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How to Treat Shoulder Pain Today

Wednesday, June 14, 2017 8:00 AM

Whether you're an athlete or just active in your everyday life, there's a good chance you've experienced some shoulder pain. Wear and tear, as well as injuries, can put a lot on hold, but today's surgical options have made a lot of progress in recovery. The experts at NorthShore's Orthopaedic and Spine Institute discuss:

Shoulder Pain

What are some common shoulder and elbow injuries?
The most common condition is shoulder bursitis. This is often a result of rotator cuff dysfunction. We also often see shoulder arthritis, shoulder instability, elbow tendinitis, elbow arthritis and fractures or the shoulder or elbow.

What can cause these types of injuries?
Specific to shoulder bursitis, this is often caused by either a rotator cuff tear or an intact rotator cuff not functioning properly. Rotator cuff tears are in large part degenerative (90%), meaning as we age the tissue because weaker and eventually tears. The more wear and tear put on the shoulder, the more likely you are to have a rotator cuff tear at a younger age. We see this more commonly in young patients when they have a history or repetitive overhead activity. Occasionally, a rotator cuff tear is traumatic (10%) due to a fall or shoulder dislocation.

How likely is re-injury?
This depends on treatment. Often with shoulder bursitis, patients' symptoms can get better with conservative treatment (physical therapy, anti-inflammatory medicine, and occasionally an injection of steroid into the shoulder). However, even if their pain goes away, if a patient has a full-thickness rotator cuff tear, it will not heal on its own, and it is likely with time that the tear will continue to get bigger. How quickly the tear will get bigger, we don’t know yet. It is likely that eventually, the symptoms will return, maybe in a year or maybe 5 years, but then the tear may be too big to repair. The potential for the rotator cuff to become irreparable is something the patient must be aware of when treated with conservative measures.

With shoulder injuries like rotator cuff tears, how are these diagnosed? By whom?
Suspicion for rotator cuff tear can often be diagnosed with a physical exam and history of symptoms, but it can often only be confirmed with an MRI. If the tear is very large and chronic, this can also occasionally be confirmed with XR. These conditions can be initially diagnosed and treated by your primary care physician, but I recommend that if symptoms fail to improve, the patient should follow up with an orthopedic specialist trained in shoulder surgery or sports medicine.

Reverse shoulder arthroplasty has been a new technique at NorthShore for treating this – can you tell us a little about it and how it’s different from other treatments?
Reverse shoulder arthroplasty (RSA) is reserved for large and massive rotator cuff tears that are chronic and irreparable. Before the introduction of RSA to the US in 2004 (FDA approval), there was little that could be done for irreparable cuff tears. Thankfully, reverse shoulder arthroplasty has been able to provide predictable pain relief and improved function for these patients.

Besides arthroplasty, what other advancements in orthopaedic surgery are currently taking place at NorthShore?
Currently, we are invested in utilizing new technologies like stem cells and platelet-rich plasma (PRP) to treat patients with varying shoulder conditions such as arthritis and rotator cuff tears.

Are there any research/studies, or procedures that the team is working on/studying?
We have just begun enrollment in a new multi-center FDA clinical trial looking at the use of a subacromial balloon spacer for the treatment of massive irreparable cuff tears. This new implant is minimally-invasive and may provide a good alternative to younger and active patients that are not good candidates for reverse shoulder arthroplasty. We are proud to have the NorthShore selected as one of only 10 medical centers in the country participating in the study.