Perfect Pitch
Shoulder Replacement Hits the Right Note

A constantly painful shoulder would affect anyone's quality of life. For Norman Scribner, founder and artistic director of the Choral Arts Society of Washington, it was particularly problematic. "A conductor's left arm really needs to have as much amplitude of movement as possible to indicate the constant variations between loud and soft, and powerful and relaxed," the Washington, D.C., resident explains.

	Sameer Nagda, MD Orthopedic Surgeon

In 2010, after five years of increasing discomfort and decreasing range of motion — despite physical therapy, cortisone injections and surgery to remove some damaged tissue — it became clear he needed a total shoulder replacement. Scribner selected Sameer Nagda, MD, a board-certified orthopedic surgeon, on the recommendation of Gerald Engh, MD, who had performed his knee replacements. "Dr. Nagda was very forthcoming in terms of expectations," Scribner says. "I felt comfortable with him right from the start."

At the time of his surgery in August of last year, Scribner was 74. "Advanced age is not a big issue as long as the patient is healthy," explains Dr. Nagda, who practices at Inova Alexandria and Inova Mount Vernon Hospitals. "More and more patients in their 70s and 80s are extremely healthy and active, and, therefore, good candidates for shoulder replacement."

Dr. Nagda had participated in a research study that identified ways to prevent nerve injury during surgery in patients at increased risk for this complication. Also, recent modifications in how surgeons access the shoulder joint make the recovery of muscle function more predictable and reliable.

Following surgery, Scribner spent one pain-free night in the hospital. A month later, he returned to conducting while continuing physical therapy for half a year. "While most patients note significant improvement in pain relatively quickly, maximum recovery is based on how poor the motion and strength were before surgery," Dr. Nagda explains. "In the severest cases, patients will continue to improve for six to 12 months after surgery."

Scribner, who no longer hunches forward to compensate for his shoulder limitations, believes recovery pays rich dividends. "Be prepared for a week or two of discomfort, and do the prescribed exercises," he advises candidates for surgery. "After a few months, you'll feel as though you have a whole new arm and outlook on life."