FAQ Category: Shoulder

You should check with your doctor about this problem. Sometimes the patches can be cut down smaller to apply less drug dosage. In some cases headache medication can be taken. For some patients the headaches get less over time so they decide to wait it out.

Pay attention to any other side effects you may be having. Nitroglycerin can also cause dizziness, weakness, and skin rash. The doctor will need to know about any of these as
well.

There are two possible explanations in a case like this. The first is that your shoulder pain could be caused by your heart disease. It’s not uncommon for pain from the heart to get referred to the neck, jaw, upper back, shoulder, and/or down the arm.

The nitric oxide (NO) in the nitroglycerin (GTN) opens the blood vessels so more blood reaches the heart. If the shoulder pain was caused by lack of oxygen to the heart, then the nitroglycerin patch appears to help the shoulder.

The second possibility is that NO helps damaged tissue heal. If you have a true tendon problem, the NO may be helping tissue grow and remodel. A recent study in Australia actually used nitroglycerin patches on the shoulders of patients with chronic shoulder tendon pain and problems. They compared the results to patients who got a dummy (placebo)patch.

The group with the real patch got much better results. Their range of motion and function improved much more than in the placebo group.

Be sure and report this incident to your doctor. It’s important to find out if the shoulder pain is coming from the heart or indeed from inside the shoulder.

Scientists at the Orthopaedic Research Institute in Australia tried nitroglycerin (GTN)patches with patients who had chronic shoulder pain. They had good results. There was less shoulder pain at rest and with activity. Even pain at night was better. Range of motion was much better, too. In fact, muscle testing showed increased strength after a six-month trial.

You may think there was a placebo effect with these patches. In other words, just putting a patch on someone’s shoulder makes them feel better. In this study they compared two groups of shoulder pain patients. All patients got a shoulder patch. Some had medication on it while others just got a plain patch.

The patients with the GTN patches had twice as much improvement in all areas. It should be noted that all patients did a home program of exercises, too. The authors suggested using the patches along with exercise might be the best approach. Talk with your doctor about this idea for treatment.

Fractures of the bone or cracks in the joint are not uncommon during this operation. Often, older patients with arthritis who need a joint replacement also have osteoporosis. The thinning, brittle bone breaks easily.

The treatment depends on where the break occurred and how serious it is. A small crack may only need a reduced or slowed rehab program after the operation. A large break may need screws or wires to hold it together while it heals.

Sometimes, the patient must be put in a sling. Restricting motion gives the fracture a chance to heal. This is the least desired treatment because immobility causes many other problems to occur.

Replacing the entire shoulder joint is called a total shoulder arthroplasty (TSA). Removing only one-half of the joint is a hemiarthroplasty.

The decision to replace part or all of a joint is made when the doctor looks inside the joint and sees the damage. A study at the Cleveland Clinic Foundation reports that a patient with decreased outward rotational motion will do better with a TSA. Likewise, severe bone damage and thinning requires a TSA.

Patients with a stable joint that doesn’t dislocate do well with a hemiarthroplasty.

Doctors use X-rays and other imaging studies to look at joints. Arthritis begins with damage to the lining of the joint that eventually leads to thinning of the joint space. The narrower the space, the more advanced the arthritis.

Other changes in the joint signal a worse condition. Bone spurs may form around the joint and prevent normal motion. The doctor may see cysts on either side of the joint, along with a flattening of the upper end of the humerus (upper arm bone).

Loss of motion, chronic partial or complete dislocation, and bone damage are All signs that point to a serious or advanced case of arthritis.

Rheumatoid arthritis (RA) is a systemic disease, which means it can affect many parts of the body. Joints are often involved including the wrists, knees, and hands. Any joint can become involved. There can also be changes in the heart, eyes, lungs, kidneys, and other soft tissues.

