Shoulder Pain Talk

Rights of Spring

The sports pages are already filled with pitchers who are having shoulder problems.  We see it every year and we know that the pitching process does put a lot of stress on the rotator cuff, specifically, the superspinatis tendon.  The Detroit Tigers have been hit most hard seemly this year.  First they have Joel Zumaya out with a somewhat of a freak shoulder accident.  This when he was clearing out his parent's San Diego house from the wild fires that swept through California.  This required shoulder reconstruction; he seems to be responding well to that, and has had some painless episodes of throwing for the first time since that surgery.  Unfortunately, they are having their set-up man, Fernando Rodney, having problems similar to last year with painful throwing shoulder and he has not pitched in several days.  This is obviously a problem for the Tigers who expected to do well thisyear, and had significant offensive players picked up.  Tigers do have very strong starting pitching; however, typically as the season goes on, the reliance on the bullpen is great.  Finally, they lost their comeback kid in Matt Mattei, I believe, who retired this year at the age of 35.  He had a really nice major baseball career.  He was trying to make a comeback with the Tigers and felt pain in his shoulder after throwing against the Cleveland Indians.  He was not particularly interested in shoulder surgery or prolonged rehab and retired.  He shared with us that the reason he tried to make a come back from previous problems with shoulder pain was that his 5 year old son wanted to see him pitch in the majors; unfortunately, he'll have to the video tape.

What needs to be done new with baseball conditioners, trainers, sports trainers?  Why does this continue to happen with literally hundreds of millions of dollars in pitching salary sitting on the sidelines or in physical therapy or on the operating table each year?  It would be nice to see some forward thinking with rehab of these shoulders and really considering what does need to be done differently after pitching that would prevent these injuries.  I hope these teams have got their pitchers jumping rope and I also wonder if they are considering some of the new braces such as the night time shoulder immobilizer to be used on the night after the players pitch.

Go Tigers!

Shoulder Pain and Treatment Discussion

VTalk Radio's interview with Expert Rex Holden, physical therapist and owner of Fast Physical Therapy and Fast Fitness in Traverse City, Michigan.  Rex focuses his discussion on causes and treatments related to Shoulder injuries.  Listen below.

with Expert Rex Holden of Rex Holden Sponsor Dr. Michael Carroll Read Transcript Play Show

Will Physical Therapy, Exercise, and Medications get my Shoulder Better?

Whenever people come to the office and we diagnose rotator cuff tendonitus they want to know what their chance of getting better without surgery.  We certainly hear alot about surgery.  It’s frequently mentioned as a possibility.  Of course it depends on the severity of the rotator cuff tendonitus, but let’s just take all comers and if you consider the numbers that reliable on the research will show that 30 million people in this country will have shoulder pain over the course of the year, and we also know that 90% of shoulder pain is caused by rotator cuff tendonitis leaving that about 27 million people by conservative measures will have rotator cuff symptoms over the course of the year in the United States.  We also know there are less than 400,000 rotator cuff repairs performed in the United States each year, we can say that these people have at least a 95% chance of getting better without surgery.  Most people find this encouraging. 

Patients also need to understand that this is something they are going to need to manage on an ongoing basis.  It’s not to say they’re gonna have pain, but like most problems that require physical therapy, they will need to continue therapy, basically exercising, keeping the muscles strong, mobile, and flexible in order to keep the problem under control.  Also, let’s not lose sight that some anti-inflammatory medicines can help out a little bit and are certainly a reasonable addition to the therapy.

Why Does it Hurt When I Throw a Football?

To my child, the joys of fall are upon us, the leaves are starting to change here in the north, and college football is in the air, and on Friday nights the high school band can be heard from blocks away at half-time of the local football game.  A frequent patient complaint at this time is shoulder pain.  Many times it’s a forty-something year old man who is throwing the football a little too hard and subsequently has been experiencing pain with various movements.  Typical for a rotator cuff tendonitis.  These have been reviewed before, but frequently involve reaching above and grabbing something, any type of extension of the arm away from the body, reaching behind the back, all of these are fairly typical rotator cuff pain.  So why does one of the joys of life that of throwing a roped spiral to your son cause so much pain in the shoulder? 

