If shoulder pain is limiting your daily activity, at Stoughton Hospital, we are able to provide a variety of interventions, surgical and non-surgical, based on what is best for you.
Dr. Ashish M. Rawal discusses common reasons for shoulder pain and the treatment options available so you can find relief and get back to the activities that you enjoy.
You Can Find Relief From Shoulder Pain
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 8/23/18
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): If shoulder pain is limiting your daily activity, at Stoughton Hospital we're able to provide a variety of interventions, surgical and non-surgical, based on what's best for you. My guest today is Dr. Ashish Rawal. He's an orthopedic surgeon with Stoughton Hospital. Dr. Rawal, what are some of the most common conditions that you see that affect the shoulder?
Dr. Ashish Rawal, MD (Guest): I think most of things that we see start with overuse type issues with the shoulder. Many times people just kind of overdo it and will have a simple strain of their shoulder, and that can get better. But as the spectrum kind of extends, we tend to see patients with rotator cuff tears as well as arthritis, and that's in the older population. In the younger population we tend to see more issues with tearing their labrum, which is the gasket in the socket of the shoulder, and that could happen just from an injury where they dislocate their shoulder or potentially from overuse.
Melanie: So because the shoulder is such a complicated joint, motion and mobility certainly has its price, doesn't it? Does the shoulder injure as easily as maybe the knee? Or is it a little bit of a tougher joint?
Dr. Rawal: It can be tougher. I mean, I think that it's been made to endure quite a bit, but it is overall because of all the motion and the different directions that it can do, and all the things that we ask our shoulder to do, we do tend to see a lot of injuries from it, probably even a little bit more so than we see knee injuries.
Melanie: So then how do you diagnose it? There's all kinds of shoulder pain, as you said, there's so much that could go wrong. So what do you do to diagnose shoulder pain?
Dr. Rawal: I think the first, most important thing is to sit down and listen to the patient. I find that in talking to my patients, most of the time if I listen long enough, they'll tell me exactly what's going on with their shoulder and it becomes fairly straightforward. In addition to that, a good physical exam, actually examining the shoulder completely and comparing it to the other side, we can glean a lot of information from that. And then if those two don't help, then we can use advanced imaging in terms of an MRI or a CT scan that can help us then pin down that final diagnosis.
Melanie: So then let's talk about some best practices for managing either short-term or long-term pain in the shoulder. What are some first non-surgical approaches to the painful shoulders that you might try right off the bat?
Dr. Rawal: Yeah, the first thing obviously is to modify activities and stop doing the activity that may be the offending cause for the shoulder pain. Then in addition to that, things like anti-inflammatories such as Advil and Aleve can be quite effective. Ice can be very helpful as well, and then as needed physical therapy may be the right adjuvant to that, and overall those are the simple first line measures that we really want to try before we start diving deeper into doing more involved tests or even considering surgery.
Melanie: Let's talk about a cortisone shot for a second, Dr. Rawal. So many people say, "Oh I'm getting a cortisone shot in my shoulder." When is that the answer or something that you might try? And how long do they last? How many can they have?
Dr. Rawal: Those are all great questions, and questions that I get on a daily basis. So cortisone injections can help definitely when we are dealing with a situation where inflammation is the problem. Cortisone is a steroid which acts as a very potent anti-inflammatory, and by putting the medicine right where the problem is, we can help decrease that inflammation.
That can really help in people who have tendonitis, people who have inflammation of the bursa, many conditions like that including arthritis, it can be very beneficial. The question is also how long can it last? And that for everybody is going to be different. If that's the million dollar question for some people, they can get benefit for three months, six months, and for some patients, they may not get any benefit at all. And sometimes we will use a cortisone injection just to help aid our diagnosis and to confirm that we're barking up the right tree.
Overall, how many cortisone injections can someone get in one year? Usually we want to try to space them at least three months apart, and we don't want to do that indefinitely because if there is a problem that needs to be addressed in another way, then we want to tackle it that way and not just continue to give cortisone injections for an extended period of time.
Melanie: Now I understand that there are so many things, rotator cuff, there's bursitis, there's all kinds of things that can go wrong with the shoulder. When does the discussion become surgical? And while we've heard about knee replacements and hip replacements, you don't hear as much about shoulder replacements. So tell us a little bit about the surgeries that might be involved in the shoulder, and when does that become the discussion?
Dr. Rawal: I think first and foremost, we have to pin down a diagnosis for the patient. And then second, try all those first line measurements we can to try to help get them better without doing surgery. And once we have a diagnosis and we can safely say we've really exhausted in a reasonable way all the conservative treatment options, I think then we get to that point where we say surgery is probably the next step for patients.
Luckily for most patients, shoulder surgery is an elective thing, so it's really on their timeline when they want to do something surgically if they need to. And it's a conversation where we talk about what the benefits of surgery are versus what are the risks involved with surgery, and what's going to happen if nothing is done? And I think in the end, as a surgeon with my patient, I have to weigh all those different aspects and then help the patient make a good decision that works specifically for them.
