Ream and Run by Dr. Matsen

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Topic Title: Ream and Run by Dr. Matsen
Created On: 09/27/2010 10:28 AM

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 06/08/2012 09:28 PM

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misty3

Posts: 132

You are asking some tough questions that there just are not answers to. I also contacted Matsen and he blew me off because I had been in so much pain (from tendon and bone injury) that I had to take narcotics for awhile just to function. He said anyone who takes narcotics is a poor surgical risk. I did go back and forth with him - not impressed.

Gobezie is my surgeon now - I had two surgeries elsewhere, he did two, then he referred me out of state for the total shoulder replacement I just had. He is following up. Granted, my problem was very challenging and complex and took 5 surgeries to hopefully fix. I was absolutely not a candidate for the biological resurfacing - not sure how it is playing out in the long run.
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 06/08/2012 07:12 PM

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ruinedshoulder

Posts: 11

I guess my biggest question, being only 30, is the longevity. Dr. Matsen did some research showing that there was no wear on the glenoid after 2-4 years. I'm just curious why fibrocartilage is able to stand up to metal while hyaline cartilage isn't.

And what do you all think of the possibility of total biologic resurfacing in the future? Is it worth waiting for? I think Dr. Gobezie has already done a few of these arthroscopically. Maybe prosthetics will be no longer needed soon? My pain affects my sleep, but not much during the day, so I'm wondering whether I should wait...it's a big decision.

The R&R seems like a great surgery in the short-term, but even Matsen's studies show the best results come after about 2 years....I wish we had a way of knowing about the long-term results. I'd like to know how 10+ year patients have been doing, that would be interesting. I don't think they've done any revisions for old patients, but it would be interesting to know if pain or function has increased/decreased. Has anyone talked to an older patient?


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 06/08/2012 06:23 PM

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buddyc26

Posts: 29

HI,

Your right, most of us have neglected this site because we are doing so well. We forget that there are still many people out there apprehensive about shoulder surgery and need our input. Sorry! I started this site after my surgery for just that reason.

I can't speak for everyone but I have absolutly no problems with my shoulder. I have full range of motion and exercise with light resistance 5 or 6 times a week. I play a lot of golf in my retirement and hit the ball further than ever.

I will try to pay more attention to this site in the future. If you have any questions you need answered, please post them and I will be happy to try to answering them.

Buddy
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 06/08/2012 05:25 PM

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ruinedshoulder

Posts: 11

How are all the ream and run people from this site doing? seems like people just stopped posting.
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 05/04/2012 05:53 PM

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misty3

Posts: 132

quote:
Originally posted by: roky


oh yes -- they were very generous with the pain medication, so i had little to no pain in any of my recovery -- my previous surgery years ago was terrible, due to the under prescription of meds

roky


I find that interesting since he refuses to see patients who have taken narcotics for shoulder pain.
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 04/25/2012 12:12 PM

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roky

Posts: 7


i would first emphasize that i have absolutely no reservations re: going the route i did -- there is no substitute for the experience of dr. matsen and his team -- having said that, here are some other observations:

u of w does not have a contract with my unitedhealthcare, although there are other versions of unitedhealthcare which do -- my uhc is part of the empire plan, government employees health care, and simply has not signed contracts with many phys8icians in washington state -- perhaps your uhc does have a contract? -- in which case you are in network, and there should be no problem -- i was out of network -- i found the person who set up my surgery was either extremely over-worked, or ?? -- she had very little understanding of out of network coverage, and gave me some incorrect information -- so attempting to get an estimate of cost was difficult -- in the end the billing code used was not the one she stated would be used(although the ream and run is at least as involved as a total replacement, it can only be billed as a hemi -- u of w billed it as a hemi, but used the "reasonable and customary" rate for a tsr, which uhc wouldn't pay -- i was then able to get u of w to reduce the rate to rcr for a hemi, and my total share of the cost was then $1400) -- also, no one at u of w explained that uhc would not pay for followup in my home area, since it considers follow-up to be part of what was paid to u of w for surgery -- also, i doubt that the attitude of orthopedic surgeons in arizona is that different than other areas: they don't like to follow up other surgeons work -- this also might have been discussed prior to surgery -- and finally, if you are not getting follow-up at u of w, or with another physician in your home area, be aware that after about 2 weeks, there will be absolutely no suppo9rt from u of w, i.e., my emails were simply not responded to after that time -- although i feel dr. matsen would respond, i did not wish to bother such a generous and busy man

