimized by carefully following the postoperative instructions.
 
Physical Therapy
 
You will be prescribed a physical therapy program on your first postoperative visit.  The rehabilitation process will take 3-4 months typically and involves a progression of stretching and strengthening exercises to restore your shoulder’s function in a careful fashion. 
 
Medications
 
You will be given prescriptions for pain medication and anti-inflammatory medicine. Use the pain medication only if you are experiencing pain. Take the anti-inflammatory as prescribed.
 
Caring for Your Incision
 
Keep your surgical dressing clean and dry.  The dressing can be changed daily upon your discharge from the hospital with a dry gauze pad and Tegaderm (clear adhesive tape).  It is common to have a small amount of blood on the dressing.  Do not shower or go in the bath until you return for your follow-up appointment. The incision has not healed yet and getting the incision wet puts the shoulder at risk of infection.  After the stitches are removed, you can take a shower and let the water run over the wound.  Do not go into a tub or Jacuzzi to soak the wound for 3-4 weeks.  Pat the wound dry after you finish showering and apply a new dressing during the first 3 weeks.
 
Physical Activity
 
You will experience some swelling and bruising of the hand and arm. This is normal and results from the swelling and bruising from your shoulder, which travels down the arm.  It is recommended that you bend and straighten your elbow frequently and make a fist to help keep your circulation flowing and help speed the resolution of this normal process.
 
Your arm will still be in a sling and it is recommended that you wear it when you are in public or moving around. If you are reading, watching television or working at a desk, you may loosen it. When you are getting dressed, it is easiest to put your operated arm through the shirt sleeve first, then put your sling on. You may use your arm to perform normal daily activities, such as eating, writing or shaving, but you may not lift any items or reach out suddenly until you are instructed that it is okay to do so.
 
Six weeks after surgery you can probably resume driving if you feel safe in doing so. At this time, I may also allow you to return to use of the operated arm at work, depending on how much physical activity is involved in your occupation. You will also start to strengthen your shoulder with physical therapy.
 
Follow-Up
 
During the first year following your surgery, routine follow-up visits will be scheduled.  You will be asked to return for annual visits thereafter to assess the status and function of your implant.





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In this day and age everyone has heard of acupuncture. Because of celebrities like Kim Kardashian posting pictures with needles in her face during her facial rejuvenation sessions, and athlete Kobe Bryant using it for ankle injury, acupuncture has made its way from the dark dungeons of Chinatown into the most prominent offices of Manhattan. Pain is the most common condition treated by acupuncture. However, many people do not know that this medicine has healing abilities that stretch far beyond just pain management.  Mila Mintsis, L.Ac. is a leading certified acupuncturist in New York City. She practices at Dynamic Sports Physical Therapy in Manhattan. She discusses here 5 things that you may not know acupuncture does.  

1.      Acupuncture decreases anxiety. 
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In our fast paced society, with increasing demands of work and family life and the challenges of finding balance between them, it is no wonder that such a high number of people suffer from anxiety. The statistics show an increase in usage of anxiety medications and in my practice, close to 90% of clients report feeling anxious on a near-daily basis. The bad news is that acupuncture will not solve your work or family problems. But the good news is that it will make you more equipped to deal with life’s challenges. Studies show that acupuncture increases production of endorphins, reduces prefrontal cortex activity and blocks production of stress hormones, which results in a relaxation response. Patients report feeling euphoric and experience a deep state of relaxation following treatments. Want to try acupuncture for anxiety but anxious about needles? Don’t be. People are often surprised by how gentle and comfortable of a procedure it is and many fall asleep during treatments.
 
2.      Clears up allergies. 

Allergies are an ever-present epidemic. You, as well as people you know, may be suffering from allergies. There are many theories as to why generations before us did not suffer from allergies as much as we do, but there are few solutions being offered. Recent studies have warned that allergy medications can impair brain function and increase the risk of dementia. Luckily, acupuncture can provide a relief from allergy symptoms without any side effects. There are two main mechanisms behind this effect: First, it modulates cytokines, which are secreted by the cells of the immune system and help to reduce inflammation.  Secondly, it reduces IgE levels, which are the immunoglobulins that react to allergens and produce the “allergic response”.  After treatments, people report reduction in nasal congestion, sneezing and itching and say they can breathe again. For best results, treatments must be done a few weeks before the allergy season begins. In addition, dietary modifications such as elimination of diary and sugar are recommended for longer lasting relief.
 