Melanie: Doctor, one of the more common things that even I hear in my field is about rotator cuff tears. Speak about them just for a minute. Are they a naturally occurring- something that happens as a result of aging? Or are they something because of what we're doing? And do they fix themselves.
Dr. Rawal: That's a great question. We see two main varieties of rotator cuff tears in general. The first one is going to be an acute traumatic tear, so someone who falls, or has some type of one specific injury, and they can tear their rotator cuff from that. The second is going to be the more chronic degenerative tear, which would be just from long-term wear and tear that patients have. And it's important to kind of treat those two differently because the pathway and how we treat them may be quite different if it happened from something acute traumatic, then those are patients that we may look at surgery earlier in the options, while ones that are more degenerative take a slow time, and just kind of tear on their own, we can take a little bit more time to really work those different options before we look at doing surgery.
And rotator cuffs in general do not heal. Once they're torn, they stay torn, but the important thing is that not all rotator cuff tears are symptomatic. Many times patients can have a rotator cuff tear that doesn't bother them anymore, so the question becomes do we do surgery on a problem that doesn't cause them any pain or dysfunction? And usually the answer for that is no, we're not going to recommend surgery in those cases.
Melanie: Give us your best advice for prevention of shoulder injuries, whether you're talking about athletes with their pitching arm, and overuse injuries, or golfers and rotator cuff tears. There are so many different aspects of the shoulder that can get injured, so give us your best advice for prevention and making sure we have strong shoulders, and taking care of them.
Dr. Rawal: Absolutely. One of the first things obviously is- when we look at overuse in our young athletes, obviously is not to overdo it. We know that single sport specialization for young athletes has become very common, and with that there tends to be a lot of overuse. So for many of my young athletes I do recommend to have a balanced sporting career where they're playing multiple sports throughout the year and not just playing one to give their body a chance to rest their shoulder or other body parts that may have an overuse injury.
And then as we get older, for recreational activities such as golf, et cetera, I think one of the important things is to make sure we stretch and warm up before we do activities. And two is that when we do engage in a program of weight lifting and exercise that we try to have a balanced program. Many times I'll see patients who do a lot of workouts and developing strength in their chest but they don't balance that with developing the muscles in their back, and then what happens is their shoulder tends to be unbalanced, and that can lead to problems. So I think that having that balance, and being stretched out, and then varying your activities; all three of those can really help decrease the risk of a shoulder injury.
Melanie: Thank you so much, Dr. Rawal. It's great information and so important for people to hear, as it's quite common to suffer from shoulder pain. And thank you for clearing up and sharing your expertise on some of the treatment options available and prevention in the first place. This is Stoughton Hospital Health Talk. For more information, you can go to www.StoughtonHospital.com. That's www.StoughtonHospital.com. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): If shoulder pain is limiting your daily activity, at Stoughton Hospital we're able to provide a variety of interventions, surgical and non-surgical, based on what's best for you. My guest today is Dr. Ashish Rawal. He's an orthopedic surgeon with Stoughton Hospital. Dr. Rawal, what are some of the most common conditions that you see that affect the shoulder?
Dr. Ashish Rawal, MD (Guest): I think most of things that we see start with overuse type issues with the shoulder. Many times people just kind of overdo it and will have a simple strain of their shoulder, and that can get better. But as the spectrum kind of extends, we tend to see patients with rotator cuff tears as well as arthritis, and that's in the older population. In the younger population we tend to see more issues with tearing their labrum, which is the gasket in the socket of the shoulder, and that could happen just from an injury where they dislocate their shoulder or potentially from overuse.
Melanie: So because the shoulder is such a complicated joint, motion and mobility certainly has its price, doesn't it? Does the shoulder injure as easily as maybe the knee? Or is it a little bit of a tougher joint?
Dr. Rawal: It can be tougher. I mean, I think that it's been made to endure quite a bit, but it is overall because of all the motion and the different directions that it can do, and all the things that we ask our shoulder to do, we do tend to see a lot of injuries from it, probably even a little bit more so than we see knee injuries.
Melanie: So then how do you diagnose it? There's all kinds of shoulder pain, as you said, there's so much that could go wrong. So what do you do to diagnose shoulder pain?
Dr. Rawal: I think the first, most important thing is to sit down and listen to the patient. I find that in talking to my patients, most of the time if I listen long enough, they'll tell me exactly what's going on with their shoulder and it becomes fairly straightforward. In addition to that, a good physical exam, actually examining the shoulder completely and comparing it to the other side, we can glean a lot of information from that. And then if those two don't help, then we can use advanced imaging in terms of an MRI or a CT scan that can help us then pin down that final diagnosis.
Melanie: So then let's talk about some best practices for managing either short-term or long-term pain in the shoulder. What are some first non-surgical approaches to the painful shoulders that you might try right off the bat?
Dr. Rawal: Yeah, the first thing obviously is to modify activities and stop doing the activity that may be the offending cause for the shoulder pain. Then in addition to that, things like anti-inflammatories such as Advil and Aleve can be quite effective. Ice can be very helpful as well, and then as needed physical therapy may be the right adjuvant to that, and overall those are the simple first line measures that we really want to try before we start diving deeper into doing more involved tests or even considering surgery.