In 90 per cent of patients with RA, shoulder symptoms begin after five years. Tissue swelling and inflammation damage the cartilage, bone, and muscles. For many patients, early treatment with drugs and physical therapy is helpful. Treatment can help prevent RA from causing permanent damage.

Cortisone is a form of corticosteroids, a treatment for inflammation. When injected into the joint, corticosteroids give relief of painful symptoms. The change in symptoms can be quite dramatic. However, pain relief may only be temporary. A flare-up in this disease can occur at any time.

Drugs taken by mouth (oral) are the first line of treatment for RA. Oral antiinflammatories for pain and swelling are often combined with physical therapy to improve motion and function. When this treatment fails, injections may be used to delay surgery.

Too many injections can have a bad effect on the soft tissues. Doctors advise no more than three injections. More than one injection is allowed when the patient gets good results with the first.

Most doctors agree that the most disabling joint should be treated first. The decision is more difficult if your symptoms and loss of function are equal between the arm and leg. In this case, several factors should be considered.

When the shoulder is replaced first, the knee must wait at least three months. This avoids putting weight on the shoulder. Sometimes, the second surgery must be delayed more than six months. This is the case when there are other soft tissues that are still healing.

The decision may be affected if there is any bone loss in either area. Severe bone loss may mean doing the operation in several steps or stages. Choosing the joint with the simplest operation may be a good idea. A faster recovery will allow you to have the other joint replaced sooner.

There are three basic ways to repair the rotator cuff. The open incision method is the traditional operation. It’s the most invasive but gives the surgeon the best access to the area.

The mini-open incision is the middle-of-the-road method. It combines an incision with arthroscopy. The patient has a much smaller incision. The surgeon has greater access while using an arthroscope.

Arthroscopy alone is the third option. The surgeon punctures two to four small holes and inserts the scope. There’s a tiny TV camera on the end of the arthroscope. The surgeon can see on a TV monitor what’s going on inside the joint.

More experienced surgeons seem to prefer the open incision method. The mini-open or arthroscopic methods may become more popular as more orthopedic surgeons use them.

If you find out which method your surgeon uses most often, you’ll probably know which one gives him (and you) the best results.

We still don’t know how well total shoulder replacements hold up over time. X-rays give the doctor an idea if there’s any loosening in the joint. This can be seen before the patient begins to have pain or loss of motion.

It’s not clear yet from studies just how often screening X-rays should be taken. Is every year needed or is every two or three years often enough? Usually finding problems early and treating them saves the patient time, money, and discomfort in the end.

About 20 percent of the patients who have a partial replacement or hemiarthroplasty cross over to a total shoulder arthroplasty (TSA). Pain and stiffness are the reasons given most often for the conversion.

Most patients cross over after having the hemiarthroplasty two years. A few patients have converted as early as 12 months. Most surgeons would advise continued rehab between six and 12 months. Bone healing can take a full year.

Muscle and joint stiffness is common with aging and can make for a longer rehab process. Review all other risk factors. Eliminate all possible causes of slow healing such as tobacco use, inactivity, or poor control if you have diabetes. Nutrition can also play a key role in healing.

You ask a good question that may not have a good answer. Variation in opinions about treatment of rotator cuff tears (RCTs) is common among surgeons. As you’ve seen it’s common among the doctors in one community. It’s also common across the United States.

There are many reasons for this variation. According to a recent study surgeons base their opinions on different factors. They may go on the basis of how many operations they perform each year. The more experienced surgeons see things differently than less experienced surgeons.

Research hasn’t helped much either. Studies don’t show one treatment method works better than any other for RCTs. There’s both a lack of evidence and mixed results reported.

One way to manage your own care is to start with a conservative approach. Options to try include cortisone injections, anti-inflammatories, and/or physical therapy. A rehab program may be all you need to recover your strength, motion, and function.

If those things don’t work, then you can think about having an operation to repair the damage. Your decision may be based on how serious the injury is and how quickly you want results.

