Shoulder Pain & Injury: Causes, Prevention & Treatment with Dr. Steven Levinhttp://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=117Shoulder pain and injuries can have multiple causes, such as athletics, overuse, acute trauma and arthritis. Don’t ignore the pain. Playing through or waiting for the pain to subside could make the pain or injury worse and potentially result in long-term negative effects. Steven D. Levin, MD, Sports Medicine Orthopaedic Surgeon at NorthShore, answers questions on shoulder injuries, pain,and arthritis, including prevention, treatment and recovery. Submit your questions early.Copyright 2014 NorthShore University HealthSystemPost at 8:27 AMDr. Steven Levin: Thank you for participating in this Shoulder Pain and Injury: Causes, Prevention & Treatment Chat I hope you find it useful and interesting.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1178:27 AMPost at 9:48 AMBrenna: Our chat will begin at 12 p.m. today. We've had some great questions submitted so far. You can continue to submit questions in advance of the chat or submit questions at any point during the chat.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1179:48 AMPost at 12:00 PMDonna: What can you tell me about Frozen Shoulder, it's recurrence and your philosophy on treatment?<br/><br/>Dr. Steven Levin (NorthShore): Frozen shoulder, or adhesive capsulitis, is a condition that causes stiffness in the shoulder joint and lack of motion. There are many causes and can be associated with diabetes or thyroid problems. It can also be seen after shoulder trauma. Typically it is a self remitting disease process, which means it runs its course and heals on its own, but may take several months. It is usually treated with extensive physical therapy, occasionally injections and rarely surgical release. It usually does not recur once it has been treated. I actually recently published a chapter on Frozen Shoulder in an orthopaedic text.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:00 PMPost at 12:04 PMJessica: I am not sure what caused it but I get what seems to be intense nerve pain up in my right shoulder when I use it too much.. but especially when driving, using the computer, writing and other fine motor movements... nothing seems to help except immobilizing it... any suggestions?<br/><br/>Dr. Steven Levin (NorthShore): Nerve type pain can be coming from the neck, actually. If it seems to be radiating pain it may be coming from nerve root irritation from a disc in the neck. If that is the case it would need to be properly diagnosed with possibly an MRI. If in fact there is a slight disc problem this can often be treated with physical therapy. Other possibilities could be impingement, or rotator cuff issues, although typically this is not described as "nerve" pain. If that were the case therapy usually helps and occasionally injection of cortisone, but one would need to make the appropriate diagnosis first.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:04 PMPost at 12:09 PMJose: I'm experiencing severe pain starting from my neck to my shoulder down my right arm. I find it very difficult to sit or lie down for a long period of time. I'm currently going to physical therapy with minimal improvement what would you recommend at this point.<br/><br/>Dr. Steven Levin (NorthShore): This situation is very similar to the previous question I just commented on. Based on the information you provided, I would probably get an MRI of the neck to see if there is a herniated disc which could be causing your symptoms. If that were to be the case and therapy is not helping, I would seek advice from a spine specialist and possibly consider epidural steroid injection. If severe and not responding to other conservative treatment options, surgery may be indicated.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:09 PMPost at 12:12 PMLouis: Can a rotator cuff tear heal without surgery? Is surgery ultimately a faster way to heal and get back to being pain free?<br/><br/>Dr. Steven Levin (NorthShore): Some studies have followed patients with small full thickness rotator cuff tears and have shown healing. However, typically they do not fully heal and can progress. If a rotator cuff tear is diagnosed early on, it usually does progress slowly and surgery is the best way to address it. Surgery allows the tendon to heal back to bone and gives the patient the best chance of increased range of motion and strength vs. non-operative treatment in most cases.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:12 PMPost at 12:16 PMPaul: I've suffered several shoulder dislocations. I've learned to be a bit more careful but it still happens. What can I do to try to combat this? What surgical options are there?<br/><br/>Dr. Steven Levin (NorthShore): There are many factors that go into the decision making process for recurrent dislocations. If you are younger and it recurs often and you have failed physical therapy, then surgery is definitely indicated. Typically when one has recurrent dislocation, the labrum, or ligaments, are torn and this then leads to shoulder instability. If a concerted effort at physical therapy has not helped, then surgically reconstructing the ligaments or repairing them has a very high success rate. This can be achieved by outpatient minimally invasive surgery.