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2 posts from April 2010

April 16, 2010

Today I received a blog response communication that I wanted to discuss a little bit more.  Diane Arsenault presents with a fairly typical story of chronic pain that resulted in some limitation of her daily use of her shoulder.  She was then canoeing after a few years of this pain, and had a movement, which stressed a shoulder that had been long-suffering from inflammation and pain.  With that movement, she tore her rotator cuff on her right shoulder.  This tear was apparently a complete full thickness tear, which required surgery.  She underwent surgery and had some restoration of function only to have the pain return a year or two later.  She had another surgery to shave off more of the bone that would presumably free up more room for her rotator cuff.  This was then followed by a certain pain free period of time only to have the pain return.

She wants to know what is going on.  Why is this happening?  She’s diligent.  She works out.  She does what her doctors tell her to do.  She goes to physical therapy and again, I think in my opinion, based on the research, she’s having problems because she’s re-injuring it every night, nighttime shoulder pain, the position of the arm at night, the loss of the gravity of the weight of the arm at night.  These things impinge upon the superior aspect of the rotator cuff, cut off blood supply and cause a lack of oxygen, nutrients.  This causes stress, lack of healing, unhealthy tissue that’s prone to tear and is a source of her significant pain and loss of function.  She has had shoulder injections.  Now, she is going back for a third MRI with the prospects of a third surgery.  I’ve given her some advice on altering her nighttime position, and I am hopeful that that will be effective.  In addition, I think that probably some more specific exercises during the day that will more effectively help her rotator cuff rather than all the muscles that surround it, are important.

I’ll look forward to see how she does on this regimen, and I wish I could say this is a unique story, but we hear it all the time.  

April 13, 2010

The Shoulder Story

Hello, my name is Michael F. Caroll, M.D.  I am a family physician in Traverse City Michigan.  I would like to tell you the story of how I came to develop the rotator reliever.  Six years ago, I was busy building my practice, a general family practice, and I was amazed at the sheer number of my patients of all ages who are having problems with shoulder pain.  At the same time, I was suffering from a recurring shoulder pain that was limiting my movement during the day, I was having a hard time reaching.  At times, I couldn’t even think about throwing a ball to my then 3-year-old, oldest son, and what was perhaps the worst part of it was that I wasn’t getting rest, I was tossing and turning.  I came to identify with my patients who were going through this same process.  I had done some physical therapy that was temporarily helpful for my shoulder pain that was diagnosed as rotator cuff tendonitis.  I’d had a few shoulder steroid injections that would provide some temporary relief, but the problem was unrelenting.  One night at two a.m. I was, as per usual, tossing and turning, trying to find a comfortable position for my shoulder, when I grabbed my right wrist with my left hand and pulled my shoulder down.  Thinking that that was the best the shoulder had felt in some time, I went into the closet, grabbed an Ace bandage, tied it around my wrist and then essentially to the end of the bed to provide some traction through the night, and had dramatic relief the next day.  I did it the next few nights and that was basically the last shoulder pain I had. 


I was excited to try this idea on my patients, and was able to formulate a very basic crude strap system that would provide some of this traction when attached to the leg to the wrist connected by a strap.  I had a few of these made up, tried it on some of my patients, and they did remarkably well, and gave me great feedback, in spite of this crude device, they basically got better with some of the exercises I was showing them, with utilizing some of my physical therapy friends expertise.  Well, thinking that I was onto something, I wanted to do this right, I wanted to do it in the right way, which in my mind was to do the research, I didn’t wanna be a guy just talking about some brace that I made up and how great it is, I wanted to back it up with research.  It’s the way we’re trained in medical school, look out for the patients best interest by applying evidence based medicine to their problems.  This led me to scrape together some money and get a few of these braces made up and essentially commission a study.  I did not wanna do the study myself, as I felt that would be an obvious conflict of interest.  So I farmed it out to a company that does this professionally, and they utilized a bunch of primary care docs to use this on their patients. 