There have been a few studies looking at the effect of age on rotator cuff tear surgery. These same studies also look at the size of the tear as a possible factor in the results.

Not too many people in your age group have this surgery. Results are mixed without a clear conclusion. Shoulder motion and function seems to be better in the younger age groups even before the operation.

Smaller tears seem to have a better final result in all age groups. Some studies have mixed results. In general researchers are unable to reach a final conclusion about the effect of patient age on the outcome.

Shock waves created by strong sound energy pulses have been found to work in the treatment of kidney stones, plantar fasciitis, and tendinitis such as tennis elbow. It can also be used to treat calcium deposits called calcific tendinitis.

An ESWT device generates shock waves or acoustical pulses to the targeted area. There may be no negative side effects. Minor skin bruising, reddening, and swelling around the treated area are possible. Many of these effects go away after a little while.

Patients have also reported pain right after the treatment. Nausea, sweating, and dizziness can occur. Muscle pain and muscle tension near the treated area have been reported. Joint stiffness, muscle cramps, and muscle spasm are also possible.

Most side effects are mild and go away in 24 to 48 hours. There don’t seem to be any long-term or permanent negative effects.

Extracorporeal shock wave therapy (ESWT) has been used to treat calcific tendinitis of the shoulder. Shock waves are sound waves that create high-pressure energy. The energy is enough to shake the calcium deposit into tiny fragments that the body can absorb.

According to a recent study from Austria, ESWT works best when the sound waves are focused directly at the calcium deposits. This requires using a special X-ray imaging called fluoroscopy. A computer program helps calculate the best angle and distance to get the best results.

Calcific tendinitis or bone spurs occur when calcium deposits around the shoulder cause pain. The deposits occur most often in the supraspinatus tendon that goes across the top of the shoulder.

The pain is unrelated to shoulder position or activity. Adults between the ages of 30 and 50 are affected most often.

It’s not clear what causes this problem. Scientists aren’t sure if it’s an inflammatory response or caused by tendon injury. Many people have calcific tendinitis without any symptoms.

Others have severe pain made worse by even the slightest shoulder movement. The size of the deposit doesn’t seem to predict the amount of pain.

A recent study from the University of Alberta in Canada looked at patients who had a mini-open method of rotator cuff repair. They used shoulder motion and function as the two main measures of results.

They also looked at patient satisfaction and number of patients who went back to work to judge the outcomes. Most of the improvement in motion and function took place in the first six months.

All but one patient was happy with the results. Most went back to work at their old jobs by the end of one year. Only a few needed job changes to make it possible to go back to work.

Take a look at these main measures (motion, function, return to work) in your life to judge your results. If you aren’t happy, make a follow-up appointment with your surgeon.

There may be a simple solution to your problem. You may need a short course of rehab. It’s possible a second surgery is needed.

There’s nothing wrong with trying conservative care before going for a rotator cuff repair. In some cases, anti-inflammatory drugs help. In other cases, cortisone injections or physical therapy can make a difference.

But for patients who still have pain, loss of motion, and reduced function, surgery may be the best option. Many patients put it off for months and even years. They still report a good result after the operation.

New methods using arthroscopic surgery and tiny incisions have changed the results of this operation. Even full-thickness tears or tendons that have retracted far away from the place where they normally attach can have a good outcome.

Many doctors hold to this idea. A recent review of the studies on partial (hemiarthroplasty) versus total shoulder replacements might call that plan into question.

Some studies show that even with a hemiarthroplasty the surface of the shoulder socket continues to wear down and deteriorate. Then when it’s time to convert to a total shoulder, there isn’t enough good, solid bone for the implant.

On the other hand, starting with a total shoulder arthroplasty (TSA) leaves the patient with no place to go if problems occur. There isn’t a good replacement for the replacement.

Overall the studies done comparing hemiarthroplasty to a TSA show the TSA gives patients better function over a longer period of time. More studies are needed to fully compare these two treatment options.