Well,  the major problem is the superspinatus gets maximally stressed during the throwing motion.  That is the tendon that can get pinched between two hard surfaces in the shoulder.  It is interesting that the rotator cuff is made up of four muscles.  The supraspinatus, the sub-scapularis, the infraspinatus, and the teres minor.  The problems with rotator cuff almost always start at the superspinatus and yet we have to rely on the other three components of the rotator cuff to rescue the supersinatus. 

One common mistake people make is in their attempt to rehabilitate.  They will go back to the exercises of youth to include bench pressing and over head pressing and the thing to understand is that these are really small muscles and they essentially need small exercises, if you will, low weights or no weights are usually a good place to start with advanting of the weight.  The shoulder is a complex joint with over $270 degree range of motion and it is difficult to do the exercises correctly.  That is why your doctor will frequently recommend physical therapy for very specific rehabilitation of your shoulder.  So, good luck with it and we hope to get you back throwing tight 30 yard spiral to your child.

Cost of Rotator Cuff Surgery

In today’s challenging economic environment,  many people have to foot the bill for some of their own costs of procedures and treatment.  Many times it’s difficult to follow the dollar in medicine.  Recently some researchers have put together an interesting cost analysis of rotator cuff repair, and I think it’s important for patients to know about the actual cost of the surgery prior to going in.  Keep in mind that a cost of the surgery in this study which was performed through Columbia University in New York did analyze the cost of the surgery and all the associated costs and then the six month follow-up costs that included some rehab.  Keep in mind it did not include any of the doctor visits and attend said physical therapy prior to the surgery.  In any case, the total cost of a rotator cuff repair averaged $12,464, a figure driven largely by physician’s fees which were on average $2,392, operating room costs average $3001, and a total per diem hospital cost average $2,122.  The remainder of the costs were largely physical therapy.  Again, sometimes the cost of medicine is difficult for people to track down.  The other costs that this study did not take into account is wages lost.  Keep in mind every, there of course, the hospital days, there’s a few days after the surgery where most people are unable to go to work, and there’s all the missed time from work in regards to the physical therapy appointments.

The Results of Shoulder Treatments

Treating shoulder pain is often a scary idea for patients who may very well require drastic surgery in order to resolve their issues. However, the daily agony of joint pain isn't something that must be stomached,  and patients do not need to shrug off the pain as a normal aspect of aging.

Physical therapy and drug treatment are normal catagories of treatments that shoulder pain patients across the globe are normally prescribed. In cases even more serious, physical therapy and drugs are not enough to relieve the pain and shoulder replacement surgery is a treatment that can often deliver amazing results.

Dr. Alampallam Venkatachalam over at Shoulder Surgery, Arthroscopy, Stabilization, Slap Repair India has some great posts documenting the results of some of these treatment options. Keeping in mind the original condition that many of these patients had been in before treatment, some of the results are amazing.

Technorati: Something Other Than Shoulders for a Sec

Technorati Profile

I have mentioned the sheer numbers of people who face shoulder pain in many of my prior posts. Many of my posts have simply attempted to break the stereotypes of rotator cuff tendonitis and shoulder disease, the way that a baseball pitcher and amateur athlete can face the same condition.

Keeping the population of sufferers in mind, it is very possible that some bloggers themselves stumble upon this blog. For those bloggers, I want to take a second to recommend something other than a shoulder treatment...

Technorati.com is a great site that connects bloggers and readers. You can even tailor your posts to the technorati search engines through tags for each individual post, making it even easier for readers to find your specific post regarding their search term.

There are also ways in which Technorati can help increase the visibility of your site, ways that I am only just now exploring. If anyone reaches any great breakthroughs, I would love to hear of your results.

Shoulder Pain Caused by Swimmers' Shoulder

Shoulder pain is an affliction of many modern athletes.  Swimming is no exception.  Swimming typically involves a fair amount of freestyle swimming stroke.  It has been said that high level competitive swimmers will have as many as 16,000 arm rotations a week.  This activity of forward movement in the shoulder and the repetitive fashion does cause significant strain on the shoulder.  Swimming coaches and swimmers will know frequent episodes of anterior and superior shoulder pain, both during the swimming and as the process worsens throughout the day.