3.     Acupuncture can get you pregnant. 

Yup, you heard me right. After pain management, fertility is probably the most sought after treatment by acupuncture. Often performed in conjunction with Western medicine treatments, acupuncture has shown to increase the success of pregnancy rates. Acupuncture increases blood flow to the uterus; decreases anxiety and stress (which often come as a result of being unable to conceive), and regulates hormone levels.  Some studies show that receiving acupuncture before and after the embryo transfer in assisted reproduction therapies, greatly increases the odds of implantation, leading to live births. There are occasions where the man’s health impedes a successful pregnancy. Acupuncture has been found to improve sperm quality in cases of male infertility. In any case, it seems that both parties can benefit from treatments, to increase their odds of conception.
 
4.    Acupuncture helps digestion. 

Digestive complaints are another issue that has been plaguing our society. Often, when I ask my patients about their digestion, they will say that it is “good” or “normal”. Unfortunately, frequent bloating and infrequent bowel movements is the new definition of normal. Many are unaware that for good health, bowel movements have to occur daily, and frequent bloating is a sign that your body is not properly digesting the food and assimilating nutrients. Proper digestion starts with proper nutrition and Chinese medicine offers specific dietary plans according to your individual digestive issues. In addition to dietary changes, acupuncture can improve digestion by promoting the parasympathetic state, which is also known as “rest and digest”.  Most of us are constantly on the go and chronically stressed, which results in sympathetic dominance or “fight-or-flight mode”. It is our body’s way of responding to and dealing with stressful situations. This sympathetic dominance physically impedes proper digestion. Creating a favorable parasympathetic state, as acupuncture does, helps to heal digestive complaints.
 
5.     Acupuncture can get rid of your headaches.

Whether you suffer from tension headaches or migraines, acupuncture can help. A study conducted at Duke University, showed that acupuncture was better at treating headaches than aspirin. Other studies have proven acupuncture to be a valuable tool as well. Tension headaches differ from migraines and other headaches in their etiology and therefore acupuncture approaches each with a different strategy.  One of the reasons we get headaches is due to constriction of blood vessels, which reduces circulation, and can induce headache pain. Needle stimulation at specific areas on the body increases circulation and induces blood vessel dilation, which can alleviate pain. Tension or spasming in the upper back and neck muscles due to emotional stress or excessive computer use, can produce a referred pain into the head, causing tension headaches. Placing needles into involved muscle groups induces relaxation in the muscle tissue and eliminates headaches. During treatments, patients often describe a pleasant warming sensation in the back, and they feel immediately better. And most importantly, acupuncture is safe and has no side-effects, unlike some medications.
 
I hope this information was helpful and insightful. And remember life can be painful but suffering is always optional. Give acupuncture a try if you have any conditions discussed above.



 
 
References:
Duke Medicine. “Duke Study: Acupuncture Offers Better Headache Relief over Medication.” MyNC.com. Dec. 1, 2008.
 
Fang J, Wang D, Zhao Q, Hong Y, Jin Y, Liu Z, Zhou K, Jing X, Yu X, Pan R, Chang A, Liu H, Zhu B. “Brain-Gut Axis Modulation of Acupuncture in Functional Dyspepsia: A Preliminary Resting-State fcMRI Study.” Evid Based Complement Alternat Med. 2015;2015:860463. doi: 10.1155/2015/860463. Epub 2015 Nov 8.
 
Feng, Shaoyan, Miaomiao Han, Yunping Fan, Guangwei Yang, Zhenpeng Liao, Wei Liao, and Huabin Li. "Acupuncture for the treatment of allergic rhinitis: A systematic review and meta-analysis." American Journal of Rhinology & Allergy 29, no. 1 (2015): 57-62.
 
Fox, Maggie. “Acupuncture beats aspirin for chronic headache. “ Reuters. Mon Dec 1, 2008
 
He Y, Chen CT, Qian LH, Xia CL, Li J, Li SQ, Liu BP. [Acupuncture treatment of male infertility: a systematic review]. Zhonghua Nan Ke Xue. 2015 Jul;21(7):637-45.
 
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. “Acupuncture for tension-type headache.” Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587. doi: 10.1002/14651858.CD007587.
 
Melchart D, Weidenhammer W, Streng A, Hoppe A, Pfaffenrath V, Linde K. “Acupuncture for chronic headaches--an epidemiological study.” Headache. 2006 Apr;46(4):632-41.

N.P. "Common allergy medications could damage brain, increase dementia risk study finds." Cox Media Group National Conent Desk.  Updated: April 19, 2016-7:01AM
 
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. “Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.” Fertil Steril. 2002 Apr;77(4):721-4.
 
Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. “Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial.” Fertil Steril. 2006 May;85(5):1341-6. Epub 2006 Apr 5.
 
Xie Y, Wan W, Zhao Y, Ye Z, Chen H, Hong X, Wu L, Wang R, Yang J. “Impacts on the life quality of the patients with allergic rhinitis treated with warming acupuncture in winter and summer.” Zhongguo Zhen Jiu. 2015 Dec;35(12):1215-20.