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:16 PMPost at 12:20 PMJohn: I play D1 rugby, and know that you have gotten many players on the USA National Team back playing after shoulder surgery. That said, I have had 2 shoulder dislocations but it has been stable for the past 2 years. What would determins if I need surgery, as I don't want to take time off from the season if I can avoic it?<br/><br/>Dr. Steven Levin (NorthShore): If your shoulder is stable and is withstanding the rigors of rugby currently without any feeling of shoulder instability then you could continue playing. However, if you have had 2 documented instances of your shoulder coming out of joint where it had to be put back in by a physician, then the chances are very high that you have ligament and/or bone damage whereby surgery would be indicated. If your shoulder dislocates again, I would strongly recommend surgery. You would need appropriate pre-op studies such as an MRI and/or CT scan to determine the specific procedure you would need.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:20 PMPost at 12:24 PMRuth: I am 70 years old, active and have a massive rotator cuff tear. I have tried all non-surgical treatments but have pain when playing golf, and lack of motion. My doctor told me I have rotator cuff arthopathy and need a reverse shoulder arthroplasty. I heard yu do a lot of these. Could you tell me about it with regard to details of surgery and recovery? Ruth<br/><br/>Dr. Steven Levin (NorthShore): Reverse shoulder arthroplasty, or replacement, is meant for patients who have irrepairable rotator cuff tears and arthritis of their shoulders. It is different from regular shoulder replacement based on the biomechanics of the shoulder joint wherein the patient does not have a functioning rotator cuff. This makes the surgery just a bit more complicated, but the procedure works very well. The ball of the shoulder is placed where the socket is, and the socket is placed where the ball typically is, thus "reverse". It is done this way to take advantage of the big muscle on the side and top of the shoulder, the deltoid, which motors the shoulder replacement. Recovery is actually not very involved. In most cases patients stay in the hospital 1 night, and do 1-2 months of therapy and then are done.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:24 PMPost at 12:29 PMliz: I am 4 months and a week s/p rotator cuff repair and I have developed a biceps tendonitis from PT. Do you see this happening with your patients? Is it best for me to work through the pain and soreness and continue to strengthen so that eventually the bicep tendon will not be compensating so much for my weak rotator cuff? Or should I just focus on stretching at this time until the tedonitis calms down?<br/><br/>Dr. Steven Levin (NorthShore): I typically do not see this, but certainly can occur. If you truly are suffering from biceps tendonitis the therapist could institute iontophoresis treatments, which are steroid medicated gels that are electrically stimulated into the area of inflammation. This along with stretching and other therapy modalities could be quite helpful. If that does not work, occasionally injection into the biceps tendon sheath helps.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:29 PMPost at 12:32 PMgerry: Is there anything I can do to strengthen my shoulder with bursitis. or possible torn rotator cuff? or does it need surgical intervention.<br/><br/>Dr. Steven Levin (NorthShore): If you have bursitis, or impingement, without a torn rotator cuff, this can be treated with physical therapy. It typically does not require surgery. If you have a torn rotator cuff and are a young, active patient, surgery is typically indicated, as the tendon tear could progress and become much more difficult to repair down the road. Treatmen for rotator cuff tears to some degree are individualized depending on patient age, activity level, degree of tearing etc.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:32 PMPost at 12:37 PMcheryl: why would I still be having so much shoulder pain 2 years after my reconstructive surgery? I do have a cadaver part in my shoulder and that's where I have most of the pain. It's become like a virus in me. tendonitis is getting worse. Neck pain is getting worse and the last xray they took of me found contusions on my ribs near my shoulder blade...<br/><br/>Dr. Steven Levin (NorthShore): This is a difficult question to answer based on the information provided, ie what type of cadaver part was put in your shoulder and for what reason. In general, however, if you are having pain after shoulder surgery where a cadaver part has been put in I would definitely want to make sure there was no infection. Other studies would be needed to diagnose this, but it would be extremely important to rule that out. After that one would want to make sure there was no other mechanical problem going on, but again more information would be needed to answer these types of questions.