Frequently Asked Questions (FAQs) About Shoulder, Wrist and Hand - Brian Butzen MD - Upper Extremity Specialist Located in Durango, Colorado
Q: Which health insurance plans do you accept?
I accept a wide variety of plans that are available in the Durango, Colorado, Farmington, NM, and surrounding areas:
Medicare
Colorado Medicaid
Blue Cross/Blue Shield
Cigna
United Healthcare
Cofinity
Presbyterian
Coventry
First Health
Multiplan
RMHMO
GEHA
HMN
AHR
SJIPA
Pinnacol WC
Please note that you should call your insurance to verify eligibility with your exact plan.
Q: What are your hours?
My office hours are from 8:00am to 5:00pm, Monday through Thursday, and 8:00am to 12:00pm on Friday.
Appointments can be made by calling the practice at (970) 259-3020, and asking for an appointment with Doctor Butzen. His main clinic is in Durango at Animas Orthopedic Associates, but he also has a satellite clinic in Pagosa Springs, Colorado.
If you have an emergency, please call 911.
Q: What should I bring with me when I come for an appointment to the Durango or Pagosa Springs office?
Drivers License or other Identification
Insurance Information ***Ask Front Desk what this means***
All related prior imaging (X-rays, CT scans, MRIs). Please bring films or a disc of the images.
If you've had surgery before, please bring the medical records from this, including the surgical report.
List of Medical History and Medication List.
Q: What is an orthopedic surgeon?
An orthopedic surgeon is a medical doctor who has completed at least 13 years of schooling and training in the diagnosis, treatment, rehabilitation, and prevention of musculoskeletal injuries. Some orthopedic surgeons treat specific regions of the body (hip, knee, shoulder) while other surgeons treat specific populations of patients (pediatrics, trauma, athletes).
Doctor Butzen has completed 16 years of schooling and training, and his focus is on sports injuries and upper extremity injuries including shoulder, wrist and hand. He has completed additional fellowship training on the upper extremity, and is double board certified in orthopedic surgery and hand surgery . He is honored to have worked in Durango since 2013.
Q: What is board certification?
Following the completion of formal training including schooling and residency/fellowship (on-the-job training) there is a confirmation of skills process called board certification. This involves a written test followed 2 years later with an oral exam. Passing these exams certifies (board certifies) an orthopedic surgeon through the American Board of Orthopedic Surgery (ABOS).
Doctor Butzen is double board certified (orthopedic surgery and hand surgery) with the American Board of Orthopedic Surgery until 2035.
Q: What is the difference between open and arthroscopic surgery?
Arthroscopic surgery is performed for joint related problems like rotator cuff tears in the shoulder. Smaller incisions are made, with access to the joint through smaller holes in the tissue, and uses a small camera for visualization. Joints amenable to arthroscopic surgery are the shoulder, elbow, wrist, knee, and ankle. Advantages of arthroscopic surgery include more rapid relief of surgical pain, less postoperative restrictions, and quicker return to activities.
Open surgery involves larger incisions on the skin, and deep dissection in an open manner. This is typically necessary for technically difficult procedures like fracture fixation and joint replacement, and when greater visualization is required. When appropriate, a mini-open procedure (like mini-open carpal tunnel release surgery) can minimize many of the risks of open surgery while retaining some of the benefits.
Q: What is joint replacement surgery?
When a joint is worn, the surface layer of cartilage is thinned or damaged, resulting in inflammation, stiffness, and pain. Initial treatment for this condition is conservative, but in the absence of symptom improvement, a joint replacement may be necessary for symptom relief. Joint replacement, also called an arthroplasty involves removal of the surface of the joint and replacement of the surfaces of the joint. In the case of a total knee replacement, this is with metal and plastic bearing surfaces. In the case of a finger joint, this is with soft tissue or flexible implant interposition.
Q: Should I apply ice or heat to an injury?
