If you have a new shoulder injury

True, true and not the only thing related

You fall off your bike and land on your shoulder, tearing your rotator cuff. The history and physical exam are consistent with a torn cuff. The MRI shows the tear. The surgeon repairs it. Off you go, yet still with all the problems you had before your accident.

True you fell. True you tore your shoulder rotator cuff. But also true that, for years, you've held your phone between your chin and your shoulder. Your range of motion was never great. You are relatively weaker on that side. You had some night pain before you fell. The new injury is in reality the icing on top of the 2-day-old cake.

You tweak your knee skiing, tearing the ACL. The knee is unstable. The meniscus is also torn. The surgeon replaces the ligament and repairs the meniscus but, unless also treated, the underlying articular cartilage damage will progressively lead to arthritis. It is true that your injury tore the key tissues in the knee, but it is also true that the surfaces of the knee are now abnormal and could lead to painful arthritis if not addressed. Newer treatments, including stem cell paste grafts, can restore durable surfaces with biologic tissues but they have to be in the repertoire of the treating surgeon.

You twisted your ankle as a college athlete years ago, suffering a torn ligament. Immobilized in a walking boot, the ligament healed but with ankle stiffness. Your gait has been off for years due to the lack of motion in the ankle, leading to hip and back pain. It is true that the ligament was torn, leading to potential instability but it is also true that the treatment may have led to a worse outcome. A stiff joint is always much worse than a loose one. Early protected motion of the injured tissues may have avoided the scar formation and stiffness, but afterwards needed careful guidance on how and when to move.

I see each of these injuries as opportunities to highlight other issues people have that make them prone to more injury and less likely to have a full recovery. The injury and the diagnosis are so often identified properly and treated, but the rest of the patient ignored or the consequences of the treatment not considered fully.

In the push for more efficient medicine by less trained health care practitioners with fewer possibilities for engaging ancillary personnel such as therapists and trainers, the time and ability to diagnose and treat the whole person has declined. So while it is true that you are injured, and true that the injury shows up in the MRI, it is also true that no one is paying attention to the person attached to the injury spot.

I encourage you to see that injury is an opportunity to become fitter, faster and stronger than you have been in years by using the resources of physical therapy, fitness trainers, and medical guidance to enhance all of your body while healing one site.

And I teach our doctors in training that the next time they see a tweaked body part, take full stock of the human attached to it and treat it as a wonderful performance unit that responds to tender loving care, meticulous repair, and total body assessment with training and fitness improvements as a lifelong gift.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments. For more info, visit www.stoneclinic.com.

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