Ask the BJC Expert

Ask the BJC Expert

Causes and Treatments for Shoulder Pain

Anthony Frisella, MD

Published on Wednesday, August 09, 2017

Dr. Anthony Frisella is a shoulder and upper extremity surgery specialist with Advanced Bone and Joint in St. Peters MO.  

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Today I am going to visit with Dr. Anthony Frisella.  He is a shoulder and upper extremity surgeon specialist with Advanced Bone and Joint in St. Peters and he is also going to talk with us about shoulder pain today. We will get into that because it is something that a lot of us deal with and maybe we don’t even know what is causing it or where it is coming from. We are going to try to address all of these issues for you this morning. Doctor, good morning.

Good morning. Thanks for having me.  

What are some of the more common activities that can cause shoulder issues for us?

Well anything where you are using your arm can cause shoulder problems but in my practice the most common things that I see or the most common complaints that the patients come in with is usually caused by working out or gym activities. It is really common for me to see someone who is wanting to get in shape, which is admirable, and they get into a gym program. They overdo it and they feel a pop or they start to develop pain in their shoulder. Another thing that we see really commonly, and I often joke that it keeps me in business, is cross fit injuries. We see a lot of shoulder injuries from people doing cross fit activities. Of course, there are also sports related injuries. The most common sports that cause shoulder problems are wrestling and football in my experience, but obviously we see problems in people who throw or pitch and swimming is also a common cause of shoulder pain. The final thing that I will mention is that work related injuries are a really common cause of shoulder pain especially for people who are working over head like carpenters, people who work with drywall, construction related injuries or falls, and those sorts of things.

So what ligaments or muscles are primarily involved when you are talking about shoulder injuries?

If you look statistically, by far the most common thing that people injure is their rotator cuff. The rotator cuff is a series of muscles that surround the shoulder and allow you to lift and reach with your arm and especially in patients over 40, tears or inflammation of the rotator cuff is by far the most common thing that is going to cause shoulder problems. Of course, there are a bunch of other structures in the shoulder; the labrum which surrounds the socket, the bicep tendon that runs up into the shoulder and the cartilage that covers the bone and all of these things can be injured. Rotator cuff tears, however, are the most common type of injury. We also see things like shoulder dislocations and separations. Often we will see patients who are lifting, they will feel a pop and or they will have a fall and hurt their muscles. We call that a pop eye deformity and that is a biceps tendon tear, but again rotator cuff is the most common.

How do you go about diagnosing these issues?

What most people don’t realize is that 90 percent of patients we can diagnose by just examining them. If you come into the office to see a physician, he is going to push on you and check your range of motion and look at different strengths and different ways that you are strong or weak. By doing that, 90 percent of patients can be diagnosed. Of course, we use x-rays for broken bones and bone spurs. X-rays can also show us arthritis, but an MRI is what we tend to use if we suspect an injury to a soft tissue like a tear in the rotator cuff or the labrum. An MRI is useful for soft tissue types of injuries, tendons and ligaments.

Do you find that a lot of people say, “I am going to deal with this, live with it?”  How long do they typically do that before they finally give in and come in to see you?

Well of course, that depends on how bad it is but most patients start to notice shoulder pain and they wait a few weeks. My advice is to modify your activities; the things that the typical doctor advises. If something is bothering you, then stop doing it for a while and see if it gets better. Obviously there are more serious injuries where patients have a fall or a significant injury where they really injure their shoulder and our practice at Advanced Bone and Joint offers a quick care service where you can just walk into the office and see an orthopedic specialist if you are concerned that you have done something more serious to your arm or shoulder. If they are just talking about developing shoulder pain over time, which is pretty typical from lifting weights, or they have been having trouble sleeping and their shoulder is bothering them, I usually suggest that they wait four to six weeks before they come in to see me.

I don’t mind giving you folks a testimonial. I came in and saw you guys. It has been a couple years now. I picked up a piece of luggage and apparently it was too heavy so I tore a piece of my rotator cuff; not enough to require surgery but I didn’t know that until I came in and saw you guys and got a cortisone shot. That leads me to my next question. Treatment options: surgery is certainly one of them but what are some of the treatment options?

Your own experience brings up a good point which is that surgery is not something that is for everyone. Surgery is a last resort and what I start with in 90 percent of my patients is physical therapy. Physical therapy can cure the vast majority of shoulder problems that we see. Patients who come in with shoulder pain, and I think it might be tendonitis or a little flare of arthritis, most of them will go to physical therapy and the majority of them will get better. If there is significant inflammation, just like in your case, we often use cortisone. Cortisone is a very strong anti- inflammatory and a cortisone injection is really effective and powerful in decreasing inflammation and it can be curative. In other words, you get an injection and it never comes back. We use ultrasound to guide our cortisone injections. I don’t know if you had that but that makes the injections a lot less painful. A lot of times people are afraid to get an injection and I reassure them that with our techniques now it is not as painful as it used to be. Obviously I am a shoulder surgeon and if those things fail or the injury is more significant and I don’t think it is going to get better without surgery then we talk about arthroscopic or other shoulder surgery to get people back to 100 per cent.

We see the baseball players who go through these types of things all the time and it looks to me that in most cases they get back to normal. What percentage of normal function can we expect after surgery with our shoulders and arms?

That depends on the surgery. Let’s just use rotator cuffs as an example because that is by far the most common type of surgery that I do. If you have a torn rotator cuff, it is important to understand that you are not going to get back to normal doing everything that you want after a month or two. Once you are fully recovered, which can take up to six months or more, you should expect normal shoulder function. I have patients that go back to very significant heavy use of their arms; carpenters, drywall installers, people who work with drywall, finishers, laborers and most of them do not notice their shoulder at all but that takes six months to a year. I expect to see 95 to 100 percent recovery, but just like the baseball players that you mentioned, you are going to be out for the season. It will be next year before you are really back to normal.

Dr. Frisella thank you so much for joining us today. I appreciate it.

You are very welcome.

Thank you very much. Dr. Anthony Frisella, again with St. Peters Advanced Bone and Joint Surgery in St. Peters and Barnes-Jewish St. Peters Hospital and Progress West Hospital.

 

Bio:   Dr. Anthony Frisella is a shoulder and upper extremity surgery specialist with Advanced Bone and Joint in St. Peters MO.  His office can be reached at 636-229-4222.

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