Ice should be used in the first 48 hours, or in the presence of an injury causing inflammation (swelling). Ice helps inflammation by decreasing the blood flow to the area. It is generally recommended to apply ice for 20 minutes at a time, with a rest period of 20 minutes (20 minutes on - 20 minutes off).
Heat helps to decrease pain and increase joint mobility. This would not be appropriate in a case of inflammation, as it would increase the blood flow and increase the swelling. In the case of rehab or therapy following the acute injury phase, a common strategy to improve range of motion is to start by applying heat to the area to warm it up, then perform the exercises (which will generate some inflammation), followed by a period of icing to relieve the pain and swelling.
Q: What are NSAIDs and how do they work?
Non-steroidal anti-inflammatory drugs (NSAIDs) are non-prescription, over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen sodium. They are popular treatments for muscular aches and pains, as well as arthritis.
NSAIDs not only relieve pain, but also help to decrease inflammation, prevent blood clots, and reduce fevers. They work by blocking the actions of the cyclooxygenase (COX) enzyme. There are two forms of the COX enzyme. COX-2 is produced when joints are injured or inflamed, which NSAIDS counteract. COX-1 protects the stomach lining from acids and digestive juices and helps the kidneys function properly. This is why side effects of NSAIDs may include nausea, upset stomach, ulcers, or improper kidney function.
Q: What is a cortisone/corticosteroid injection?
Cortisone is a steroid that is produced naturally in the body, which has natural anti-inflammatory activity. Synthetically-produced cortisone works in a similar way, and can also be injected into soft tissues and joints to help decrease inflammation. While cortisone is not a pain reliever, pain may diminish as a result of reduced inflammation. In orthopedics, cortisone injections are commonly used as a treatment for chronic conditions such as bursitis, tendinitis, and arthritis.
Q: What is tendon/ligament/cartilage?
A tendon is a band of tissue that connects muscle to bone. A ligament is an elastic band of tissue that connects bone to bone and provides stability to the joint. Cartilage is a soft, gel-like padding between bones that protects joints and facilitates movement.
Q: What is the difference between X-rays, MRI, and CT (CAT) Scan?
X-rays are a type of radiation, and when they pass through the body, dense objects such as bone block the radiation and appear white on the x-ray film, while less dense tissues appear gray and are difficult to see. X-rays are typically used to diagnose and assess bone degeneration or disease, fractures and dislocations, infections, or tumors.
Organs and tissues within the body contain magnetic properties. MRI, or magnetic resonance imaging, combines a powerful magnet with radio waves (instead of x-rays) and a computer to manipulate these magnetic elements and create highly detailed images of structures in the body. Images are viewed as cross sections or “slices” of the body part being scanned. There is no radiation involved as with x-rays. MRI scans are frequently used to diagnose bone and joint problems.
A computed tomography (CT) scan (also known as CAT scan) is similar to an MRI in the detail and quality of image it produces, yet the CT scan is actually a sophisticated, powerful x-ray that takes 360-degree pictures of internal organs, the spine, and vertebrae. By combining x-rays and a computer, a CT scan, like an MRI, produces cross-sectional views of the body part being scanned. In many cases, a contrast dye is injected into the blood to make the structures more visible. CT scans show the bones of the spine much better than MRI, so they are more useful in diagnosing conditions affecting the vertebrae and other bones of the spine.
Q. What is the hardest shoulder surgery to recover from?
The hardest shoulder surgery to recover from is often rotator cuff repair. This is because the repaired tendon needs to heal securely to the bone, requiring patients to be extremely cautious during the recovery process. For the first 6-8 weeks, most patients must wear a sling to protect the repair, significantly limiting arm movement.
Additionally, rotator cuff surgery is known to be very painful during the early recovery phase. There is also a risk of re-tear if post-operative instructions are not followed carefully, which makes the recovery process both physically and mentally challenging.
Q. What is the easiest shoulder surgery to recover from?
The easiest shoulder surgery to recover from is often a reverse total shoulder replacement. This procedure is designed for durability, allowing many patients to begin light use of their arm within two weeks after surgery. Unlike other shoulder surgeries, it relies less on the rotator cuff and more on the deltoid muscle, reducing the risk of complications.
