A patiently recently contacted me inquiring as to the best way to treat shoulder pain. The patient was a male, 76 years old, who had had three months of shoulder pain. The patient was having pain predominantly at night. He was completely functional during the day and did not expierence significant pain. He had no history of shoulder surgeries, injury, or problems, and was generally healthy. This patient’s shoulder pain was again disturbing sleep, causing problems at night. The patient bypassed his primary care physician and arrived at the orthopedic surgeon’s office. The orthopedic surgeon ordered an x-ray and an MRI, which showed an intact rotator cuff. The x-ray was normal. There was some inflammation and thickening of the supraspinatus tendon at the rotator cuff.
After this imaging, the patient went back to the surgeon, who did not recommend physical therapy, exercise, or anti-inflammatories. The surgeon recommended surgery. This was a gentleman who had not received any physical therapy, had not had steroid injections, had not been on any type of medicine, had pain only at night, and was fully functional and pain-free during the day. He was, in my opinion, a bit too quickly triaged to surgery without a trial of those other modalities. I think the patient was not served by this rather aggressive surgical treatment plan, and I would like to have seen him enjoy some benefit from therapy and possibly medications. Also, we would like to see the surgeons using a standard approach, a standard plan of treatment where these types of patients will not be automatically placed in the OR and where they at least have a chance to recover from this problem without surgery.