Patrick DenardDirector Oregon Shoulder Fellowship, Oregon Shoulder Institute · Director Oregon Shoulder Fellowship at Oregon Shoulder Institute

Optimize Recovery The Power of Vitamins & Glucose Monitoring #shoulder #rotatorcuff #orthopedics

15 Feb 2025 · 2 min

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1:50

In this presentation, the clinician outlines a pre‑ and post‑operative optimization protocol for patients undergoing rotator cuff surgery. The protocol begins with screening for vitamin D deficiency, noting that about 30% of U.S. adults are deficient and that deficiency is associated with higher infection rates and poorer tendon healing. All patients are advised to take a baseline 800 IU of vitamin D daily for at least one to two months before surgery, with higher therapeutic doses for those identified as deficient. The speaker also recommends vitamin C supplementation to reduce postoperative pain and magnesium to improve sleep quality and further alleviate pain. Finally, the clinician advocates for continuous glucose monitoring (CGM) before and after surgery, citing evidence that even non‑diabetic patients experience postoperative glucose spikes that correlate with complications and slower recovery. By identifying dietary or lifestyle factors that provoke these spikes, patients can adjust intake to blunt the excursions, potentially accelerating recovery and lowering complication risk.

Chapters

step further, what I like to do for my patients is to think about vitamin intake and glucose. So how do we do that? Well, one thing we do is we measure vitamin D levels because vitamin D deficiency is present in 30% of individuals in the United States. Vitamin D is linked to higher rates of infection if people are deficient. It's also related to lower healing of the rotator cuff. So if we can identify those people in advance by preparing the 1 to 2 months in advance, I'll recommend everybody at the minimum take 800 international units of vitamin D prior to surgery. But if we can recognize or identify those people are deficient, we can treat them with higher doses of vitamin D so they can be in line to have normalized levels going into surgery and then supplement afterwards. There's some additional things like vitamin C is very beneficial in reducing pain. Magnesium can help with sleep and pain. Another consideration is glucose control. Now, one way to do this that I will help support my patients do is use a glucose monitor, so a continuous glucose monitor, because There's lots of data that shows that even in non-diabetic individuals, glucose levels spike after surgery and the duration of those spikes is correlated with complication. So if we can reduce those spikes, we're not going to eliminate them. But if we can reduce those spikes, we can perhaps have a benefit of patients having quicker recovery and a lower risk of complication. So I recommend that my patients do continuous glucose monitoring prior to surgery and after surgery for a couple of weeks. They can identify factors that help elevate or will elevate their glucose levels so that they can modify their intake and then afterwards have a better chance of reducing those glucose spikes after surgery and perhaps have a quicker recovery as a result.