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2 posts from October 2010

October 18, 2010

A Patient Railroaded to Surgery

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. 

A Solution to a Large Problem

Forty-eight million Americans have shoulder pain.  Almost 90% of that shoulder pain has at least something to do with rotator cuff pathology.  The rotator cuff is a group of four muscles that are attached to the upper part of the arm bone on one end and to the shoulder bone, also called the scapula, on the other end.  The purpose of the rotator cuff is to keep the head of the humerus, a large ball, in a very small joint, similar to trying to keep a large ball on a small dish. 

The shoulder is a remarkably complex joint with a 270-degree range of motion, and 17 muscles are attached to the scapula. This means it is very difficult for people to exercise the shoulder appropriately when it is weakened because they are frequently exercising the wrong muscles and making matters worse. 

The insight within the creation of the ROTATORELIEVER is that it realizs a lot of the problem has to do with the sleep position at night.  At night the arm loses gravity as a friend, which causes some upward migration of the whole arm.  Frequently people sleep with their hands up behind their head in a position where the arm is away from the body.  This causes a very critical tendon in the shoulder to be pinched.  When the supraspinatus tendon is pinched and is robbed of blood flow, it weakens, thickens, and will tear and cause pain. 

Two critical missions that need to be accomplished to get rid of the vast majority of shoulder pain are:

1.    Stop the nightly pain cycle.  This involves putting the arm in a position where it can get blood flow to the entire rotator cuff. 

2.    The appropriate muscles need to be exercised in the appropriate way.   The RotatoReliever has sequentially weighted balls that, when spun, cause the rotator cuff to be exercised and not the pectoralis, deltoid, or trapezius.  The strengthening of the rotator cuff muscles, as well as stopping nightly injury, is the key critical aspect of getting shoulder pain better.  This has been proven in the first clinical trial looking at this approach to treating shoulder pain, and there is a significant ongoing study.   

I highly recommend looking at the ROTATORELIEVER system when my patients and others are suffering from shoulder pain.