my recovery has been going fine, and as a retired guy, i have had the time to do my exercises religiously -- but each shoulder is different -- having multiple dislocations for 40 years, my whole upper body had adjusted to a mostly immobile left shoulder, with much atrophy, stiffness -- dr matsen had told my wife that it was one of the stiffest shoulders he'd seen -- and due to the tendency to dislocate, it required an eccentric ball, and a rotator interval plication, to resore stability -- so i'm still only at about 150 degrees overhead, and may never get to 180, and have a long way to go building up these atrophied muscles -- but all the more reason that i am glad i chose dr. matsen

i'll be glad to answer any questions, but will be packing in a few days to "migrate", so may have a delay in responding, but ask away

oh yes -- they were very generous with the pain medication, so i had little to no pain in any of my recovery -- my previous surgery years ago was terrible, due to the under prescription of meds

roky


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 04/25/2012 09:33 AM

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retupmoc1

Posts: 5

quote:
Originally posted by: roky
...and then i found out that my insurance(unitedhealthcare) will only pay for follow-up with the surgeon who did the surgery -- so, end of this story is: no follow-up...



Hi Roky,

Your note about unitedhealthcare reminds me of my biggest fear. I have coverage through them, too, and am concerned about their seemingly never ending search for loopholes to avoid payment. Did you have some sort of preregistration well in advance of going for the one-stop? I'm scheduled in July with Dr. Matsen for the one-stop (I live in NC) and so far no one but me seems concerned. The scheduler at UWMC says no problem and Unitedhealthcare says Matsen has a very high rating in their system. However, they also indicate pre-approval and possibly a review are required, and that usually takes between days and several weeks. I don't want to end up denied after the surgery!!

Any notes about your experience would be greatly appreciated.

Retupmoc1


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 12/13/2011 09:46 PM

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FullROM50

Posts: 81

Hi Illini66,
I check in only from time to time, but want to chime in. Bob is absolutely right. I, too, went to so many surgeons and unless they were students under Dr. Matsen, they don't understand Ream and Run and won't do it. My surgeon, Dr. Moskal, was also a student of Dr. Matsen's.

I thought this to be very strange myself; almost like a conspiracy. The only thing I could figure is that most surgeons, like most other humans, follow a common "proven" path. Some will leave the beaten path and explore new avenues. Dr. Matsen was incredibly thorough in his research and I firmly believe he accomplished a major breakthrough and identified a new way for many shoulder patients. Why the community of practice doesn't give him more recognition for it, I don't understand.

If you want to be able to gain full unrestricted use of your shoulder, do not settle for anything else than the R&R. And if this takes you to Seattle, so be it. No cost can be too hi for being painfree and enjoying full range of motion. Since my surgery, I feel more rested in the mornings, allowing me to concentrate and work harder when at work and on the farm. It's simply amazing.

Best regards,
FullROM50
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 12/11/2011 11:02 PM

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roky

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illini66, welcome -- i believe if you look down this topic a bit, you'll see where fullrom50 mentions dr moskal, who did his r&r -- i don't know of any others -- what is confusing, and you need to be aware of, is that many surgeons perform hemiarthroplasty, and perhaps will do some reshaping of the glenoid -- this is not the same as what dr. matsen is doing -- one might say that he does an extremely precise hemi, using equipment that was specifically designed for the r&r -- also, unlike the ususal hemi, with the r&r there has apparently been no problem with the new humeral ball wearing an off center depression in the glenoid

buddy -- good to hear from you, and no problem -- this is the first i've looked at the forum since returning from seattle

