Don't Live with Shoulder Pain
Advanced treatment options can help patients shrug off shoulder pain.
Written by John Ferrari
Every joint in your body plays a role in your daily life. When we think of joint conditions, knees get the most attention. But they aren’t the only joints that experience daily wear and tear; we use our shoulders just as much. We put strain on our shoulders almost every time we use our arms. And as with knees, shoulders suffer from overuse, injury and degeneration.
Fortunately, like knees, treatments for shoulder conditions have advanced with the widespread adoption of minimally invasive surgeries, as well as nonsurgical options. Pulse spoke with orthopedic surgeon Stephen Nuccion, MD, to catch up on the latest options for shoulder treatment.
The first step in any treatment is a diagnosis based on the individual’s medical history, a physical examination and X-rays or MRI scans. Many shoulder complaints are diagnosed as overuse injuries that can be treated through a combination of rest and activity modification. Sports and exercise are common sources of overuse injuries.
“Playing different sports in different seasons allows certain muscles to rest and recover,” Dr. Nuccion says. Young athletes who play a single sport all year long, and recreational athletes who take advantage of Southern California’s weather to the play the same sport year-round, don’t give those muscles a rest. The preventive measure is simple: varying sports and exercise routines.
High-intensity activity isn’t the only cause of overuse injuries though. Something as basic as office ergonomics or poor sitting posture can have an impact. “Coming in for evaluation and treatment can be as simple as recommending a new pillow or ergonomic adjustments,” Dr. Nuccion says.
If the pain persists and the shoulder isn’t healing, physical therapy is the next treatment option. “This can definitively fix many issues,” Dr. Nuccion says. “Physical therapists have added a lot of tools in the last 10 to 20 years.”
Other options include the use of platelet-rich plasma (PRP) injections**, using the body’s own regenerative processes to stimulate healing in a specific area. In this procedure, platelets that have been filtered out of whole blood are injected into the shoulder, where they release signals that stimulate the body’s healing response. “Today, PRP is the first-line treatment for nonoperative arthritic treatment,” Dr. Nuccion notes.
Some shoulder conditions just don’t respond to nonsurgical treatment. Fortunately, most shoulder repairs are minimally invasive outpatient surgeries, including torn rotator cuff repair. The tendons and muscles comprising the rotator cuff can weaken with age, and sometimes they aren’t strong enough to heal on their own. In the past, this limited recovery. Today patients can benefit from allograft augmentation, a procedure in which donated tissue is added to the rotator cuff, where it stimulates healing and acts as a scaffold for the growth of new tissue.
Degeneration, usually arthritis, is the third major source of shoulder pain and can lead to the need for a shoulder replacement. “Today shoulder replacement can be thought of as resurfacing the joint as opposed to actual replacement,” Dr. Nuccion says. “We resurface the cap of the humerus,” that is, the arm bone and ball part of the shoulder’s ball-and-socket joint.
Patients who are not good candidates for this procedure—with osteoporosis or weak rotator cuffs, for example—have another option: reverse shoulder replacement. In this procedure, the parts of the shoulder joint are swapped. A ball is added to the shoulder bone, and a socket is created at the cap of the humerus. This changes the mechanics of the arm’s movement, allowing the body to use muscles that are still healthy.
Even with these advanced treatments, the best way to handle shoulder pain is to avoid it in the first place. Dr. Nuccion’s advice? Watch your ergonomics and vary your exercise and sports routines to avoid overuse. If you do feel shoulder pain, he says, don’t put off a visit to your physician. Treatment begins with a good diagnosis.
** Check with your insurance provider for coverage eligibility and to see if this treatment right for you.
Stephen Nuccion, MD, is an orthopedic surgeon at Torrance Memorial Physician Network in Torrance and is located at 23550 Hawthorne Blvd., Suite 120. He can be reached at 310-517-1216.