Additionally, reverse shoulder replacement has a low likelihood of failure, which gives patients confidence in the recovery process. For most people, this leads to a smoother and quicker return to daily activities compared to other shoulder surgeries.
Q. Who is best for shoulder surgery?
Upper extremity orthopedic surgeons, especially those who are board-certified and fellowship-trained, are the best choice for shoulder surgery. They specialize in treating shoulder, wrist, and hand conditions and have advanced training in surgical techniques.
For complex procedures such as a reverse total shoulder replacement or rotator cuff repair, expertise in the upper extremity is critical. Surgeons like Dr. Brian Butzen, MD, who focus on shoulder, wrist, and hand surgeries, provide the highest level of care tailored to these specific issues.
Q. What is the best hospital for orthopedic surgery?
The best hospital for orthopedic surgery often depends on the surgeon’s affiliation and the facility’s reputation for orthopedic care. Hospitals with specialized orthopedic departments, advanced surgical equipment, and high patient satisfaction scores are preferred.
For residents of Durango, Colorado, and the Four Corners area, Animas Orthopedic Associates, where Dr. Brian Butzen practices, is an excellent choice. Proximity to the surgeon is also important for follow-up care and rehabilitation.
Q. What is the average heal time for shoulder surgery?
The average healing time for shoulder surgery varies by procedure. For minimally invasive surgeries like rotator cuff repair, recovery can take 3-6 months, with significant improvement seen within the first few weeks.
More complex surgeries, such as reverse total shoulder replacements, may require 6-12 months for full recovery. The healing process depends on individual factors like age, overall health, and adherence to physical therapy.
Q. How to find a good shoulder/hand surgeon?
To find a good shoulder or hand surgeon, look for a board-certified, fellowship-trained orthopedic surgeon with expertise in the upper extremities. Check their credentials, years of experience, and patient reviews.
It’s also helpful to ask for referrals from primary care physicians or physical therapists. In Durango, Colorado, Dr. Brian Butzen, MD, is a highly regarded surgeon specializing in shoulder, wrist, and hand conditions, serving the Four Corners region.
Q. What is the difference between a hand surgeon and an orthopedic hand surgeon?
A hand surgeon may specialize in treating conditions of the hand but might not have the broader training of an orthopedic hand surgeon. Orthopedic hand surgeons are board-certified orthopedic specialists with additional fellowship training in the hand, wrist, and sometimes elbow.
This additional expertise ensures they can treat complex musculoskeletal issues, such as fractures and nerve damage, while also addressing soft tissue and functional concerns.
Q. Is rotator cuff repair a major surgery?
Yes, rotator cuff repair is considered a major surgery, especially when performed as an open procedure. Even though minimally invasive arthroscopic techniques are common, the surgery involves reattaching torn tendons to the bone, which is a complex process.
Recovery involves a significant rehabilitation period, often lasting 4-6 months, to restore full shoulder function. However, with proper care, most patients experience excellent outcomes.
Q. How long does it typically take to recover from rotator cuff surgery?
Recovery from rotator cuff surgery usually takes 4-6 months for most patients, though some may require up to a year for full strength and mobility. Initial recovery focuses on rest and controlled movement, followed by physical therapy to rebuild strength.
The exact timeline depends on the size of the tear, the type of surgery performed, and adherence to post-operative guidelines.
Q. How painful is torn rotator cuff surgery?
Pain after rotator cuff surgery can be moderate to severe, especially in the first few weeks. This is managed with pain medications, ice therapy, and rest.
As healing progresses, the pain typically subsides. Physical therapy may cause some discomfort initially but is essential for recovery and regaining movement.
Q. What are the worst things to do after rotator cuff surgery?
The worst things to do after rotator cuff surgery include:
Overusing the shoulder prematurely: This can disrupt the healing process and lead to complications.
Ignoring physical therapy: Skipping therapy sessions can result in stiffness and reduced mobility.
