Understanding Shoulder Pain

Deep, persistent shoulder pain can affect individuals of all ages. Young, active patients often attribute their shoulder pain to overuse. While current exercise regimens typically emphasize strengthening the deltoid muscles, the rotator cuff is often overlooked. For chronic shoulder pain without a history of a single traumatic event, strengthening therapy is usually effective.

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Limitations of Corticosteroid Injections

If pain persists, the standard of care discourages corticosteroid (cortisone type) injections due to their negative impact on the integrity of normal tissue. Although pain relief from cortisone injections can be dramatic, it is often short-lived and may accelerate rotator cuff degeneration and arthritic changes (loss of joint lubricating cartilage).

Alternative Treatments: PRP and Biologics

Patients often respond well to platelet-rich plasma (PRP) therapy, which introduces growth factors into the affected area to reduce inflammation and promote biological healing. Newer off-the-shelf biologic treatments are also available. These treatments are more concentrated and do not require drawing blood. Stem cell treatments remain controversial and essentially provide growth factors, similar to those achieved with PRP and other biologics.

Advanced Imaging and Arthroscopic Procedures

For persistent symptoms, imaging studies such as MRI may be necessary. Occasionally, an arthroscopic procedure is required to diagnose and repair the problem using mini incisions and a fiberoptic camera. Complete tears of structures like the rotator cuff or labrum (stabilizing soft tissue of the socket) can be repaired using all-arthroscopic techniques. Partial tears can now be treated with technologies such as the arthroscopic introduction of a collagen patch, which relieves pain and limits the propagation of the partial tear, leading to rapid recovery and minimal pain.

Common Issues in Older Patients

Older patients often suffer from bursitis stemming from partial or complete rotator cuff tears. Primary osteoarthritis may also be a cause, and shoulder replacements have become as successful as hip or knee replacements. This includes resurfacing replacements, which can be easily performed in an ambulatory surgery center, reducing the risk of hospital-acquired infections.

Importance of Specialized Evaluation

Regardless of the cause, shoulder pain deserves evaluation by an orthopedic surgeon, particularly an upper extremity & shoulder specialist, to ensure a speedy recovery and avoid misdiagnosis.