yes, i'm doing way better, been off pain meds for a while now, and just coming now to my 6 week point -- i'm in perhaps a unique position -- i flew into seattle for the "one-stop', expecting to have follow-up locally, here in arizona -- went into my doctor 2 weeks later to have the staples removed, and found out he wouldn't provide follow-up! -- said he didn't feel qualified -- so he referred me to a local orthopedic surgeon, and then i found out that my insurance(unitedhealthcare) will only pay for follow-up with the surgeon who did the surgery -- so, end of this story is: no follow-up -- fortunately i've had no difficulties -- i'm "winging it", using the information they gave me when i was discharged, a little bit of tips i've gotten from sarah via email, and some other tips i've found on the u of w site -- since this is week 6, i assume i start strengthening, i believe initially just pressing the washcloth to the ceiling, and i think add some of the other exercises --- i'm waiting for an answer from sarah as to whether i can begin outward rotation -- up to now, they limited it to lying on my back, rotating no farther than straight up, which is essentially 0 degrees of outward rotation

when dr. matsen called my wife, she said he told her that i was one of the "stiffest" shoulders he had seen -- also, when i left, they prescribed celebrex, which alex said was unusual, and is only used at discharge for "one of our stiff ones" -- this may have something to do with the fact that this shoulder has been a mess since age 15, and i'm now 63

havn't done much jogging, and i'm missing that, so i bought a used "stepper", and am able to get a decent workout that way

take care, bob
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 12/11/2011 09:30 PM

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illini66

Posts: 1

I noticed that you are going to Dr. Marsten for the ream and run procedure. Did you discover any other surgeons that do do such a procedure?

Thanks,
Illini66
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 12/04/2011 10:38 AM

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buddyc26

Posts: 29

Hi Bob

I haven't kept up with this blog I started back in September 2010. Sorry! Based on what I read you are probably in your first month of rehab. I'm feeling so good I forget that there are peope like you out there looking for guidance just like I was a year ago. All of what I have read is "spot on". It's all about your commitment to the rehab program. We all know that it is not easy at the start but, trust me, it does get better and better.

I hope youare felling better and will keep us appraised on your progress. We all have that special bonding, having experienced the R&R.

buddy
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 10/10/2011 10:26 AM

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roky

Posts: 7

glad to hear you're doing well -- i could have had a shoulder replacement done by a provider within my network for $35, but decided, i think wisely, to go out of network and pay the exra myself, in order to have matsen's expertise

i'm 63, and although i don't do judo, etc., i am very physically active, running daily, biking, and mountain climbing -- i've had very limited rom since age 15, due to dislocations -- something i learned to live with, but then the arthritic pain started more recently -- apparently, this was aggravated by an operation i had in the 90s to "tighten", stabilize, the joint -- anyway, although the mri says that the cuff is "intact", with probably only a partial tear, i do have concerns that my cuff may be too messed up to do the ream and run -- rick has seen my mri, and says i am a candidate for arthroplasty, but i wonder whether it will be the r and r, a standard replacement, or even a reverse -- i would prefer the r and r, but could live with the limitations of the other two options -- and this is also why i am seeing him, to have expert opinion as to which operation is best for me, and then have a doctor who is most likely to acheive success

i'll be flying in to seattle on sunday, see rick for pre-op on monday, operation tuesday, out, i hope, thursday, one night in a motel, and fly home friday -- i am not looking forward to this, as i still remember my recovery from the "tightening" operation -- it was very painful, and the tylenol w/codeine was about as effective as aspirin -- couldn't sleep, even with a hospital bed at home

but as you may have observed yourself, as we age, we are extremely lucky if this is all we have to deal with health-wise
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 10/03/2011 10:23 PM

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FullROM50

Posts: 81

Hi Bob,
You're right. There is not a lot of activity on this forum. Maybe shoulder problems are at an all time low.

I had ream and run performed by Dr. Moskal, who was a student of Dr. Matsen's. Dr. Moskal did a phenomenal job on me about 18 months ago, and I don't even think about it any more. I'm absolutely pain free, have full ROM and great strength. I'm 50 years old and have gone back to full force, competitive judo.