Patients should also avoid heavy lifting, overhead movements, and sleeping on the affected shoulder during the early recovery phase.
Q. What is the downside of reverse shoulder replacement?
The downside of reverse shoulder replacement includes the potential for:
Limited range of motion: While pain relief is significant, some shoulder movements can remain restricted.
Complications: These can include infection, joint instability, or damage to surrounding nerves or tissues.
Additionally, the artificial joint may wear out over time, necessitating revision surgery.
Q. What is the recovery time for a reverse total shoulder replacement?
Recovery from a reverse total shoulder replacement typically takes 6-12 months. The first 6 weeks involve immobilization in a sling, followed by physical therapy.
Significant improvements in pain and mobility are often seen within 3 months, but full strength and function may take the better part of a year, and many times even two years.
Q. What is the success rate of reverse shoulder replacement?
The success rate of reverse shoulder replacement is high, with studies reporting satisfaction rates of 90-95%. It is particularly effective for patients with severe rotator cuff damage or arthritis.
Most patients experience excellent pain relief and improved shoulder function, although some permanent limitations in range of motion are possible.
Q. What are the long-term limitations after reverse shoulder replacement?
Long-term limitations after reverse shoulder replacement include a recommendation to avoid repetitive impact activities, such as splitting firewood by hand, using a sledgehammer, or riding down a bumpy train on a mountain bike. While daily activities are usually restored, high-impact activities or sports may need to be avoided.
Patients should discuss specific expectations with Doctor Butzen to understand how the procedure will affect their lifestyle.
Q. How long does it take to recover from endoscopic carpal tunnel surgery?
Recovery from endoscopic carpal tunnel surgery is typically faster than traditional open surgery. Most patients can return to light activities, such as typing, within 1-2 weeks, and heavier activities within 4-6 weeks.
Full recovery, including a reduction in symptoms like numbness and tingling, may take several months. The exact timeline depends on the extent of nerve compression and the patient's overall health.
Q. How painful is endoscopic carpal tunnel surgery?
Endoscopic carpal tunnel surgery is generally less painful than open surgery due to the smaller incisions and reduced tissue disruption. Patients may experience mild to moderate pain for the first few days, which is typically managed with over-the-counter pain medication.
Most patients report significant pain relief from carpal tunnel symptoms soon after the procedure, though some soreness at the incision site is normal during the healing process.
Q. Is endoscopic surgery better for carpal tunnel?
Endoscopic surgery has several theoretical advantages over mini-open surgery (smaller incision than traditional open surgery), including less pain and faster return of function. Doctor Butzen sees a relatively fast recovery with either technique, and presents both options (mini-open and endoscopic), discussing the pros and cons of each technique with his patient, who ultimately decides which is best for them.
However, certain cases, such as severe or complex carpal tunnel syndrome, may benefit more from open surgery. The choice depends on the patient’s specific condition and the surgeon’s recommendation.
Q. Do they put you to sleep for endoscopic carpal tunnel surgery?
Endoscopic carpal tunnel surgery is usually performed under general anesthesia or sedation, meaning patients can be anywhere from awake to fully anesthetized for surgery.
Q. Is carpal tunnel release a major surgery?
Carpal tunnel release is not considered a major surgery. It is typically performed as an outpatient procedure, often in under 30 minutes.
Despite being a relatively simple surgery, it requires careful post-operative care to ensure proper healing. Most patients experience significant symptom relief after the procedure.
Q. How painful is carpal tunnel release?
Pain after carpal tunnel release is usually mild to moderate, with most discomfort occurring in the first 1-2 weeks. Patients often feel relief from carpal tunnel symptoms, such as numbness and tingling, almost immediately after surgery.
Pain can be managed with over-the-counter medications and proper wound care. Some soreness or stiffness may persist temporarily as the hand heals. If the pain is greater than anticipated, Doctor Butzen can prescribe prescription pain medication if needed temporarily.
