This is the first of a two-part column on shoulder pain.
Shoulder problems are ubiquitous in society. It’s estimated that approximately one in every five people will complain of shoulder pain at some point in their life. There are many causes, which vary based on a patient’s age and lifestyle.
Shoulder injuries can involve the acromioclavicular or AC; the glenoid labrum, a rim of cartilage around the shoulder “socket” that helps stabilize the “ball;” the biceps tendon that enters the shoulder joint before it attaches to the top of the “socket;” the rotator cuff, a group of four muscles that help to elevate the arm and stabilize the ball on the socket; or the ball and socket themselves.
When shoulder problems get worse, arthritis can set in and become the major pain generator. Generally, arthritis occurs in two varieties. One is the regular “wear and tear” arthritis that occurs with aging and overuse, also known as osteoarthritis. The second form of arthritis occurs in patients with advanced rotator cuff dysfunction, causing instability of the ball and socket configuration of the shoulder, which is called rotator cuff tear arthropathy.
Initially, both forms of arthritis can be treated non-operatively, usually using anti-inflammatory medications and corticosteroid (cortisone) injections. But when symptoms persist and worsen despite medical treatment, shoulder replacement can be used to drastically reduce pain and improve the function in these degenerative shoulders.
Patients who are candidates for shoulder replacement surgery are those who have unremitting pain or poor motion from shoulder arthritis. Shoulder arthritis is generally initially treated medically, as is arthritis of the hip and knee and other joints. Your doctor will generally prescribe a regimen of anti-inflammatory medications and possibly a course of physical therapy to help increase mobility. Usually this is enough to ease the pain from shoulder arthritis and make the symptoms more tolerable. When anti-inflammatory medications do not do the trick, the next step involves some type of intra-articular cortisone injection, similar to those administered for hip and knee arthritis. Generally, the local anti-inflammatory actions of these cortisone injections help relieve pain in patients to a greater degree than the oral anti-inflammatory medications.
It’s not unusual to have one injection that works well and have a smaller benefit from subsequent injections. When these medical treatments no longer achieve acceptable pain relief, or when shoulder range of motion has become so limited that activities of daily living are impossible to perform, a shoulder replacement should be considered.
Patients are the ones who tell their doctors when they are ready for shoulder surgery, having reached a point where more conservative methods aren’t offering relief. Sometimes X-rays taken by your doctor may show advanced arthritis, but pain and function are not severely impaired, and sometimes the inverse is true. Generally a patient who may be “ready” for a shoulder replacement is someone who has pain that is not adequately relieved by medication, increases with an increase in activity, persists at night and/or results in severe limitations in range of motion of the shoulder.
(To be continued next week.)
Dr. Matthew Walker practices with Long Island Bone and Joint, with offices in Riverhead and Southampton.