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9 posts from July 2007

July 25, 2007

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.

July 23, 2007

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.

July 21, 2007

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.

July 18, 2007

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.

July 14, 2007

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.

July 09, 2007

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.

July 02, 2007

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.