Dr. Matsen has an excellent reputation, and there are many success stories like mine out there. You're in the best of hands with him. My advice would be to continue your exercises pre-op until about a week prior to surgery. Once you've had surgery follow Dr. Matsen's directions closely. The overhead stretches five times a day were hard, but with the help of my wife I managed ok. Do not slack, but also don't overdo it. If you are an over-achiever, continue on past the 12 week rehab program and build up your strength gradually over the course of two years. You see, I'm not quite finished with my program which is sort of my own creation.

Take care!

FullROM50
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 09/25/2011 04:43 PM

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roky

Posts: 7

Hi – i'm scheduled for shoulder replacement surgery with dr. matsen on 11/1/11, probably ream and run – i'm wondering how others who have had this surgery are now doing – not much activity on this sub-forum in a while

if there's anyone still out there, give a holler

thanks, bob

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 03/10/2011 09:07 PM

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FullROM50

Posts: 81

Hi geffed,
Good luck with Ream and Run. IMO you made the right choice. By now, judging from the date of your message, you have had your surgery and will be in rehab.

I've had Ream and Run performed about a year and half ago, and it was one of my best decisions ever. I'm 50 years old and very athletic. I started back into full force competitive judo a few months ago. I take falls, grapple standing and on the ground with 18 to 35 year-old athletes with no sign of pain. I have the same ROM in both shoulders and my operated shoulder, which is my dominant one, has become slightly stronger than the left one.

My demands of the Ream and Run were much greater than those of most patients from the start. Here is a little bit about my history. I fell off a bike in my mid teens and my right shoulder hadn't been right since. However, I continued to train and competed for decades. In 2003 my ROM decreased and arthritis started to show. In 2006 the xrays showed virtually no cartilage left. I researched on-line met various surgeons and decided on Dr. Matsen and the Ream and Run.

I took supplements and continued to train with bungies and light weights and practiced judo twice a week until I was ready for the surgery. In fact, I still trained judo four days prior to surgery, but with a lot of pain. I ended up having the surgery performed by Dr. Moskal, who was a student of Dr. Matsen's. The socket and the ball were severely damaged, with lot of loose debris floating around. Dr. Moskal showed me pictures of about a dozen pieces of cartilage and bone he found.

After surgery I followed the prescribed rehab without ever missing a session, and of course protected the new joint as much as possible. I now feel great and have no limitations, restrictions or discomfort. I can throw a baseball, basketball, rope cattle from a galloping horse, climb a rope or whatever I like to do. I took 2 and half months off from work to be as thorough as possible with the rehab. My wife who is an RN took family leave and helped me with the stretching exercises the first four weeks. I found that to be an advantage.

In summary, the importance of proper rehab is not to be underestimated. In fact, this seems to be praticularly true for the main shoulder joint, because the muscles and tendons are immensely critical for the joint to function correctly. I remember that I had been worried that the metal ball would not glide smoothly on the reamed glenoid. Not true at all. I can't tell a difference. I'd like to add that I followed Dr. Matsen's advice not to have debridement or anything else done to the shoulder until I was ready for a full replacement. The more surgeries people have on a joint, the worse the final result will be.

Hope all is going well for you and my write up helped some. I remember being on this forum a few years ago, hoping to hear from someone who might push the envelop a little. That's why I got back on to tell folk like you not to worry.

FullROM50
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 02/20/2011 09:29 PM

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fivespeed

Posts: 12


GEFFED,
Fivespeed here, I have a man who would like to talk to you via email. If you still montior this forum still please contact me through your private email so I can forward it on to this person. My email address is in a earlier post in this forum. Thanks. As far as my surgery is going Im doing quite well it is coming along quite nice. Stretching everyday and weights everyother day now. Its work but well worth it. Now I just hope Phill is right and we have a early spring so I can get out in the yard and get to work. Fivespeedl
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 02/16/2011 01:34 AM

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buddyc26

Posts: 29

Hi mblock66,

I feel you pain, sorry your having such a difficult time with your shoulder. To answer your question about how bad my shoulder was.. Dr. Matsen wrote..There was complete loss of the articular cartilage on the humeral and glenoid surfaces and the biceps tendon was severely frayed requiring a biceps tenotomy. I had very little function of my shoulder at the time I decided it was time to seek a solution. I had all that grinding going on as well.

