Deep, persistent pain in the shoulder can affect young and old alike. Young, active patients often feel that shoulder pain stems from overuse. Current exercise regimens usually emphasize strengthening the deltoid muscles, but the rotator cuff is largely ignored. If the pain is a chronic problem, with no history of a single traumatic event, the patient will usually respond to strengthening therapy.
If pain persists, the current standard of care does not support corticosteroid (cortisone type) injections due to the negative effects on the integrity of normal tissue. Pain relief can be dramatic but often short-lasting and can accelerate rotator cuff degeneration and even arthritic changes (loss of joint lubricating cartilage). Patients often respond well to PRP (platelet rich plasma) where growth factors are introduced into the area to reduce inflammation but also promote a biologic healing response. Newer off the shelf biologic treatments (i.e. CTM® biomedical) are also available that are much more concentrated and avoid need for drawing blood. Stem cells remain controversial and in essence simply provide growth factors which is already achieved with the above mentioned techniques.
Persistent symptoms may require imaging studies such as an MRI and occasionally arthroscopic procedure to diagnose and repair the problem via mini incisions and surgery via a fiberoptic camera. Patients with complete tears of structures such as the rotator cuff or labrum (stabilizing soft tissue of socket) can be repaired with all-arthroscopic techniques. Partial tears are now amenable to technologies such as the arthroscopic introduction of a collagen patch that relieves pain and limits propagation of the partial tear (Regeneten® patch etc.) This leads to rapid recovery and minimal pain. Older patients usually suffer from a bursitis stemming from a partial or complete rotator cuff tear.
On occasion a primary osteoarthritis may be the cause and shoulder replacements are now as successful as hip or knee. This includes resurfacing replacements that are easily performed in an ambulatory surgery center, virtually free of hospital acquired infection risks.
Regardless of cause, shoulder pain deserves evaluation by an orthopedic surgeon, particularly an upper extremity/shoulder specialist in order to speed recovery and avoid misdiagnosis.
Alejandro Badia, MD, FACS
Hand and upper limb surgeon
Badia Hand to Shoulder Center
305 227- HAND (4263)
Founder, OrthoNOW® Immediate Orthopedic Care Centers