Julie Meiste endured years of shoulder pain. Constant. No respite. Stab you in the upper arm and steal your energy kind of pain.
She lost so much function that she couldn’t put a fitted sheet on her bed or reach for food in her kitchen cupboards.
“I was really in bad straits,” the 84-year-old Holland, Michigan, resident said. “It kept getting considerably worse.”
Doctors gave three options—pain pills and ice, cortisone shots, or surgery.
“At one point I said I was not going to have surgery,” she said.
As intense pain continued to hammer her shoulder, she set up an appointment with Brian Paff, DO, an orthopedic hand and upper extremity surgeon.
“I was having so much pain and a lot of fatigue,” she said. “I would empty the dishwasher and have to sit down. I would empty the dryer and have to sit down. People say if you have a lot of pain, you have fatigue. I would sit down and ice it some more. My rotator cuff is completely gone.”
‘Light at the end of the tunnel’
In the early hours of Sept. 10, Julie arrived at a Spectrum Health Zeeland Community Hospital pre-op room to prep for surgery. Her daughter, Nancy, and son, Tim, accompanied her.
“I left the house this morning and said, ‘I’m coming home with a new shoulder,’” Julie said. “We’re off to a new start. It can’t be any worse. There’s light at the end of the tunnel.”
Hospital staff entered the room with forms for Julie to sign. She grimaced as she scratched her signature on the pages.
“Doing something like this, my shoulder hurts,” Julie said.
Next, Tara Anama, RN, handed a black marker to Julie and asked her to place an X on the shoulder they would be operating on.
“Everyone is going to be looking for that X,” Anama explained.
Anama told Julie she would be in the operating room for almost three hours, then spend half an hour to 45 minutes in the recovery room, before settling into a hospital room.
Anesthesiologist Brett Sprtel, MD, came in to explain his role in the surgery, formally called a right reverse total shoulder arthroplasty.
“We’re going to do a nerve block in your shoulder, then we’re going to get you off to sleep,” he said.
Julie told him that in the five weeks since she scheduled the surgery, the pain had become almost unbearable.
“I’ve been anxious to get this over with,” she said. “I’m just glad there’s something that can be done for it.”
As Julie spoke, Chad Pierce, a pastor from her church, entered the pre-op room to pray with the family.
“Hi Chad, nice to have you here,” Julie said.
Shortly before 9 a.m., Dr. Paff came in to ask if anyone had questions. He signed Julie’s right shoulder, then the patient said her goodbyes to her family.
“Love you to pieces,” Nancy told her mom.
“Good luck with your new parts,” Tim said.
Julie thanked her children for coming, and for all their help, as staff wheeled her gurney out of the room, down the hall, and into the operating room.
“We’re going to put the socket on the ball side and the ball on the socket side,” Dr. Paff said. “This allows for the muscles to drive the shoulder without a rotator cuff because she doesn’t have an intact rotator cuff.”
In the OR
As Dr. Paff set up his preferred music playlist for the surgery, at 9:10 a.m., with anesthesia on board, Julie drifted off to sleep.
Dr. Paff raised the operating table into a near-seated position, placed Julie’s right hand in a strap and secured her arm to a pole in a raised position to gain better access to the shoulder. He placed a towel behind her head, and draped her head and body with a cloth, so that only her shoulder remained visible.
At 9:44 a.m., he made the first incision. About 15 minutes later, he had a clear view of the inside of her shoulder.
“This is all really just worn down,” Dr. Paff said. “There’s no cartilage at all.”
As Paul Simon’s “You Can Call Me Al” played on the soundtrack, Dr. Paff drilled and removed the humeral head as an assistant opened boxes of new shoulder parts.
At 10:45 a.m., as Queen’s “Bohemian Rhapsody” played in the background, Dr. Paff put the new shoulder parts together and inserted a new ball. He placed his right hand inside her shoulder, moving and rotating Julie’s arm.
A minute after 11, he pieced the parts together inside her shoulder, rinsed the area and sutured the site.
“Everything went great,” Dr. Paff said. “We were able to get in there and gauge the severity. She had a very large cyst in front trying to make lubrication for the joint (1.5 by 3.5 inches). It didn’t know it was to no avail.”
Dr. Paff said on a scale of 1 to 10, with 10 being the worst shape, Julie’s shoulder graded out at 8.5 to 9.
“It’s hard to say which came first, the rotator cuff (demise) or the arthritis,” Dr. Paff said. “My suspicion is it was the arthritis.”
Dr. Paff stepped out of the OR and headed to the pre-op room to update Nancy.
“It went great,” he told her. “It looked pretty nasty in there, but that wasn’t a surprise really. She had an internal groove down the middle of her socket, almost like a small canyon.”
Dr. Paff said with such a surgery, patients typically can use their arm within six weeks and regain 80 to 85 percent of function within three months.
“The last 15 to 20 percent fills in in a year,” he said.
Nancy said her mom was game for the physical therapy necessary to complete the healing process.
“A million thank-yous from our whole family,” Nancy told Dr. Paff. “You’ve given her a new life, you really have.”
He told Nancy he expects great healing for her mom.
“I’m optimistic she’ll be one of those people who gets better fast,” Dr. Paff said.
His prediction proved prophetic. Fast forward two weeks. Julie and her daughter arrived for a follow-up appointment with Dr. Paff.
He removed her sutures and tested her range of motion.
“He says another week and I’ll be without my sling,” Julie said, a broad smile flashing across her face. “That’s progress. The ironic thing of this is I have not had one bit of pain. No pain since I came out of surgery.”
Dr. Paff said it’s not an uncommon report.
“When folks have really severe arthritis, they’re kind of in a bad enough place that it’s not uncommon to hear they don’t have much pain (after surgery),” he said. “Her motion is right where I expect it to be, and maybe slightly better than average. And it’s hard to improve on ‘no pain.’”
Julie said she’s thrilled with the results, and is committed to continuing to get stronger.
“I couldn’t ask for anything better,” she said. “I’m just so happy I had it done.”