What is going on here?  Firstly, swimming, an excellent form of exercise and a very popular competitive sport, has to some degree some possibility for over use of the shoulder.  Over use is defined as using a body part in a repetitive way beyond which it was designed.  This stress can, at times, lead to impingement upon the superspinatus tendon, therefore, setting off a cascade that leads to full blown rotator cuff tendonitis. This condition causes significant shoulder pain.  It more frequently limits a swimmer’s training schedule due to shoulder pain. 

How are swimmers able to prevent shoulder pain caused by swimmer’s shoulder?   A few things are very helpful in understanding the anatomy of the rotator cuff.  Firstly, the superspinatus is only one of four muscles comprising the rotator cuff.  It also is the muscle that is most stressed and at times the one most warn down by repetitive use of free stroke swimming.  Swimmers need to understand that there are three other muscles of the rotator cuff that need to be strengthened.  Trying to balance out the amount of freestyle with at least increasing the amount of backstrokes when swimming will relatively strengthen some of the other three muscles, particular the infraspinatus.  Additionally, I typically recommend that swimmers include a very slightly weighted jump rope at the end or beginning of their swimming workout.  The jump rope by keeping the arms low and particularly when used in a very rapid fashion will strengthen the other three muscles of the rotator cuff.  This allows for balance within the very complex shoulder joint and specifically the structure of the rotator cuff.  This will go a long way towards helping prevent swimmer’s shoulder.  Specifically, I typically recommend the blue jump rope put out by Lifeline Fitness.  It’s called a speed/workout jump rope.   

Problems with shoulders are common with both high level and low level competitive and fitness swimming.  It is important to address this problem early.  It is important to understand that the shoulder needs balance in its strength.  Again, I recommend to my swimmers that they employ usually some increase backstroke and again I recommend using a weighted jump rope for ten minutes of jumping rope at the beginning or end of their practice. This will hopefully prevent shoulder pain, shoulder disease, and allow people to enjoy the rather incredible and unique sport of swimming which I uniformly recommend as an excellent form of low impact exercise.

More Thoughts on Shoulder Imaging

So, when you go into your physician with complaints of longstanding shoulder pain, he may or may not recommend imaging of the shoulder.  The fact of the matter is much of shoulder pain can be diagnosed without any x-rays.  However, there are some times with an initial evaluation that x-rays are needed.

When we think about this imaging, physicians can simply go through the following process.  Plain x-rays – the old fashioned x-rays – will give you good information about the bones.  Is there any arthritis? Is there any bone fractures?  In deed, in one of the fairly common problems called calcific tendonitis, one of the tendons becomes calcified and essentially starts to turn to bone and that can be picked up on x-rays. Certainly cancer, tumors, all these things, if they involve the bone, can be picked up on plain x-rays.  If the tumors are cancer, or not within the bone, then they basically escape the attention of plain films.

Magnetic Residence Imaging, or MRI, is technology that’s been around since the early 80s and it is the best way we have to look at soft tissues.  So that will show any tumors that are not involved in the bone.  They will show more importantly and much, much, much more commonly abnormalities in the tendon, inflammation in the tendon, rupture of the tendon, they will reveal bone fractures that are not seen on plain x-rays and that does happen up to 10% of the time.  They essentially give the most information available cutting without into the shoulder and looking at it.

Ultrasound is a new modality, and it is very useful.  You do need to understand its limitations.  Ultrasound will basically tell you how someone superspinatis tendon is.  Now, keep in mind, the superspinatis tendon is where most of the problems originate with the rotator cuff.  And many times, we will get an ultrasound if we want to find out if its’ worth while to try to treat someone conservatively.  Basically, if a superspinatis tendon is just showing partial tears or inflammation or swelling, then this person will likely get better without any type of surgery.  Even moderate tears can shown on ultrasound, can very frequently be healed without surgery; however, if there is a complete tear in the tendon then there is actually retraction on both sides – so there is basically a separation between the tear – there’s not a great place for physical therapy in my opinion.  So, the ultrasound is a one trick pony, but it can be quite practical and can give us a dream life if we really push the non-surgical rehabilitation aggressively.

Biceps Tendon Rupture - What Does it Mean?