As you know most of the rehab is self motivated. I did see a physical theropist once a week to monitor my progress. I am now in my sixth month and have revised my rehab schedule to stretching every day and weight lifting every other day. I'm at a level that works for me already because my major activity is golf. I golf 4 or 5 times a week and don't experience any pain or discomfort. In your case because you are such a highly athletic person and so young, I don't have any answers for you. I don't know why they don't want to perform the ream and run on young people? I have NO restrictions on what I want to do when I am finished. I guess they don't have the data on how long the parts last. I could do all he thngs that you want to do , right now, except throw a softball. I have been able to sleep on my shoulder without any pain fo months. I hope this give you some hope that there is a light at the end of the tunnel.

You may want to get another opinion. Give Dr. Matsen a call and get his perspective. He's an awesome guy and will tell you straight out what your options are. Tell him I told you to call and GOOD LUCK!

Buddy

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 02/11/2011 11:52 AM

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mblock66

Posts: 20

Hi Buddy -

I have a few questions for you. I am jealous of how well you are doing. I am 33 years old and I haven't thrown a baseball in well over 5 years now. I have had 2 surgeries and the last one was 2 months ago with Dr Williams at Rothman in Philly. He didn't want to raplace anything due to my age so he went in and did a "modified arthroplasty" which was basically everything in a full replacement without putting in new parts. He reshaped my humeral head from sqaure to as round as he could. I posted in another thread in here if you want to read the whole story. 33 year old need help...

So I have been reading about the ream and run. Your success is amazing. Post op for me I feel I am maybe 5% better then pre op. I still have no internal rotation, can't even get in the range to pretend to throw a ball, and have pain. I am highly athletic and was a possible olmpic level sprint freestyler in 2000. Turned to weights and was benching about 425 with great form. I am 6'4 235 and "was" solid muscle. But this shoulder has gotten so bad that I am now not able to do anything really.

I want to get back in the pool, play some freindly softball, and light weights and I would be content. sleeping without pain would be nice too. But this last surgery just didnt' do it. Lots of grinding still as well.

How bad was your shoulder from the start? Any cartilage left? I am bone on bone. When did you know you were better then pre surgery? How often do you do PT? Was/is it with a professional?

I go back to Williams in a month and really want to see if this is an option for me. I am too young to get a Full and have no other real options. Was your glenoid side in good shape? Mine suppoedly isn't too good.

THanks


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 01/31/2011 08:45 PM

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buddyc26

Posts: 29

Hi Geffed,

I started this blog just after my ream and run surgery in August. I am five months post-op and I just can't get over how well it went. You said you were experiencing pain when you lift you arm over your head, I couldn't lift my arm up to shoulder hight. I can now lift my arm comfortably in all directions. I'm still working on building strength. I'm in South Carolina for the Winter and play golf every day without any problems from my shoulder. I also like to lift light weights and I don't expect that to be a problem down the road.

Under Dr. Matsen there is a simple shoulder test of 12 movements. I can do 11 out of 12 already. I was an avid Baseball/Softball player and have not been able to through a ball, overhand, for over twenty years. I can now do it again, but it has a long way to go.

Go for it! You won't regret it!

Good Luck,

Buddy
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 01/03/2011 10:05 AM

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fivespeed

Posts: 12

Hi Geffed,
I am 9 weeks post surgery and so far Im doing great. Its a lot of work but will be well worth it. I have no more ache and pain when I move my shoulder and arm now. Sleeping is greatly improved and I can now put a shirt on unassisted which I couldnt do before. I'm putting a link on here for Dr. Matsens web site for the University of Washington. It is pretty informative of the procedure and what to expect and what will be done. Good luck and remember the rehab is the most important part. This is a great informational site. Good luck with your procedure http://www.orthop.washington.edu/uw/reamandrun/tabID__3376/ItemID__316/PageID__685/Articles/Default.aspx#9322


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