The shoulder is an incredibly mobile part of the body. It’s the first mechanical linkage that allows us to put our hand in space. Without the shoulder’s remarkable range of motion, we would not be able to carry out some of the most vital movements in everyday life – reaching, grasping, tossing, throwing!
That means when shoulder pain and shoulder injuries pop up in your life, it usually causes quite a bit of disruption and dysfunction. Dr. John L. Todd, medical director of The Shoulder Center at Baldwin Bone and Joint, has over 20 years of experience treating shoulder pain and shoulder injuries. Dr. Todd regularly gives educational seminars at hospitals and community centers to de-mystify the shoulder for patients. Here’s what we learned from his seminar:
1. Younger patients have usually experienced a specific traumatic event
There are generally two types of patients who walk into his office complaining of shoulder pain when you exclude people who have broken shoulders and senior populations with osteoarthritis.
“The first type of patient is usually 20-25 years old. They’ve never had any problems with their shoulder before until a memorable traumatic event – whether it’s Friday night football, waterskiing, or reaching up too high to grab something,” Dr. Todd said. “They’ve not lived long enough, played hard enough, or worked hard enough to have worn their shoulders out. The patients in this group have usually damaged something in their shoulder and fall into the broad category of instability.”
For this category of patients, who have most likely damaged their cartilage and/or ligaments resulting in an unstable shoulder, there are generally three treatment options: live with it, physical therapy or surgery. Mild instability usually responds well to physical therapy while gross instability often requires surgical repair of the injured soft tissue.
2. Older patients are usually facing a progressive disease
“The second group of patients I see often are about 40-50 years and older. They have not had a specific traumatic event; rather, their shoulder pain is an insidious progressive onset of pain over an extended period of time. These patients are often complaining that their shoulder hurts every day, they can’t sleep on it, and it hurts with any overhead activities such as lifting and reaching.” Dr. Todd said. “Older patients have put a few miles on their wheels, so to speak, and are typically showing the symptoms of rotator cuff disease--previously called bursitis, tendonitis, or impingement.”
One of the key takeaways from the seminar is to get treated as early as possible for shoulder pain. Beginning in the 40s and 50s, rotator cuff disease is a common progressive disease that can advance to a rotator cuff tear. “That’s the end game, just like the end game of diabetes might be kidney failure or loss of eyesight,” Dr. Todd said. “We need to catch rotator cuff disease early on so that we can work with you to minimize the outcome.”
There is a common misconception that patients who consult an orthopedic surgeon for their shoulder pain will usually be recommended for surgery. In fact, surgery is typically the last line of defense. Orthopedic surgeons are medical experts available to provide an array of operative and non-operative options for rotator cuff disease. “The vast majority of patients who come into my office with these types of shoulder complaints never see the inside of an operating room. Using conservative care, which means non-operative care, we have had great success minimizing the symptoms of rotating cuff disease or even reversing it.” Dr. Todd said.
Patients who walk into his office with rotator cuff disease generally respond very well to non-operative care—with 70-80% of patients getting better with a combination of an oral anti-inflammatory, 1-2 cortisone injections, and physical therapy. While physical therapy doesn’t work for all parts of the body equally well, it works very effectively for the shoulder. That means patients who are skeptical about physical therapy because they have not experienced stellar results for another part of the body may want to give it a chance for the shoulder.
For patients who do need surgery, it’s almost always outpatient, arthroscopic, and minimally invasive. Depending on what the surgeon finds, surgery might involve removing bone spurs or perhaps smoothing off a partial tear of the rotator cuff (called decompressive surgery), and it means the patient will be returning to their normal life within 6-12 weeks. Patients who have an actual rotator cuff repair will need 3-6 months to recover and those that recover successfully usually don’t feel fully normal until a year has passed. “That’s why it’s important to come in early,” Dr. Todd said. “Don’t wait until you can’t lift your arm overhead and can’t sleep at night. Once the rotator cuff tears, non-operative care won’t be able to achieve lasting results.”
Dr. John L. Todd is a fellowship trained orthopedic surgeon and expert on the shoulder at Baldwin Bone and Joint. Are you having trouble lifting and reaching or experiencing shoulder pain? Get it diagnosed and treated as soon as possible to avoid future complications. Call Dr. John L. Todd at the Shoulder Center at Baldwin Bone and Joint for a consultation: (251) 625-2663.