Frequently patients with long term shoulder pain will at certain times develop a sudden worsening of this long term pain and come in for an assessment which will frequently involve an MRI.  It is not uncommon when someone has had years of shoulder pain to find a rupture of their biceps tendon.  This causes great distress amongst patients and typically represents accumulation of years of inflammation in the rotator cuff area.  The biceps tendon longhead of the biceps tendon inserts deeply into the shoulder joint and attaches fairly close to where the primary inflammation of rotator cuff tendonitis.  Frequently when the rotator cuff is inflamed the patient will have a cycle of inflammation, pain, and there is some collateral damage unfortunately when the longhead of the biceps tendon is surrounded by this inflammation and swelling. 

 

The surprising aspect of this tendon rupture is that it does not particularly impair the patient’s functionality of their arm.  The superior aspect of the bicep where it attaches to the upper arm has actually two attaches.  The longhead of the biceps tendon accounts for anchoring the smaller portion of the muscle.  Additionally, when this part of the muscle has been exposed to so much inflammation, it will become weaker over time.  Therefore, the patient may have this loss of the tendon, but the other superior attachment of the biceps tendon will basically be able to give them adequate strength and function.  So, if someone’s bicep tendon does rupture, it typically means they have a fairly severe rotator cuff problem.  What it does not mean is that it is absolutely necessary that they get surgery.  We can expect that some people will get better with physical therapy and certainly all people should have a trial physical therapy even if they go to their doctor at their initial assessment they have a ruptured biceps tendon.  Certainly some of these people will end up with rotator cuff reconstruction, however, the patient should know that most of the time; the biceps tendon is not reattached because it frankly doesn’t need to be.

Rotator Cuff Injuries Aren't Only for Pitchers

Shoulder pain and rotator cuff injuries are not restricted to the professional athletes. As I have posted before, there is nothing that protects the rotator cuff and shoulder of the weekend amateur athlete from the professional pitcher - both groups of people are straining their shoulder in ways that could quickly become tears in the rotator cuff that require medical attention.

I just stumbled upon a post from the Purple Medical Blog that illustrates this same conclusion titled "Shoulder Pain: Does Your Shoulder Hurt? Maybe Its Your Rotator Cuff". As the author writes, both the amateur athlete or normal Joe share the same "repetitive stress on the shoulder" as the professional athletes who are seen hurling baseballs at 90 miles an hour through 9 innings.

What is important to realize is that your shoulder CAN be suffering from a serious condition that requires the same medical attention as the baseball pitcher, even if you aren't on the mound for the Detroit Tigers.
 

Treatment of Shoulder Pain: What Works

In a recent study from the Annals of Rheumatic Diseases, the authors, Dr. Hay and Dr. Van Der Windt, out of both the Netherlands and United Kingdom, compared how people did when they had their shoulder pain treated in the primary care setting.  They tried to assess the differences in how these patients were treated and the progress they made.  They first noted that shoulder problems are common with up to 47% adults in the general population reporting such symptoms in a 1 year period. 

In the Netherlands trial, performed by Dr. Van Der Windt, it was found that the effectiveness of a steroid injection did help in the short term, but did not show any evidence there is a long term difference in the recovery when compared at 12 months.  These people were also referred to physical therapy. 

In the United Kingdom group, a study performed by Dr. Hay, it was also noted that the success of steroid injection was also helpful in the short term, but not in the long term.  These groups did not necessarily differentiate the exact cause of the shoulder pain, but focused more on treatment.  Overall they found there was similar improvement between the two groups despite the United Kingdom group using steroid injections later on in the course of the treatment. 

In their conclusions, they note that further study needs to be considered for the place of steroid injections given that they have not been shown to have long term benefit.  The authors are also proponents of continued physical therapy for this and know that in their study groups they had almost 90% improvement in their respected populations and they feel that supports more aggressive use of physical therapy for shoulder pain.

Hard Work Never Hurt Anyone: Or Did It?

Recent review of shoulder pain causes.  A recent article in Annals of Rheumatic Diseases authors, Bone and Tooper, looked at how prolonged exposure to repetitive activity at work can cause shoulder pain.  In their study, they noted that population based studies suggest a lifetime prevalence of over 70% for neck and shoulder pain.  The study also found that shoulder pain was second only to back pain and workers’ compensation insurance claims.  They also found that the risk of developing shoulder pain when starting a new job was related to the amount of lifting above someone’s head as well as exposure to monotonous work.  They concluded that shoulder pain is a common problem among working age adults and contributes importantly to sick leave. 

