John E. (Jed) Kuhn, M.D. Chief of Shoulder SurgeryVanderbilt Shoulder Center

Clinical Interests: Arthroscopic shoulder surgery, the evaluation and treatment of the athlete’s shoulder, and methods of keeping the older athlete active

Education: University of Michigan Medical School

Post Graduate Training: Orthopaedic Surgery Residency at the University of Michigan followed by a fellowship in orthopaedic sports medicine and shoulder surgery at the Steadman-Hawkins Clinic in Vail, CO

Interview with Dr. Kuhn:1. What type of symptoms would indicate a referral to your office?

Shoulder pain, a feeling of instability in the shoulder, an injury to the shoulder.

2. What would you consider an average length of time for conservative treatment prior to initiating surgery?

This depends on the condition. For work related overuse injuries a minimum of 3 months is typical.

3. What is your criteria for doing surgery (i.e. rotator cuff tears)?

Again this depends on the condition. Some conditions to not require surgery, others require surgery if conservative treatment fails, and others are best treated with surgery early. In addition, the treatment of some disorders, like rotator cuff tears depend on patient specific factors. For example, we are more likely to recommend repairing a rotator cuff if it produces pain and disability, and if the patient is younger. There are some rotator cuff tears that are not painful, and do not cause disability. These could be managed non-operatively.

4. You have performed over 2,400 shoulder surgeries in your career. What percent of your patients does this represent?

About 20% of the patients I see will require surgery to treat their problem

5. What treatment measures are normally indicated during the conservative treatment period?

The focus is on appropriate physical therapy, which is an essential part of the care of shoulder disorders. In my opinion, surgery frequently serves as an adjunct to good therapy. In addition employing good pain relief techniques will help with physical therapy.

6. If surgery is indicated, at what point do your patients normally return to work with restrictions?

I try to get patients back with restrictions within 2 weeks after surgery.

7. Is surgery always necessary?

No. There are some shoulder problems for which surgery is a last resort. Many get better with appropriate therapy.

8. How do you feel about returning patients to modified duty if it is possible?

I think returning patients to work in modified duty is an important step in returning them to their pre-injury role.

9. How open are you to direct communication with the case management/adjustor community?

I have found case managers and I share common goals. We want our patients to get better and return to their work as quickly as possible. As such I appreciate their help and input.

10. In what types of situations would you order a Functional Capacity Evaluation (FCE)?

When a patient has not returned to normal and has reached maximal medical improvement, and there are questions or concerns regarding the limitations we propose, a Functional Capacity Evaluation can be helpful in setting permanent restrictions and yet allow a patient to return to work in some capacity.