I remember sitting down with the study coordinator after she compiled the information and it was one of my most anxious moments in this whole process, and I can not tell you how excited I was when she told me the results.  The study was what’s called an adjunctive study.  So we took a group of patients and all of the patients got what I would term the usual treatment, what the doctor had prescribed, is usually physical therapy, some anti-inflammatory medicines, they may have gotten some instructions from the doctor on some specific exercises, and then we took half of those people and we put them in a – and half those people got the brace in addition to all the other treatments.  Well, 100 percent of the people who had the brace got better, and 47 percent of the people who did not get the brace got better.  This 53 percent differential was dramatic, it was more than I could’ve possibly hoped for, and it was a exhilarating moment for me, and with that, I gathered my information, compiled it, and presented it in written form to the American College of Sports Medicine, a very well-respected group of scientists and clinicians.  They accepted my research for a prominent presentation at their annual meeting in Denver in 2006.  So with great anticipation I went out there and was very pleased to present it to my colleagues who grilled me on the research, grilled me on the patients selection, and I felt that all the questions were answered, and I got a very, very positive response to this research, it was very encouraging and gratifying. 


At that time, my real education in the business world started.  I felt certain that the leaders of the brace industry would be there to greet me and write me a big check and take my brace and do wonderful things with it, that did not happen, nobody took me to dinner.  So I tracked down the brace company executives and presented my idea to about six companies.  All six companies gave me the same response, which was we can not charge enough money for this system to make our usual profit.  They went on to explain that their salesman work on certain commissions and because it wasn’t at least $250.00, that there’s just no way that they could make any money on this, and so thanks but no thanks, but we don’t want your brace, we’re not interested in developing it, and marketing it.  Finally, one of the more disheartening comments and observations they made was that it is too expensive to teach doctors anything new, that it just takes too long, education is expensive, and they flat out weren’t interested. 


Certainly I was a bit disappointed to hear this news.  I turned my attention to my own clinical practice, continued to work with patients and use the brace and get people better, and at the same time, this was actually an invaluable period in that I was able to essentially make the product better.  At the same time, I was implementing electronic medical record, and having my third child, and it was a busy and wonderful time in my life.  In 2008, I realized that I needed to basically take this to the people, there were too many people suffering, this is too easy of a solution, too effective to just use in my own practice, and talk to my own local colleagues, and with some determination, I embarked on this process of further developing the brace and the system, I added an outstanding, efficient exercise component that, in my opinion, perfectly isolates the rotator cuff, and allows it to strengthen while not strengthening all the muscles around it, and you really wanna isolate the rotator cuff and get it stronger, that’s really one of the keys, as well as the critical nighttime component of not injuring your shoulder every night when you go to sleep.  I came to realize that sleep positions and sleep mechanics often lead to an impingement on the most important part of the rotator cuff, which is the supraspinatus tendon during sleep, this is absolutely devastating to people.  Sleep is a time to restore the bodies functions, to restore energy, and to heal the wear and tear over the course of a day, and if you’re injuring something at night, then it’s difficult no matter what you do during the day to actually improve someone’s function, relieve their pain, and get them back to a functional, pain free existence.  So with help of a lot of wonderful people I’ve met along the way, I’ve been able to bring the rotator reliever to reality, it’s a very exciting time, I’m looking forward to rolling this product out.  I think that there’s a lot of barriers to health care, we all know about that.  Some people don’t have access to even go see their family doctor regarding this issue, and I have communicated with thousands of people who are long suffering from rotator cuff pain, shoulder pain.


Certainly during this time I remained current with the literature and with shoulder pain, and I remain flabbergasted by the sheer volume of people that have this.  There have been two recent studies and one out of Europe and one out of Australia, that showed that 22 percent of the adult population has shoulder pain at any given time.  I think that this product, this system of preventing injury at night, and strengthening the rotator cuff during the day can cure 95 percent of people with shoulder pain.  I look forward to the challenges ahead, I look forward to people living a pain free existence, chronic pain is exhausting, disheartening, difficult, and when you’ve got a solution to one problem, you’ve got to shed some light on it, and that’s what my team is all about, is getting this out there, teaching people about their bodies a little bit, and giving them a remarkably efficient and effective means to heal their body.