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:37 PMPost at 12:40 PMPaul: How long would recovery for that miminally invasive option take? How long to people normally need to stay out of work? Is there rehab involved?<br/><br/>Dr. Steven Levin (NorthShore): If you are talking about arthroscopic rotator cuff repair it is approximately a 4 month process for full recovery. This is somewhat individualized however based certain factors. One could do a desk type job within a couple of days, but heavy labor would take anywhere from 4-6 months or longer depending on the actual job requirements. Patients are usually pretty functional after a couple of months, but are not ready at that time to do heavy activity as the tendon is still healing and one could risk damage to it at this early juncture.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:40 PMPost at 12:44 PMDeeDee: My son is a high school football player. He's had 3 shoulder dislocations at this point. How young is too young to consider surgery? If he did have surgery, could he expect to be able to continue to play at the same level he was before surgery?<br/><br/>Dr. Steven Levin (NorthShore): It is rare for very young patients, ie under age 15 or 16 to have shoulder dislocations. If your son is older and has had 3 dislocations it would seem to me that he needs surgery. I absolutely believe he would be able to continue playing at the same level. There are many examples of professional athletes who return to their same level of play after reconstructive surgery for shoulder dislocations. I have personally seen the same with USA National Rugby players also.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:44 PMPost at 12:48 PMDanielle: I have been told I may have Tendinitis in my Rotators cuff and was told to take anti-inflammatorys. They did not work and it has been 4 months since it first started to hurt. It throbs now and is tender when I raise above my head or put a jacket on. It is around the joint that I feel the pain and I am not able to hold my daughter for a long period of time.<br/><br/>Dr. Steven Levin (NorthShore): If antiinlammatories and other measures such as physical therapy have not helped, I would be inclined to look into your problem further with possibly an MRI, as you may have something more significant going on such as a rotator cuff tear. If that were to be the case, surgery may be necessary, depending on other factors such as your age and activity level.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:48 PMPost at 12:52 PMMike: I have bone spurs in my shoulder. What causes them? they are quite painful. What can I do about them? Is this somethign that requires surgery?<br/><br/>Dr. Steven Levin (NorthShore): Bone spurs can be acquired over time from overuse or trauma. They can also be part of your normal anatomy. There is a bone that sits over your rotator cuff called the acromion that had three basic shapes. One of them is a hooked or curved bone that patients often refer to as "spurs". If therapy and general strengthening has not helped, oftentimes arthroscopy acromioplasty, or burring down the spur, is curative. A similar procedure could be done at the end of the clavicle or AC jont.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:52 PMPost at 12:56 PMFranklin: What are the signs of arthritis? I'm 60. Both my shoulders ache but I wouldn't say the pain is something that interferes with sleep or anything. Should I see a doctor?<br/><br/>Dr. Steven Levin (NorthShore): Lack of motion and chronic pain are the usual signs of arthritis. This diagnosis could easily be made with xrays. If the pain is to the point where it is affecting your daily activities I would certainly recommend seeing a doctor as there are many things that could be done to help alleviate your pain. If you were at the point where you had bone on bone with arthritic spurs, then typically shoulder replacement surgery is the ultimate treatment option. That would be indicated only after you have exhausted all other non-opertive treatment options first.http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:56 PMPost at 12:59 PMBrenna: Thank you everyone for your participation in today's chat. We apologize that we were unable to take every question. If you wish you find out more or make an appointment with Dr. Levin, click here on the words <a href="http://www.northshore.org/apps/findadoctor/physicians/steven-d.-levin?oqs=doctor%3dLevin"> Find a Doctor. </a>http://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=11712:59 PMPost at 1:01 PMDr. Steven Levin: Thank you for participating in this educational Chat. For further information please visit stevendlevinmd.com Thank you. Steven D. Levin, MDhttp://www.northshore.org/communityandevents/chat.aspx?id=6004&chat_id=1171:01 PM