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When Shoulder Pain Won’t Go Away

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Use these latest therapies to get the best results…

When you’ve got a painful shoulder, you’re reminded of it many times each day. It can hurt when you’re, say, scratching your back, taking off your shirt or washing your hair. If it’s severe, the pain can even wake you up at night.

As many as half of all Americans suffer from shoulder pain each year. For a significant number of these people, the problem lingers on…for weeks, months or even longer.

There is hope: Whether the pain stems from an injury, overuse or some unknown cause, chronic shoulder pain can be dramatically improved—and usually eliminated. The treatments may also help those whose shoulder pain is caused by arthritis. Here are the latest approaches for the most common shoulder problems…

ROTATOR CUFF PROBLEMS

Most people are quick to chalk up shoulder pain to tendinitis, a nagging form of inflammation. But that’s usually a mistake.

New thinking: The shoulder pain thought of as tendinitis is typically a result of tendinosis, a related condition that occurs when the tendons (ropelike cords connecting muscle to bone) begin to deteriorate. Tendinosis can usually be diagnosed with a physical exam and an X-ray and/or MRI.

Red flag for the patient: The pain may be barely perceptible while the arm is at rest—but if you extend the arm outward, in front of the body or overhead, the pain can range from dull to excruciating.

Rotator cuff tendinosis develops when tendons in the rotator cuff (a group of tendons and muscles that attach the upper arm to the shoulder joint) break down over time. This can occur due to age…repetitive use…or weakness of the rotator cuff muscles.

What works best: During the first week or two, to “quiet” the inflammation around the tendon, apply ice (for 15 to 20 minutes several times daily)…and take a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin).

If pain continues, your doctor should also refer you to a physical or occupational therapist, who can recommend exercises (such as those below) to strengthen the rotator cuff and shoulder blade (scapula) muscles. If pain worsens or lasts longer than a week or two, a cortisone injection into the bursa surrounding the rotator cuff tendons can help. Good news: Within six weeks, this nonsurgical regimen alleviates the pain 90% of the time. Beware: Chronic use of cortisone can damage tendons, so surgery (see below) should be considered if two or three injections (given no more than every three months) have not relieved the pain.

If you don’t get relief after six weeks or the pain returns after cortisone therapy wears off, you may want to consider surgery. Arthroscopy (inserting a tiny camera via small incisions) allows the surgeon to assess the shoulder joint and correct the damage that has led to rotator cuff tendinosis. When performed by an experienced surgeon, the procedure has a high success rate. Complications are rare but may involve infection or stiffness.

To find an experienced surgeon, consult The American Orthopaedic Society for Sports Medicine.

Two approaches that are less invasive than surgery…

Platelet-rich plasma (PRP) injection involves the use of platelets from a patient’s blood. The platelets are separated from the blood with a centrifuge and reinfused into the affected tendons. The platelets are rich in growth factors that aid healing, and the technique is considered safe, since the patient’s own cells are used.

A small study published in 2013 in Global Advances in Health and Medicine found that a single PRP injection significantly improved pain and function at a 12-week follow-up. More research is needed, however, for definitive evidence of its effectiveness. Some patients opt to have a series of PRP injections. Insurance rarely covers the cost—typically about $1,500 per injection.

Stem cell treatment. With this therapy, which is currently experimental, certain bone marrow cells are reinjected into the shoulder area, where they can help replace degenerated tendon tissue. Though promising, this therapy is not yet widely available. Several clinical trials are now ongoing. To find one, go to ClinicalTrials.gov.

FROZEN SHOULDER

Frozen shoulder (or adhesive capsulitis), which usually occurs for unknown reasons, develops when the capsule surrounding the shoulder joint gets inflamed and then stiffens. A dull ache in the shoulder can come and go, slowly worsening to a ferocious pain that may awaken you during sleep or hurt even when your arm is at your side.

In the past, doctors recommended physical therapy to “thaw out” the joint and restore range of motion. But the physical therapy typically aggravated the condition—and it often did not improve for more than a year.

New thinking: With a two-part approach—a cortisone injection given early on into the joint and gentle exercises—sufferers can get pain relief and restore their range of motion within a matter of weeks to months.

Surgery is rarely needed if frozen shoulder is promptly diagnosed and treated at this stage. Cortisone injections are usually not helpful when frozen shoulder has progressed to severe stiffness, but physical therapy may help restore mobility.

After receiving a cortisone injection, the following exercises should be performed on the recovering shoulder three times a day. Gently hold each for five seconds and do 10 reps of each exercise… 

Overhead stretch. What to do: Lie on your back with your arms at your sides. Lift your arm straight up in the air and over your head. Grab your elbow with your other arm and gently press toward your head.

Cross-body reach. What to do: Stand and lift your arm to the side until it’s a bit below shoulder height, then bring it to the front and across your body. As it passes the front of your body, grab the elbow with your other arm and exert gentle pressure to stretch the shoulder.

Towel stretch. What to do: Drape a towel over the unaffected shoulder, and grab it with your hand behind your back. Gently pull the towel upward with your other hand to stretch the affected shoulder and upper arm.

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Source: Beth E. Shubin Stein, MD, an associate attending orthopedic surgeon and a member of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York City, and Sarah Tryon, MD, FNP-BC. Dr. Shubin Stein is an associate professor in the department of orthopedic surgery at Weill Cornell Medical College, also in New York City. Her medical practice focuses on arthroscopic and reconstructive surgery of the shoulder and knee. Updated Date: April 16, 2018 Publication: Bottom Line Health
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