Shoulder Injury Threatens To Keep Athlete from Activity He Loves

Scott Starr has been a competitive athlete for decades, playing soccer in high school and — for a short time — in a British professional league. Later, he discovered CrossFit, the popular high-intensity strength and conditioning training regimen. He loved it so much he and his wife, Marisol, opened a CrossFit gym in Eustis.

“I’m a naturally competitive human being, and I like the challenge of it — how do I become more efficient? How do I move faster?” said Starr, 51, a former Marine.

Over time, though, Starr’s workouts became increasingly difficult as a combination of arthritis and bone spurs took their toll on his left shoulder.

The pain became so intense, he couldn’t sleep more than a couple hours a night. In the gym, he could hear grinding in his shoulder on the pull-up bar. One day, he couldn’t hang onto the bar at all.

Already having gone through one shoulder surgery for a torn labrum years before, Starr realized he’d need to head into the operating room again.

Less Is More

Traditional shoulder replacement can be tough on athletes. Surgeons replace the ball of the ball-and-socket joint and attach a plastic liner to the socket to allow smooth movement. That liner can loosen or wear out, causing pain and sometimes requiring even more surgery.

Looking for a better option, Starr began doing research. He found an alternative surgery called ream and run, and a physician who’s an expert at it. Dr. Benjamin Service is a board-certified orthopedic surgeon at Orlando Health Jewett Orthopedic Institute who learned the procedure during post-residency fellowship training from the physician who developed it.

With the ream and run surgery, the ball is replaced and the socket is reamed smooth to the appropriate size, slightly larger than the ball. No liner is attached to the socket. Over time, the bone of socket grows a layer of fibrocartilage that allows for smooth shoulder motion.

“By doing that, we avoid the risks of the plastic liner loosening or wearing away over time. That’s really important for patients who want to get back to the high intensity sports or weight training,” Dr. Service said. “By doing the partial replacement, these patients are able to achieve more.”

When Dr. Service realized how advanced Starr’s arthritis was, he was surprised his patient could even lift his arm over his head.

Starr emphasized to Dr. Service how much he wanted to return to CrossFit, and the two agreed that the ream and run was a logical option.

The procedure isn’t for everyone. Because of the time it takes for the body to resurface the ball of the shoulder, the ream and run requires much more intense physical therapy and dedicated home exercises, usually for about a year.

“The ream and run is for patients with a long-term focus and a lot of diligence,” Dr. Service said. “They have to be extremely motivated to want to push through a challenging recovery for an end result that is higher than possible with other surgeries.”

Starr was ready for the challenge so he could get back to the active life he loved.

Dr. Service used a mixed reality headset in combination with a 3D preoperative planning program based on Starr’s CT scan of the shoulder. The program let Dr. Service assess the sizes of the implants Starr would need. After the surgery at Orlando Health Dr. P. Phillips Hospital, the next phase began: Physical therapy.

Focus and Diligence

Starr's therapy took place near his Mount Dora home, at the National Training Center, part of Orlando Health South Lake Hospital in Clermont.

Even an athlete as disciplined as Starr needed the physical therapists to push him through the intense rehab.

 “They just never let me off the hook when I was whining and complaining. I had to be pressed beyond my limits,” Starr said. “I remember many times getting off the physical therapy bed, it was just coated in sweat from working.”

Continual Progress

When he first began rehab, Starr couldn’t even lift his arm up while lying on his side.

Three months later he started doing CrossFit on a limited basis. At the six-month mark, he could hold himself in a pushup position. In a year and a half, as he was wrapping up therapy, he was power cleaning 225 pounds over his head and doing handstand pushups.

The therapy not only made him stronger, but it retrained him to avoid the bad habits he’d developed over the years as he tried to compensate for weakness and pain in the shoulder. That lengthened the time of his therapy, said Starr, who works as a service delivery leader for a cybersecurity company.

They just never let me off the hook when I was whining and complaining. I had to be pressed beyond my limits. – Scott Starr

Now, almost two years after the surgery, Starr said, “I’m much more efficient.” Dr. Service and the physical therapy team are “the reason I’m able to do the type of exercise I love.”

Innovations in the procedure will make recoveries like Starr’s even easier in the future, said Dr. Service, who specializes in shoulder surgery. A new surface for the ball of the ball-and-socket joint called pyrocarbon is now available. The pyrocarbon surface is self-lubricating and more similar to the density of bone. This may allow for quicker recovery in the future.

Ream and run is not for everyone; Dr. Service performs it on only about 10 percent of patients undergoing shoulder surgery.

Because the rehab is so long and intense, they must not only be willing to go through it but have a strong support system they can lean on through a challenging time.

But for those who are good candidates, the operation is often life-changing.

“The ream and run surgery really is a tool to help patients stay active to keep doing what they love and keep doing what they need to do,” Dr. Service said.