Shoulder pain is one of the most common reasons that a patient is seen in the orthopaedic office. The vast majority of shoulder pain is treated non-operatively with physical therapy and sometimes a cortisone injection. The most common source of shoulder pain is the rotator cuff. For most patients, they have either a partial rotator cuff tear or tendinitis. Partial tears of the rotator cuff occur with increasing frequency with increasing age, but overhead activities can certainly incite more severe symptoms. These are the types of injuries that very rarely require any type of surgical intervention. Therapy and an injection normally resolve 80 percent of these problems. There are only a small percentage of patients who continue to have symptoms for greater than six months, despite therapy. For those still symptomatic despite conservative treatment, shoulder arthroscopy becomes an option. The patients who have a full thickness rotator cuff tear, particularly tears that are large, will require surgery to repair the cuff. Although this can be done arthroscopically, rotator cuff repairs will require at least three months of physical therapy post operatively. The consequence of not repairing a rotator cuff is a tear that continues to worsen potentially leading to severe arthritis.
The other common diagnosis in the evaluation of shoulder pain is a cartilage or labral tear. This can present symptoms of just pain or potentially pain and the shoulder dislocating. Initial treatment for labral tears can also begin with physical therapy to relieve the pain and instability. Arthroscopic surgical treatment for labral tears is considered if a patient has continued complaints of pain or instability despite conservative treatment. Patients who suffer shoulder dislocation in their teen-age years are at very high risk of recurrent dislocation and a discussion about surgical treatment is appropriate at the initial meeting with the orthopaedic surgeon.
Shoulder arthritis is the third most common reason for shoulder pain. Not surprisingly, this is often seen in the older patient. This can also be treated with cortisone injections and therapy at the initial stages. Shoulder replacement can also be done, but this is only considered as an option of last resort for very severe arthritis.
In my almost 30 years of practice as on orthopaedic sports medicine specialist, I have seen shoulder procedures become less and less invasive. When I first started practice in the year 2000, many shoulder procedures were still done open leaving big scars, resulting in significantly more post-operative pain, and requiring more therapy. The technology to do repairs arthroscopically has vastly improved leading to better result for the patient.
• Dr. Frank Moussa is a board certified, fellowship trained orthopedic surgeon specializing in sports medicine in Ahwatukee Foothills. Reach him at (602) 466-7581 or http://orthosurgeryaz.com/ahwatukee.