Treating Shoulder And Elbow Pain

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Interviewed by Melissa Moniz
Wednesday - January 14, 2009
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Dr. Ed Weldon
Orthopedic Surgeon, Chief of Shoulder and Elbow Service
Interviewed by Melissa Moniz

Where did you receive your schooling and training?

After graduating from Punahou High School, I attended the University of California at Santa Barbara for my undergraduate education. I then earned a master’s degree from Boston University in Medical Science before attending medical school at Boston University. I returned home for my orthopedic training at the University of Hawaii John A. Burns School of Medicine. After becoming an orthopedic surgeon, I continued my training. I did my first fellowship in adult shoulder and elbow reconstruction at the University of Washington in Seattle. I spent one year training in both operative and non-operative aspects of the adult shoulder and elbow. Following this, I did a second fellowship studying and treating shoulder and elbow injuries in children at the Shriners Hospital in Sacramento.

How much of your practice is working with children and how much of it is adults?

Roughly 80 percent of my patients are over 18 years of age. Twenty percent are children or minors.

You are the only person in the state of Hawaii who has completed two fellowships on shoulder and elbow problems. Can you discuss your sub-specialized practice?

This is true, and I am sub-specialized. My elective practice is confined only to people with shoulder and elbow problems. Some people might find such a narrow scope of practice boring, but to me, I enjoy employing my years of training and practice in an effort to reduce pain and increase function.


 

You also do a unique shoulder replacement. Can you explain that procedure and how it differs from the traditional approach?

The traditional shoulder replacement is where we replace the ball with a metal ball and we replace the socket with plastic. Unfortunately, in active people, such as most people here in Hawaii, the plastic will wear out, fracture or loosen. When this happens, the person will need another surgery. Because of this, people who have the traditional shoulder replacement are discouraged from upper-extremity exercise and activities. At Straub, we’re doing a new type of procedure where we replace the ball with a metal ball just as in the traditional surgery, but instead of putting plastic on the cup, we reconstruct the cup using the person’s own bone. Because bone is living tissue, it does not wear out. In fact, it gets stronger with use.

Dr. Ed Weldon assessing the range of motion of a patient’s shoulder capsulitis

How long have you been performing this procedure?

I’ve been doing it since 2001.

Can you talk about the feedback you’ve had from patients who have had this surgery performed?

Most patients do very well and are able to return to all levels of activity without restrictions. I have treated patients who have returned to almost every sport, including golf, boxing, tennis, skydiving and martial arts. In patients who had their shoulder replaced using the traditional method, such activities would be highly discouraged.

As far as elbow surgeries, is that procedure more or less involved/difficult compared to the shoulder?

Elbow problems can be complex and difficult to treat. Also, elbow problems are less common than shoulder problems. Because of this, it is even more important for patient with elbow problems to seek care from a doctor with training and experience.

When your patients have shoulder pain, is it due to simple wear and tear because of aging, or it is injury-related?

In general, younger people have shoulder problems related to injuries and older people have shoulder problems related to wear and tear. There are exceptions to this rule. Acouple of years ago I treated a 90-year-old man for a shoulder injury he sustained while crossing the Pacific in a sailboat race. I would like to say, in general, the people of Hawaii have healthy shoulders. I believe this is because people here use their shoulders so much for all of our outdoor sports. The more you use your shoulder, the stronger it becomes.


Is there anything preventative that people can do to avoid some of the injuries you see?

Absolutely. I think the No. 1 message that I want to get out is that a vast majority of shoulder pain and injuries can be treated without surgery. That is why most of my practice is non-operative. I’ve been able to treat people and get them back to their activities without surgery. This is very rewarding for me because many of these people have become convinced that they need surgery to get better. It turns out that when you delve deeper into the understanding of the shoulder, you don’t just get better treating people operatively, but also non-operatively.

Can you talk about some of these non-surgical treatments?

Stretching. The shoulder needs to be stretched. The majority of shoulder pain is due to tightness. Following a simple home-stretching program, people can often resolve their pain. Our office has a home-stretching program sheet with instructions available to anyone who is interested. They can call our office (522-4332) and we will fax them a copy. Or, if they are in Straub, they can stop by and pick one up.

What do you see as the future of shoulder and elbow reconstructive surgery? Do you see it leaning more to non-surgical options, or do you see the surgical options improving?

There will always be conditions about the shoulder and elbow that can be helped by surgery. But as our understanding of the shoulder and elbow improves, I believe the number of patients requiring surgery will decrease.

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