If you’re a regular reader of Eisenhower's Healthy Living magazine, you may have first met professional golfer J.R. Delich in 2004 when his finger (multiple) joint replacement surgery was the cover story of this magazine, titled “The Bionic Golfer.” At the time, the professional golfer, who played in the United States and European senior tours, suffered from painful arthritis in his left hand so severe he couldn’t hold onto a club. “I would hit a shot and the club would go flying out of my hand,” he recalls.’
Board Certified Orthopedic Surgeon Stephen J. O’Connell, MD, Director, Hand and Upper Extremity Surgery and Chairman of Desert Orthopedic Center, performed a cutting-edge procedure, implanting new finger joints made from an innovative material called pyrocarbon.
“They’re still there 14 years and a number of tournament wins later,” says Dr. O’Connell, who is an avid golfer himself and has become friends with Delich. “J.R.’s hands are so arthritic, it’s hard to imagine he can hold a club, but he has the most beautiful swing.” At the end of 2015, however, Delich was once again sidelined from the game he loves.
“It was the day before Christmas and I was carrying a case of tea upstairs in my home in Philadelphia,” he relates. “I tripped on the landing and my right shoulder hit the wall. I felt some major pain right away, and it was excruciating when I tried to lift any weight.” Delich tried icing his injury, resting his arm and taking anti-inflammatory medication, but the pain persisted. So when he and his wife returned to their desert home after the holidays, he went to see Dr. O’Connell.
“It was clear from examining him that he had suffered a massive rotator cuff tear,” Dr. O’Connell says. “J.R. is tough and has played through many other injuries. When he told me he was having so much pain, I knew it was serious. In fact, he was so disabled it was alarming.”
Dr. O’Connell ordered an MRI to confirm his clinical assessment and evaluate the extent of the injury.
“I had the MRI on a Saturday, and Steve called me Monday,” Delich relates. “He told me that the injury caused tearing of three of my four rotator cuff tendons as well as my biceps.”
“It was a devastating injury,” Dr. O’Connell affirms.
The rotator cuff is a group of muscles and tendons in the shoulder that connect the upper arm (humerus) to the shoulder blade (scapula). The rotator cuff tendons give the shoulder stability, while the muscles enable the shoulder joint to rotate. Each rotator cuff muscle originates on the scapula, and has a tendon that attaches to the humerus, forming a cuff around the humerus to provide stability and function.
“The shoulder joint is a ball and socket,” Dr. O’Connell explains. “One of the functions of the rotator cuff is to stabilize the shoulder joint and enable the larger muscles to power and move the shoulder efficiently.
“Three of J.R.’s four rotator cuff tendons were torn off and had retracted over an inch from their insertion site,” he continues, noting that his patient had also dislocated and partially torn his biceps tendon (which attaches the biceps muscle to bones in the shoulder and in the elbow). “When he attempted to lift his arm, the shoulder joint was unstable, resulting in his inability to elevate his arm. It was a dramatic functional loss —and painful.
“While the pain may subside over time, those torn tendons never heal,” Dr. O’Connell adds. “Surgery is needed to repair them.”
While he felt confident that surgery was the best option for his patient, Dr. O’Connell urged Delich to first get a second opinion. Dr. O’Connell feels the best patient is someone who is confident in their surgeon and decision to have surgery, and enthusiastic about the rehabilitation process.
Delich spoke with a surgeon back in Philadelphia who agreed with Dr. O’Connell’s recommendation. Eager to move forward (“I’m not a procrastinator”), Delich got back in touch with Dr. O’Connell about scheduling his surgery.
“I asked him, ‘By the way, how long is the recovery process?’” Delich relates. “He suggested I’d be out of golf for about six months. I went ‘Whoa!’ but said okay, let’s get it done.”
Delich underwent his rotator cuff repair on February 26. Dr. O’Connell performed the surgery arthroscopically — a state-of-the-art, minimally invasive approach that doesn’t disrupt the outer muscles.
Like pulling down a window shade, the torn tendons had to be stretched and reattached using sutures and tiny anchors that are screwed into the bone.
“An average rotator cuff repair might require two anchors and four to five sutures,” Dr. O’Connell says. “For J.R., we used seven anchors and 16 sutures due to the severity and size of his injury.” The operation took two hours.
But surgery is only part one of the process, Dr. O’Connell stresses.
“We surgeons can do a beautiful repair, but unless the tendon heals to the bone, it will fail,” he says. “So there’s a very rigid and lengthy post-operative protocol.” Delich had to wear a sling for the first eight weeks after surgery and wasn’t allowed to actively lift his arm. During this time, he began doing gentle stretching exercises to regain range of motion, and then began a strengthening program.
“Steve cautioned me that because I’m a golf pro, I must be very careful with the post- operative rehabilitation if I wanted to compete again,” Delich says. “If I were to tear the ligaments away from the bone again, I’d need a complete shoulder replacement. My golf career is too important to not follow instructions.” Dr. O’Connell knows what he’s talking about.
“I’ve been on both sides of the operating table,” he says. “I’ve not only performed a couple thousand rotator cuff repairs, but two summers ago I had my own repaired, and it took 14 months before I achieved my final result.
“And one-and-a-half years out, I won my club’s golf championship,” he adds. “So golfers can go back to the game.”
Delich is counting on it.
In July, he was five months out from his surgery and returned to the golf range hitting easy pitch shots. In September, J.R. was able to hit full shots and return to the game he loves so much. He continues to do his exercise program daily and takes no pain medication. “Steve predicts I’ll get back to playing as often as I want,” he says, “and I have complete confidence in him — he’s a magnificent surgeon and wonderful person, husband, father and friend.
“I will play competitively again,” Delich adds. “
Rotator cuff repair: Is surgery always necessary?
While professional golfer J.R. Delich sustained a devastating rotator cuff injury that required surgery, that’s not always the case.
“If you were to do MRI scans of people over age 70, 100 percent would have some pathology of their rotator cuff,” says Board Certified Orthopedic Surgeon Stephen J. O’Connell, MD.
“It’s a part of the body that simply tends to wear out,” he continues, “but most people don’t ever have symptoms.”
Some people, however, experience inflammation, pain and limited function. “If you have symptoms, it’s important to see a doctor early,” he says. “The majority of chronic cases can be treated with anti-inflammatory medications, modification of activities and physical therapy to strengthen the rotator cuff and make it more stable.
“Even if it’s a partial or full tear, you can strengthen the surrounding muscles to accommodate it,” he continues, “and if you have good function and no pain, no surgery is needed. The earlier you seek treatment for a chronic rotator cuff issue, the higher the probability you won’t need surgery.”
To contact Eisenhower Desert Orthopedic Center, call 760-568-2684.