Melanie: Let's talk about a cortisone shot for a second, Dr. Rawal. So many people say, "Oh I'm getting a cortisone shot in my shoulder." When is that the answer or something that you might try? And how long do they last? How many can they have?
Dr. Rawal: Those are all great questions, and questions that I get on a daily basis. So cortisone injections can help definitely when we are dealing with a situation where inflammation is the problem. Cortisone is a steroid which acts as a very potent anti-inflammatory, and by putting the medicine right where the problem is, we can help decrease that inflammation.
That can really help in people who have tendonitis, people who have inflammation of the bursa, many conditions like that including arthritis, it can be very beneficial. The question is also how long can it last? And that for everybody is going to be different. If that's the million dollar question for some people, they can get benefit for three months, six months, and for some patients, they may not get any benefit at all. And sometimes we will use a cortisone injection just to help aid our diagnosis and to confirm that we're barking up the right tree.
Overall, how many cortisone injections can someone get in one year? Usually we want to try to space them at least three months apart, and we don't want to do that indefinitely because if there is a problem that needs to be addressed in another way, then we want to tackle it that way and not just continue to give cortisone injections for an extended period of time.
Melanie: Now I understand that there are so many things, rotator cuff, there's bursitis, there's all kinds of things that can go wrong with the shoulder. When does the discussion become surgical? And while we've heard about knee replacements and hip replacements, you don't hear as much about shoulder replacements. So tell us a little bit about the surgeries that might be involved in the shoulder, and when does that become the discussion?
Dr. Rawal: I think first and foremost, we have to pin down a diagnosis for the patient. And then second, try all those first line measurements we can to try to help get them better without doing surgery. And once we have a diagnosis and we can safely say we've really exhausted in a reasonable way all the conservative treatment options, I think then we get to that point where we say surgery is probably the next step for patients.
Luckily for most patients, shoulder surgery is an elective thing, so it's really on their timeline when they want to do something surgically if they need to. And it's a conversation where we talk about what the benefits of surgery are versus what are the risks involved with surgery, and what's going to happen if nothing is done? And I think in the end, as a surgeon with my patient, I have to weigh all those different aspects and then help the patient make a good decision that works specifically for them.
Melanie: Doctor, one of the more common things that even I hear in my field is about rotator cuff tears. Speak about them just for a minute. Are they a naturally occurring- something that happens as a result of aging? Or are they something because of what we're doing? And do they fix themselves.
Dr. Rawal: That's a great question. We see two main varieties of rotator cuff tears in general. The first one is going to be an acute traumatic tear, so someone who falls, or has some type of one specific injury, and they can tear their rotator cuff from that. The second is going to be the more chronic degenerative tear, which would be just from long-term wear and tear that patients have. And it's important to kind of treat those two differently because the pathway and how we treat them may be quite different if it happened from something acute traumatic, then those are patients that we may look at surgery earlier in the options, while ones that are more degenerative take a slow time, and just kind of tear on their own, we can take a little bit more time to really work those different options before we look at doing surgery.
And rotator cuffs in general do not heal. Once they're torn, they stay torn, but the important thing is that not all rotator cuff tears are symptomatic. Many times patients can have a rotator cuff tear that doesn't bother them anymore, so the question becomes do we do surgery on a problem that doesn't cause them any pain or dysfunction? And usually the answer for that is no, we're not going to recommend surgery in those cases.
Melanie: Give us your best advice for prevention of shoulder injuries, whether you're talking about athletes with their pitching arm, and overuse injuries, or golfers and rotator cuff tears. There are so many different aspects of the shoulder that can get injured, so give us your best advice for prevention and making sure we have strong shoulders, and taking care of them.
Dr. Rawal: Absolutely. One of the first things obviously is- when we look at overuse in our young athletes, obviously is not to overdo it. We know that single sport specialization for young athletes has become very common, and with that there tends to be a lot of overuse. So for many of my young athletes I do recommend to have a balanced sporting career where they're playing multiple sports throughout the year and not just playing one to give their body a chance to rest their shoulder or other body parts that may have an overuse injury.
And then as we get older, for recreational activities such as golf, et cetera, I think one of the important things is to make sure we stretch and warm up before we do activities. And two is that when we do engage in a program of weight lifting and exercise that we try to have a balanced program. Many times I'll see patients who do a lot of workouts and developing strength in their chest but they don't balance that with developing the muscles in their back, and then what happens is their shoulder tends to be unbalanced, and that can lead to problems. So I think that having that balance, and being stretched out, and then varying your activities; all three of those can really help decrease the risk of a shoulder injury.
Melanie: Thank you so much, Dr. Rawal. It's great information and so important for people to hear, as it's quite common to suffer from shoulder pain. And thank you for clearing up and sharing your expertise on some of the treatment options available and prevention in the first place. This is Stoughton Hospital Health Talk. For more information, you can go to www.StoughtonHospital.com. That's www.StoughtonHospital.com. This is Melanie Cole, thanks so much for listening.