An association between workplace factors in such symptoms they noted that evidence continues to accumulate factors such as prolonged abnormal posture and repetition contribute markedly to shoulder pain. They also noted that more recent studies have considered the psycho-social influences such as monotony of work and the amount of stress might also contribute to shoulder pain.

In their conclusions, they call for more studies looking at psycho-social stressors as wells as repetative movement and how it can be modified in order to prevent further injuries to the shoulder in the workplace setting.

NyteTyme Immobilizer

There are SO many products on the market today that promise to relieve your shoulder pain, and it is often difficult to wade through the exaggerations in order to find those that are actually going to be helpful and worthwhile. The NyteTyme Immobilizer is definitely one worth "wading" for.

In an earlier post I referenced a nighttime shoulder brace that had amazing results in a study at The American College of Sports Medicine, and this is the brace I was talking about. The Immobilizer acts to simulate the natural position of the shoulder in the daytime, avoiding the normal nighttime shoulder positions that cause the chronic pain by pinching important parts of the joint.

The results of using the Immobilizer are amazing both because of the brace's effectiveness, and also its speed. As I mentioned before, patients only had to use the brace for a month before they saw drastic results when compared to traditional shoulder pain treatments.

The Immobilizer is a treatment option that gives hope to those who had given up on relief of their chronic shoulder pain as a result of a rotator cuff tear or other shoulder condition.   

Rotator What?

Shoulder pain can be a scary thing. The shoulder is one of the most important joints in the body, and to have its mobility severely hampered is to have one's daily activities drastically affected. However, by acting quickly and following your doctor's advice, it is very possible that a rotator cuff tear could be healed with little change in lifestyle at all.

But when you go to the doctor for shoulder pain, and the doctor gives you the common diagnosis of a rotator cuff tear, oftentimes patients have no idea what the rotator cuff is, or even what it is doing in the shoulder!

Check out this great article on eOrthopod to try and answer those questions - I don't know that I could have put it better myself!

Widespread Pain

Shoulder pain is commonly only one of many types of joint pain that a person will face during their lifetime. Whether it is the shoulder and the knee, the ankle and the shoulder, or any combination of any other joint, joint pain is an issue that is rarely restricted to a single location.

This is why sufferers should be aware of the differences in the pain that they are going through, even though the only difference they may assume between shoulder and knee pain is the location of the familiar torment. A great tool for educating oneself on the different types of joint pain is at Joint Pain Info.

Joint Pain Info has an extensive database on ten different types of joint pain, which leaves a lot of introductory information within reach of those who may find themselves with unfamiliar afflictions, and even less familiar solutions.

Sometimes You Need To Find a Doctor

Nowadays Americans are always looking to take care of themselves without the help of an expensive specialist. That do-it-yourself mentality is one of the reasons why WebMD has quickly become a household name.

Just like many other types of conditions, seeking a joint pain specialist to deal with shoulder pain is often one of the last things a sufferer will do, as they normally choose to wait out the pain. However, if the injury to the shoulder is serious enough, it is not something that can be "waited' away.

For those who are considering their first visit to a joint pain specialist, the webmasters over at Shoulder Pain Solutions have put together an easy tool for finding one wherever you are. There is even a very helpful guide that will help you prepare for that first consultation.

More often than not, shoulder pain is a condition that must be treated with more respect than a simple scratch. If you are experiencing shoulder pain and discomfort consistently, it may be best to consult a nearby physician.

Relief from Shoulder Pain With Pilates

Shoulder pain is an issue that plagues millions of Americans from all walks of life. But, luckily, there are many different methods to deal with that shoulder pain, so many that there are relief techniques that can fit into anyone's lifestyle.

I have posted earlier on the benefits of steroid injections, or even joint replacement surgery, but over at How to Deal With Shoulder Pain by Carol, a Pilates Instructor in the United Kingdom, she explores many other treatments that can provide relief.

