FAQ: Shoulder

Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem

At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.

Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.

Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.

Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.

Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.

If you have been diagnosed with a “rotator cuff tear,” that can mean many different things depending on the severity, location, chronicity and dysfunction it is causing. Many times, a small or partial tear can be found on an MRI, but a patient may not even have symptoms. We treat the patient and not the MRI findings. That being said, MRIs can be very helpful in diagnosing a tear, and imaging gives us the ability to visualize the location and extent of the tear. With that information, we can come up with the best treatment plan. Thankfully, most people who have a rotator cuff tear on an MRI do not need surgery, but many people do. We are here to help, whether you just need a few sessions of therapy or you need surgical intervention.

Many patients complain of shoulder pain that disturbs their sleep. It can be caused by many different shoulder issues. The pain comes from inflammation in the shoulder that may be a result of tendinopathy, rotator cuff tear, frozen shoulder, arthritis or a number of other issues. When lying in bed, it is difficult to find a position that is comfortable due to the fact that many people lie on their sides, stomach or with their arms overhead. In many cases, if the pain is persistent, patients will find sleeping in a recliner is most helpful. Whether you have had months of restless nights or just a few days, we can help you understand what is wrong and determine the best ways to improve your quality of life.

Cortisone injections offer an excellent way to decrease inflammation in the shoulder and surrounding tissues. Many patients find cortisone injections greatly beneficial in decreasing pain and increasing motion, although there are some drawbacks to having too much cortisone. Cortisone is a steroid that can weaken tissues and damage cartilage. It can also cause an increase in blood sugars and make patients more prone to infection. We usually reserve injections for patients who are having difficulty with stiffness or have pain that cannot be managed with therapy or oral NSAIDs. Technically, cortisone injections can be done every three months, but we are more conservative and do not give them to patients on a routine basis.

Shoulder pain can arise from a variety of different issues. We commonly see patients who have had longstanding shoulder pain, did something to make it worse and have decided to have it looked at. They may have rotator cuff tendinopathy, a partial rotator cuff tear or maybe even a full-thickness tear. Some patients are very active — often times athletes who have had an injury in the past. They continue to have shoulder pain with certain activities and want to know what their prognosis is. These patients may have a labral tear, a rotator cuff tear or an overuse injury.

Other patients come into our office with shoulder stiffness. They usually noticed that their shoulder became progressively stiff and painful. Once it becomes dysfunctional and affects their daily life, they call for an appointment. This is most commonly adhesive capsulitis, also known as a frozen shoulder. Sometimes, patients will come in with a longstanding history of shoulder pain and crepitus. They may have shoulder arthritis. Other patients present with severe acute shoulder pain that may be from calcific tendonitis.

Regardless of the shoulder problem, our specialists are eager to help you achieve your goals, whether that is getting you back to the game you love, decreasing your pain, increasing your motion or helping you sleep at night.

Generally, we would recommend NSAIDs to help decrease the inflammation that is causing your pain. This could be Motrin, Advil, Naproxen, or other anti-inflammatories. These can also be taken in conjunction with acetaminophen (Tylenol) for acute pain or postoperatively. Although these medicines are over the counter (OTC), they still come with risks and should not be used as a long-term solution to your pain. We would recommend discussing this with your doctor to see what regimen or combination of OTC medicine would be most helpful.

Following an arthroscopic rotator cuff repair, we tell patients that it will take about six months until they are returning to most activities and about one year until they are feeling back to normal. The first six weeks after surgery, you will be resting the shoulder in a sling with no active motion while the rotator cuff heals. After six weeks, you will begin physical therapy that will be prescribed by your doctor as part of your recovery. Exercises will begin gradually, and you will slowly progress from small range of motion exercises to eventual strengthening exercises by three months after surgery. Although the recovery is lengthy, it is crucial to comply with all restrictions to ensure proper healing.

Shoulder imaging may help us determine your diagnosis. Our doctors will see you in the office for a consult prior to ordering any imaging. If you have imaging from another office, it would be helpful to bring that to your appointment. We may order an x-ray to look at your bones and joints. X-rays allow us to see the alignment of your shoulder, potential arthritis, calcific tendonitis, fractures and other bony abnormalities. An MRI may be ordered if there is concern for soft tissue injury. This imaging allows our doctors to see if you have any rotator cuff or labral pathology. Once the imaging has been completed, you will return for an appointment to review your imaging in detail. This will give you a chance to ask questions and be involved in your care.

Physical therapy can be extremely helpful in addressing shoulder issues. It will likely be involved in your treatment to some extent, whether it’s to help manage pain, increase strength or mobility, or rehabilitation after surgery. Your therapist will design a program that is unique to your problem and help guide you through exercises and stretches. Generally, we send patients to therapy three times a week so they can develop a consistent routine. We can recommend the names of specific therapists who are particularly skilled in treating shoulder issues. Although therapy is time consuming, it may help you avoid surgery or manage your pain without medication. Physical therapy also helps you to develop good techniques and habits for exercise that you can then use at home.

Personalized care

As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free. 

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