Monday Medical: Keep shoulders free of pain
The shoulder is complex, so it’s no surprise it can sometimes get hung up.
“It’s a pretty complicated joint,” said Dr. Andreas Sauerbrey, a board certified orthopedic surgeon in Steamboat Springs who specializes in shoulder and upper extremity surgery, sports medicine and joint restoration. “There’s a lot going on around the shoulder.”
With a number of muscles and tendons coming together and a very shallow socket that allows for great mobility, the shoulder is predisposed to unique injuries, such as dislocation.
One of the most common issues is shoulder impingement, which often impacts people when they hit middle age.
“It’s something that’s very common,” said Sauerbrey, who operates on about 300 shoulders each year for various reasons. “Probably over 50 percent of the shoulder patients I see have some form of impingement.”
At the shoulder, muscles and tendons come together to form the rotator cuff, which attach the upper arm bone to the shoulder blade. If a bone spur develops or a ligament thickens in the area, a tendon can rub each time the arm is moved and may eventually tear.
Shoulder impingement is a gradual process: It can start off as mild swelling, then slowly develop into a partial or complete tear.
“I always use the analogy of a rope rubbing over a rock. You’re going to get fraying, and then, eventually, it may give completely,” Sauerbrey said. “It doesn’t always happen all at once. Impingement is more of a subtle process, where the damage is occurring slowly.”
Depending on the way bones in the shoulder form, someone might be predisposed to impingement. Trauma to the shoulder can also cause impingement. It may start with a fall off a mountain bike or a yoga stretch that causes a pinch.
One of the main symptoms of shoulder impingement is gradually worsening pain.
“That pain would just continue to smolder and get to the point where it starts bothering their activities,” Sauerbrey said. “A lot of times, when sleeping becomes painful, that’s when people finally come to see me.”
If impingement is suspected, Sauerbrey conducts a thorough examination, then may request an MRI of the shoulder to determine whether there is a tear to a tendon. If a tear is present, it often needs to be repaired with surgery. If there’s no tear, the patient should avoid activities that irritate the impingement, and the injury can be treated it with physical therapy.
Through physical therapy, muscles around the shoulder are retrained and strengthened to better move and hold the arm bone down, creating more space in the shoulder socket and preventing further irritation to the rotator cuff tendons.
Another helpful treatment is platelet-rich plasma injections, in which a sample of the patient’s blood is spun to concentrate platelets — cells that stimulate a healing response. The treatment can be especially useful in the shoulder, where blood supply might be compromised due to the impingement.
Patients may also see benefits with anti-inflammatory medicines, chiropractic work, acupuncture and massage.
The most important thing is to know what you’re dealing with.
“The key in the whole issue is getting the right diagnosis. If anything can be frustrating for me, it’s that people may go on for a long time without knowing what’s going on,” Sauerbrey said. “It’s important to get in front of somebody like me to sort out exactly why the shoulder hurts.”
Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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