One of the options that Carol posted on that I found most interesting was How Pilates Can Help With Shoulder Pain. As Carol writes, "Pilates has proven beneficial for persons with shoulder pain as a method to avoid surgery, prepare for surgery or rehabilitate after surgery."

While Pilates is definitely not the traditional physical therapy that most doctors have in mind when they suggest it to their patients, it is definitely an option that those who suffer from shoulder pain may want to explore.

Education is Often the Key

As is the case with every type of medical condition, education is the foundation upon which relief can be achieved. This "foundation" can often be built with the help of doctors and physicians who have spent a large portion of their life learning about the common ailments that afflict the population.

However, I just found a tool that can help educate those who suffer from joint pain, but without the cost of a consultation with someone with a Ph.D. This is Dr. Gordon Cameron's ebook, which he is publishing for free on his joint enterprise site. As his site writes: The book covers everything from the anatomy of how your shoulder works to the problem of choosing a therapist.

In an age in which the Internet makes information access and fabrication so easy, it is often hard to find help that is verifiable and from an actual expert. However, Dr. Cameron's ebook is the advice of an expert at the cost of Wikipedia.

Frozen Shoulders

Frozen shoulder is a disorder that often arises from a lack of use, commonly arising from pain in the shoulder. When one is afflicted with what doctors call adhesive capsulitis, referring to the actual adherence of the shoulder capsule to the humeral head, the shoulder severely loses mobility and the patient experiences severe shoulder pain.

Many of the traditional treatments for frozen shoulder are similar to those of chronic shoulder pain: anti-inflammatory drugs and physical therapy. Sometimes doctors even use electrical nerve stimulation in order to block the pain receptors and reduce the shoulder pain.

However, A New Way To Treat Frozen Shoulder may be on the horizon as reported by Gordon Cameron, MD over at Joint Enterprise. His post reports a study presented at the American College of Rheumatology that suggests that synovial fluid replacement products may be a useful tool in treating frozen shoulder.

While these injection fluids are often used for patients who are suffering from knee arthritis, doctors may soon find them in their new quiver of shoulder pain treatment options.

Rotator Cuff Injury Cycle

There is a frequent pattern of injury amongst those who suffer from rotator cuff inflammation. The shoulder goes through a cycle of injury followed by healing and then the patient will have a certain period of pain-free time only to re-injure it. Soon enough, the periods of pain-free times are less and the movements that cause pain are more and the threshold for re-injuring the rotator cuff lessens.

What is going on is that the rotator cuff will become injured as it is impinged under the coracoacromial arch. The rotator cuff has a very sensitive area on its superior muscle called the supraspinatus. The rotator cuff is made up of four different muscles. 90% of the injuries originate at the supraspinatus muscle. As a person goes through years of this cycling, the rotator cuff becomes scarred; becomes less flexible; it becomes more easily torn; it becomes less subtle. In affect, this rotator cuff prematurely ages and in this cycle of injury, inflammation, healing, scar tissue, the rotator cuff at some point becomes torn. The key to treatment is to break that cycle of repeated injury to allow the rotator cuff to restore some of its flexibility to reduce some of its scar tissue. Constant re-injury needs to be avoided at all cost. It delays the healing process and contributes to scare tissue and overall decreases the range of motion.

If you have a shoulder injury, it is critical to heal it quickly and completely.

Shoulder Replacement Surgery

Shoulder arthritis is an affliction affecting millions of Americans. Frequently we hear about knee replacement, hip replacement. More rarely is it suggested that patients undergo shoulder replacement. Primarily there is a lack of expertise that causes this. Also it has been cited that shoulder surgery has more risk. A recent study by the Johns Hopkins Department of Orthopedics led by Doctor Edward McFarland, MD, director of the division of adult orthopedics at Johns Hopkins Hospital analyzed a series of hip replacement versus knee replacement versus shoulder replacement procedure. After looking at how the patients fair, researchers concluded that comparatively total shoulder replacement was just as safe and effective as other types of joint replacement.

