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3 posts from September 2007

September 12, 2007

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.