Dr. Miller: Shoulder pain could be managed without surgery. We're going to have a surgeon to tell you how to do that next.
I'm Dr. Tom Miller, and I'm here with Dr. Robert Tashjian. He's an orthopedic surgeon here at the University of Utah specializing in shoulder surgery. Talk a little bit about shoulder pain. You see a lot of that, but you don't operate on all of it, that's for sure.
Dr. Tashjian: That's absolutely right, Tom. You know, people's perception a lot of times is that when you come to a surgeon, the only patients that we actually treat require an operation. And I'll tell you that in a day that I will see probably 30 or 40 patients and in that 30 or 40 patients usually only 3 or 4 of them actually need an operation. So treating patients conservatively with problems is one of the primary things that we actually do in the clinic.
Common Causes of Shoulder Pain
Dr. Miller: And it's always better not to have an operation if you can do that. So tell us the kinds of things that cause, you know, the most common causes of shoulder pain.
Dr. Tashjian: Sure.
Dr. Miller: That might be a good way to start and then how you deal with those.
Dr. Tashjian: Absolutely. Obviously, there are traumatic and non-traumatic things that can cause shoulder pain. Oftentimes if someone does have a trauma like a broken bone or a torn tendon in their shoulder, that can be a subgroup of patients that actually do need an operation early. But more often than not what we typically will see are people that have problems with overuse. Overuse is a very common problem or issue that then leads to inflammation around the shoulder that will precipitate someone to actually come into the clinic and be evaluated.
Dr. Miller: So not just athletes?
Dr. Tashjian: Not just athletes. They can be athletes so we can see overhead athletes that have problems but oftentimes they are laborers, people that work that actually use their arms to actually make a living. And then also the more... instead of someone who is a high-performing athlete, maybe just a recreational athlete, a weekend athlete that works during the daytime maybe not using their hands and then on the weekends get a little bit more aggressive with their sport and they overuse their shoulders.
Treating Non-Traumatic Overuse Injuries
Dr. Miller: So when you have an overuse injury, is that most commonly a sprain or a strain of the shoulder?
Dr. Tashjian: Yeah. Usually, typically what we see is it's actually inflammation or tendinitis and it's usually the tendinitis or inflammations either of the biceps or the rotator cuff. And that's the typical scenario that we'll see and we'll treat patients conservatively for shoulder pain.
Dr. Miller: So how do you do that? Is that just typically with pills or is that with physical therapy or both?
Dr. Tashjian: Both actually. So we, the initial... the first thing that we do when we see patients in the clinic is obviously making a diagnosis. And that's probably one of the most important things. So we want to first rule out to make sure that they don't have a problem that does require something urgently. And once that's been done and it looks like they don't need initial operative care, then we usually have a standard protocol for patients to actually get into conservative care and that's a combination of using oral anti-inflammatory medications.
Dr. Miller: Like ibuprofen or Aleve?
Dr. Tashjian: Absolutely. Those are two great ones. Local ice can actually be very good. It's a good pain reliever as well as an anti-inflammatory. So usually I recommend ice for 10 minutes two to three times a day right on the area that is affected.
Dr. Miller: Just ice alone is a good modality, isn't it?
Dr. Tashjian: It's excellent. Make sure that you don't put that ice bag right on your shoulder. Make sure that there's a towel or something right underneath it so that it's not directly on your skin, as people can get burned. But the reality is that using ice is a very good modality, topical that we'll use.
Strengthening and Stretching Exercises for Shoulder Pain
And then therapy and therapy usually consists of two things -- it's both stretching and strengthening. We want to make sure that you get your range of motion back and at the same time we want to try to strengthen the other muscles that might not be inflamed and irritated to be able to compensate for the ones that are more irritated and inflamed.
Dr. Miller: Now, I would think you'd tell the athlete or the laborer to lay off what they were doing. I mean, is that true or can you continue to do these other things without impacting their level of activity in sports or their job?
Dr. Tashjian: Sure, very common question. And usually, it's very simple advice: if it hurts don't do it. And so that common simple advice usually is we'll tell patients, so if they go to the gym and they like to do 15 different exercises and 3 of them hurt, I say lay off the 3 that hurt and continue to do the 12 that don't.
Dr. Miller: Until at least maybe the physical therapy gets them back to a point where they can do the exercise.
Dr. Tashjian: Correct.
Dr. Miller: And I would assume maybe they're doing the exercise incorrectly.
Dr. Tashjian: Potentially, and that's the actual benefit of the therapist. And so that's why just pulling exercises off the internet, we usually actually have a very good home program in the pamphlet that we give to the patients in the clinic but at the same time getting instructed by a physical therapist on exactly the proper form and technique to be able to actually do the exercises is just as important as actually physically doing them.
Dr. Miller: Now, this treatment is also one that highly involves the patient. The patient has to be motivated in order to have a good outcome.
Dr. Tashjian: Absolutely. Actually, all of what I do is dependent on the participation level of the patient that... even from a surgical standpoint my job only is you know, it's only half done at that time of the operation the other half is making sure that patients actually are able to complete the physical therapy that's required to get them better. So in non-operative treatment, it's even more so in the hands of the patient.
Dr. Miller: Now, let's say that they go through the treatment, what percentage of the patients that you see for pain and that you prescribe a conservative course of therapy end up having a good outcome versus the rest or a percentage that go on a surgery? Do you have a number for that?
Dr. Tashjian: Sure.
Dr. Miller: What's your experience with that?
Dr. Tashjian: So it really depends upon what the problem is but let's say let's take the typical patient that has classic rotator cuff tendinitis. They come in. They might have a history of about 6 to 8 weeks of shoulder pain. They have difficulty sleeping on the shoulder at night. They have problems with overhead use. They can't do the sports that they typically will do with overhead use. They have no history of trauma. That patient will typically get them into the program that we talked about and I'll tell you 80% of the time patients will come back and their pain levels are reduced to the point where they're able to get back to the situation where they were prior.
Dr. Miller: That's great news. To wrap it up, basically, it sounds like if you've got shoulder pain, it might not be necessary to have surgery if you follow some instructions from your physician and as well the physical therapist who will be working for you, you could have a great outcome.
updated: August 4, 2023
originally published: April 18, 2017