According to a nationwide 2003 Medicare figure, 6700 people had shoulder joints replaced that year compared with 107,000 hip replacements and nearly 200,000 knee replacements. It is interesting that patients in the study who had shoulder surgery, had far fewer in hospital post-surgical complications compared to those who had their hips and knees replaced. This includes a risk of death. Additionally, despite the fewer numbers, the shoulder replacement surgery also called arthroplasty was also less expensive according to the researcher. Shoulder replacements total cost on average were just over $10,000 where hip replacement was $15,000 and knee replacement was nearly $15,000.

The conclusion of this article is that shoulder replacement surgery should be performed more frequently noting that 99% of people who have had shoulder replacement for arthritis get pain relief and say they wish they had done it sooner. The study indicates there may be little reason to wait.

Rotator Cuff and Baseball

When you hear rotator cuff injury, what comes to mind? Typically a pitcher for your local team will have been recently placed on the disabled list. Most recently Orlando Hernandez and Jaret Wright are two of the big names on their respective team’s disabled list. This is not a problem restricted to baseball players, but they are particularly susceptible to it, given the throwing motion and how that impacts the upper part of the shoulder.

Essentially, they have something called impingement syndrome and this leads to rotator cuff tendonitis. It is also called the weekend warrior syndrome. This can be exasperated by playing basketball, by serving a tennis ball, by throwing a football. It is routine to feel somewhat sore after increased activity; particularly as one ages, but if routine movements such as turning off the alarm clock or reaching on the top shelf become painful, you need attention. Most of the time rotator cuff tendonitis can be healed and managed with physical therapy and full activity can be restored.

Occasionally, steroid injections are needed and more rarely than that , surgery is recommended. The critical aspect is to treat this problem early before there is major scarring or rotator cuff tears. Keep in mind that 90% of all rotator cuff tears are the original result of chronic inflammation. It is essentially something that starts small and gets progressively more difficult. If the shoulder is hurting, medical attention should be sought more quickly rather than less.

New Shoulder Therapy

Given that 90 + percent of shoulder pain is due to rotator cuff tendonitis it is worthwhile to consider those therapies set focusing on rotator cuff tendonitis. A recent study presented at The American College of Sports Medicine showed impressive results with using a nighttime brace to treat rotator cuff and tendonitis.

The study started with all patients receiving traditional care, which included hands on anti-inflammatory medications and physical therapy. However, half the patients then received an additional treatment of a nighttime brace that they wore for one month. The study was blinded. The results showed remarkable 100% improvement in those people who used the brace on a regular basis.

The patients did not need to wear the brace for more than three weeks. Only 50% of those in the group not using the brace got better over a one month period. This small but powerful study did reach statistical significance. This brace does represent new and exciting therapy to deal with this incredibly common problem of rotator cuff tendonitis.

Shoulder Pain - How are shoulder problems diagnosed

As with any medical issue, a shoulder problem is generally diagnosed using a three-part process;

Medical history – the patient tells the doctor about any injury or other condition that might be causing the pain.  Time line of the shoulder pain.  Exacerbating and remitting factors...How does the pain get worse?  How does the pain get better?  This will give many clues to the physician about what might be causing this.

Keep in mind the differential diagnosis for shoulder pain is long.  Many different things can cause it.  The second part of the process is physical examination.  The doctor examines the patient to feel for injury and discover the limits of movement, location of pain, extent of joint instability.  Many times this will be enough and medical history and physical exams do a very accurate diagnosis about what exactly is going on with the shoulder. If the doctor still has more questions, the doctor may order more imaging tests to help make a specific diagnosis.

 

A standard x-ray in which low level radiation is passed through the body to produce a picture called a radiograph.  This type of x-ray is useful for diagnosing fractures or other problems with the bones.  Soft tissue such as muscles and tendons do not show up on x-rays.  Ultrasound is a different non-evasive technique in which ultrasound waves can be used to visualize some structures in the shoulder particularly the ones closer to the surface.  Many times the problems with the rotator cuff are due to some of the structures located close to the surface and therefore is very helpful in making this diagnosis.

Finally, a frequently used imaging technique is the magnetic residence imaging (MRI) which is another non-evasive procedure in which a machine with a strong magnet passes a force through the body to produce a series of cross-sectional images of the shoulder.  This allows the doctor to look at the soft tissues and help make a more definitive diagnosis.  Most certainly before a surgery is proposed, an MRI will likely be available for the doctor to review to plan surgery.