Patient Perspective

Anatomical illustration of a shoulder

A sit-down between a shoulder replacement patient and his surgeon

by Celia Spell

Most health care providers pursue medicine to exercise compassion or empathy, but the speed of daily schedules and the number of daily patients can cloud that desire. Hearing from patients can serve as a reminder. In this article, we check in with Todd Fisher, a patient at MUSC Health, to learn more about the impact his health care providers had on him.

As a mechanical engineer in his 40s with an active lifestyle and a love for kayaking, Fisher knew his shoulder pain was holding him back. He had put off getting his first shoulder replacement on the right side for years because of fear, but the pain became unbearable. He came to MUSC Health to work with Josef Eichinger, M.D., an orthopaedic surgeon and professor of orthopaedics at MUSC Health, whom Todd jokes is another kind of mechanical engineer. Eichinger focuses on shoulder and elbow surgery, and he is also interested in sports medicine for overhead throwing athletes.

After seeing the results of his first shoulder surgery, Fisher realized just how bad the left side had become. Once the pain on the right side no longer eclipsed it, the pain on his left was thrown into relief. But he wasn’t nervous the second time around; he was ready. Eichinger sat down with Fisher to learn more about his experience with his reverse total shoulder replacement and his anatomic total shoulder replacement.

Josef Eichinger, M.D. Eichinger: Thanks for sitting down with me today, Todd. Could you tell me a little bit about your two shoulders and your discomfort prior to surgery?

Fisher: My range of motion was so limited in both shoulders. Every day when I’d go to put on deodorant, I would be reminded how bad it was. I was in near constant pain, especially during any kind of motion or activity. The pain started in high school with a combination of genetic instability and martial arts, but in the years since it had only gotten worse after my motorcycle accident.

Eichinger: On your right shoulder you have what is known as glenoid dysplasia, which basically means your socket didn’t form normally, and it can range from mild to severe. Yours was severe enough that it was contributing to your pain. That’s why we decided to go with a reverse total shoulder replacement. We flipped where the ball and socket are in your shoulder, which makes dislocation in the future much more difficult. What was it like leading up to that surgery?

Fisher: The surgery was a little scary upfront. I put it off for years because of that fear, but the pain just became worse, and I felt like I had nothing left to lose. I had such a small range of motion, and I was in constant pain. But this was the biggest surgery I had ever been through. I came into MUSC a week before the procedure to make sure I was healthy enough to undergo the procedure. Then the night before, they called me to let me know what time my surgery would be. I didn’t eat anything that morning, met with my anesthesiologist and the rest of the surgical team. They took me back for what felt like a long nap, and then I woke up wearing a sling. And the next day they send you home. Definitely not a bad experience, and I was especially surprised by how quickly I was able to stop taking painkillers.

Eichinger: We always try to limit our patients’ narcotic consumption, and we often explore other methods for treating pain. You were given a pump that provided localized general anesthesia to your shoulder, which helped curb any need for narcotic medication. So what about physical therapy? Could you tell me a little bit about that experience?

Fisher: Physical therapy was intense, but it was all muscular. The pain was gone, and I was left with weak muscles after not using them for so many years. It didn’t hurt, but I was very sore. It was like going to see a personal trainer who only cared about three or four of your muscles. And I did that for about six months. I was back to performing normal tasks like showering, getting dressed and driving after about six weeks, but it took six months of physical therapy before I was able to go back to activities like kayaking.

Eichinger: Now let’s talk about your left shoulder. How did it feel after your right shoulder replacement?

Fisher: The pain in my left shoulder had always been so minor compared to the right shoulder, but once I no longer felt that right-side pain, the left side started screaming at me. And I was no longer scared of the surgery since I had already experienced a successful one, so six or seven months after my other surgery, I was ready for the next one.

Eichinger: Since you’re so young, we talked about alternatives to another shoulder replacement, but ultimately decided it was our best option after realizing you didn’t have any cartilage between the ball and the socket of your left shoulder. It was just bone on bone with no space between, so we performed an anatomic total shoulder replacement. What was the recovery like for that procedure?

Fisher: Recovering from the left shoulder replacement was slightly easier than the right. Prior to surgery, I had decent range of motion. I had pain, but my muscles didn’t need to be retrained like with the right side. After only about four months of physical therapy, I felt like myself again.

Eichinger: And what are your pain levels now that it has been a few years since these procedures?

Fisher: Every so often I’ll feel a slight spasm of pain, but it’s always temporary and never anything close to what it was before surgery. I’m almost pain-free, and I can do anything I want now. I’m only limited by activities that would shorten the lifespan of my replacements, like operating a jackhammer or impact sports. But being in my 40s means I shouldn’t be doing those things anyway!

Eichinger: Technology is always changing, and these replacements have improved in recent years. Many patients will have 20 years before needing any part of it replaced, and others will go the rest of their lives without another replacement surgery. What would you think about needing another surgery?

Fisher: I would say it was still worth it. If after 20 years of having my freedom and independence back means I would need a relatively minor surgery to replace some of the equipment, it would be a success in my book.