Shoulder pain is one of the most common problems I see in our offices. There are many causes of shoulder pain ranging from overuse injuries in throwing athletes to dislocations from sports and trauma to arthritis and the most common cause which is rotator cuff dysfunction. The rotator cuff tendons are quite vulnerable to wear and tear as they occupy a space between two bones. When the arm is used in the overhead position, this space becomes even smaller. The tendon will then rub on these bones which can lead to fraying of the tendon. This is called tendinosis or a disease of the tendon. In the office, I often describe the tendon as a rope between the muscle and the bone. In tendinosis, the rope is not torn but it is frayed. When fraying occurs, it can lead to pain. It is easy to imagine that once a rope is frayed, it is more likely to snap and this is true for the rotator cuff as well.
Treatment depends on the nature of the tear which is why an MRI will be ordered. For some tears, physical therapy is the treatment. This will focus on strengthening the remaining muscles in the shoulder to assist with any deficits from the injured muscle and tendon. Often a cortisone injection will be recommended to assist with pain and inflammation in the shoulder. A cortisone injection does not heal the tendon but can be helpful with pain relief especially so the patient can be a better participant in physical therapy. Anti-inflammatories are also commonly used. There are new treatments available such as platelet rich plasma and bone marrow aspirate injection as well which can help to decrease pain.
Surgery may also be recommended based on the nature of the tear. This would be performed arthroscopically through 3-4 small 1 centimeter incisions in the front, side, and back of the shoulder. Surgery functions to bring the torn and retracted tendon back to where it is supposed to be using suture and absorbable screws into the humerus. The tendon is placed in the anatomic location of where it is supposed to be but then the body must heal it in that location before the patient can begin to use the shoulder again. The patient is in a sling for 6 weeks after the procedure for this reason. If the tendon does not heal to the bone, the sutures will tear through the tendon resulting in a new tear. Patients will often start to feel better before it is time for the sling to be removed but it is very important to give the body time to heal the tendon. Physical therapy is performed throughout the rehabilitation period to strengthen the repair and muscle.
Return to Activity
After treatment, the goal is to return the patient to the activities they enjoyed prior to the injury and lessen their pain. One of the most satisfying parts of my job is seeing patients back on the tennis court or back swimming or even just back to sleeping at night. If you are experiencing shoulder pain, please come see us in the office for evaluation and hopefully we can have you back at the activities that bring you enjoyment as soon as possible.
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