Q. What are the do’s and don’ts after carpal tunnel surgery?
Do’s:
Keep the surgical site clean and dry to prevent infection.
Follow your surgeon’s instructions on when to start gentle hand movements and exercises.
Wear any prescribed splints or braces as directed.
Don’ts:
Avoid heavy lifting or repetitive hand movements for at least 3-6 weeks.
Don’t ignore signs of infection, such as redness, swelling, or excessive pain.
Avoid smoking, as it can slow the healing process.
Q. Can you overuse your hand after carpal tunnel surgery?
Yes, overusing your hand too soon after carpal tunnel surgery can delay healing or cause complications, such as increased swelling or pain. It may also put stress on the surgical site, which can slow the recovery down, but does not typically cause structural injury or problems.
Gradual return to normal activities, as guided by your surgeon or physical therapist, is essential to avoid setbacks and ensure full recovery. Also, listening to pain will be a good guide to help determine which activities are safe to do.
Q. How long does distal radius fracture surgery take?
Distal radius fracture surgery typically takes 1-2 hours, depending on the complexity of the fracture and the surgical technique used, such as plate fixation or external fixation. This timeline accounts for all aspects of surgery, including the block (performed by anesthesia for postop pain control), anesthesia, preparing the arm, setting up equipment, the surgery itself, dressing placement and the wakeup.
Q. When does a distal radius fracture need surgery?
Surgery for a distal radius fracture is needed when the fracture is unstable, displaced, or involves the joint. Surgery is also recommended if the bone alignment cannot be restored through non-surgical methods like casting.
In severe cases, surgery ensures proper healing, prevents long-term functional limitations, and reduces the risk of arthritis.
Q. How long can you wait to have surgery on a broken wrist?
Surgery on a broken wrist is ideally performed within 2 weeks of the injury to ensure proper bone alignment and healing. The surgery is easier and can be more successful if it addressed earlier. Delaying surgery can lead to complications such as improper healing or reduced wrist function.
However, in some cases, temporary stabilization with a splint or cast can allow for a short delay until surgery is feasible.
Q. What to expect after radius fracture surgery?
After radius fracture surgery, patients can expect swelling, pain, and limited wrist movement for the first few weeks. A splint or cast is often used to immobilize the wrist during the initial healing phase.
Physical (or hand) therapy is frequently optional, but can be prescribed if the patient is slow to recover, either with pain or stiffness. In most cases, the patient begins home range of motion exercises after 2 weeks, with the support of a removable brace. Function slowly improves over time. Full recovery can take 3-6 months or longer, depending on the severity of the fracture.
Q. Is trigger finger release surgery worth it?
Trigger finger release surgery is often worth it for patients with severe symptoms, such as pain, locking, or limited finger movement, that do not respond to non-surgical treatments. The procedure is highly effective, with a success rate of over 95%.
Most patients experience immediate symptom relief and a quick return to normal hand function within a few weeks. The surgery itself has minimal risk, as it is performed wide awake (no anesthesia) and in the office, and it only takes a few minutes.
Q. How long does it take to fully recover from trigger finger release surgery?
Full recovery from trigger finger release surgery typically takes 4-6 weeks, though patients often notice significant improvement in symptoms within a few days. Doctor Butzen usually says that his patients recover 85% of function by 2 weeks, and that it can take a few more weeks to get the last bit of function, usually firm grip, or repetitive grip activities.
During recovery, patients are encouraged to perform gentle finger exercises to maintain mobility and prevent stiffness. Typically there are no restrictions on activities, but relative restrictions apply, to try and minimize swelling and pain.
Q. What is the downside of trigger finger surgery?
The downsides of trigger finger surgery are minimal but may include:
Scarring: A small scar at the incision site, which usually fades over time. Occasionally this can cause problems, especially if the scar is large or sensitive
Stiffness or swelling: Some patients may experience temporary stiffness or swelling after surgery. This usually resolves, but in the setting of excessive scar tissue, this stiffness can persist.
Rare complications include infection or incomplete symptom relief.
