Common sources of shoulder pain and how to treat it

From summitdaily.com
By Lauren Glendenning

Shoulder pain can range from temporary to long-lasting, from motion-related to constant, but one of the most disruptive symptoms of any shoulder injury is its effect on sleep.
“When you don’t sleep, everything in life becomes harder,” said Dr. Aaron Black, a shoulder, knee and trauma specialist at Panorama Summit Orthopedics.

Some of the most common sources of shoulder pain include rotator cuff injuries and arthritis. In Summit County, it’s common to see patients who develop shoulder arthritis as a result of previous injuries to the shoulder, such as a shoulder dislocation earlier in life, Dr. Black said.

A specific diagnosis and treatment plan can result in years — or perhaps a lifetime — of pain relief and increased mobility in this important joint. It’s Dr. Black’s mission to make sure he’s helping patients not only eliminate shoulder pain and weakness, but also get back to consistently healthy and restful sleep.

Primary arthritis vs. rotator cuff arthropathy
The two broad categories of arthritis most commonly seen in Summit County are primary arthritis and rotator cuff arthropathy, or secondary arthritis. Primary arthritis has no specifically known cause and is usually related to age, sex and genes, according to the Arthritis Foundation. Rotator cuff arthropathy happens after a large, long-standing rotator cuff tendon tear that no longer holds the head of the humerus in the socket, causing it to move upward and damage the surface of the bones, according to the American Academy of Orthopaedic Surgeons.

“Shoulder arthritis is experienced as achy pain and stiffness around the shoulder that often feels worse in the morning,” Dr. Black said. “Rotator cuff arthropathy is usually associated with stiffness and weakness.”

Non-operative arthritis treatment
Non-operative shoulder arthritis treatment includes physical therapy and injection therapies.
“As with any arthritic joint, the more you use it, the less stiff it is and the less pain you have,” Dr. Black said.

PT can help improve range of motion in the shoulder, while icing the shoulder two or three times a day can reduce inflammation and ease pain.

Dr. Black’s injection therapy options include cortisone and biologic agents, such as platelet-rich plasma (PRP), all of which act primarily as anti-inflammatories.

No biologic injection therapies contain stem cells for tendons or cartilage, despite advertisements to the contrary, and thus do not regrow cartilage or tendons, he said.

Cortisone injections can offer pain relief for three to six months, while PRP tends to last a bit longer, Dr. Black said. The procedures are performed in the office under ultrasound guidance.

Shoulder joint replacement (arthroplasty)
If shoulder arthritis is severe, it’s less likely that the non-operative options will get the job done. The next option for these patients would be shoulder joint replacement surgery.

Dr. Black said there are two types of shoulder replacements: anatomic total shoulder replacement and reverse total shoulder replacement. There are roughly 53,000 of these surgeries performed each year in the United States, according to the American Academy of Orthopaedic Surgeons.

Both procedures have differing benefits. Dr. Black said that anatomic replacements can be done on patients of any age, but those who have it at a younger age might require another surgery later in life. The procedure works well for getting patients back to their normal activities.

Reverse replacements are extremely reliable for reducing or eliminating pain, but less reliable for getting full range of motion back, he said.

“I do all of my shoulder replacements with custom 3D modelling and patient-specific guides made to ensure the components are in exact right position,” Dr. Black said.
Dr. Black stresses that all joint replacements are elective surgeries.
“I will never tell a patient they have to have a joint replacement,” he said. “This is symptom-based — when you say it’s time, it’s something I’ll say you should have. I want all of my patients to be informed about the options.”

Shoulder joint replacement recovery includes about six weeks in a sling, and in three to four months most patients are back to regular activity with continued improvement from there.

Rotator cuff injuries
Another common local shoulder affliction is to the rotator cuff, which is the combination of muscles and tendons that keep your arm bone centred in your shoulder socket to provide shoulder motion and stability. Dr. Black said these injuries can happen during a fall when the arm is thrown away from the body, but sometimes rotator cuff injuries are chronic and happen over time.
Some people even have large tears to the rotator cuff without ever feeling any symptoms.
The good news is that there are a lot of treatment options, from physical therapy and injections to repair or reconstruction surgery.

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