Many people suffer with shoulder pain. Whether this limits one’s sleep, work or play, it is very frustrating. Sometimes symptoms will improve with rest, ice, topical medications, or oral medications. Other conservative treatments may include physical therapy, ultrasound, electrical stimulation or injections. However, sometimes symptoms can continue for many months. Symptoms such as pain, weakness, loss of motion, or loss of function may indicate more serious problems. These symptoms need further evaluation by specialists. Traditionally, orthopedic surgeons are most equipped to treat and manage shoulder problems that do not respond to conservative modalities.
The shoulder joint is a complex modified ball and socket joint. For normal function it relies on bones, ligaments, muscles and soft tissue structures. Injury to one or more of these structures can lead to long-term pain, instability, and loss of strength or motion. You may need further evaluation, testing or treatment.
Frequently, patients will present with problems involving the muscles of the rotator cuff. The rotator cuff is a dynamic stabilizer of the shoulder. It is comprised of four tendons attached to the arm bone (humerus). These tendons work in coordination with the other muscle to provide normal rotation. When injury occurs, these tendons lose their balance, which leads to pain and loss of active motion. Tendon injury occurs from either compressive forces leading to attrition or tensile forces leading to ruptures. Both mechanisms lead to tendon failure and shoulder dysfunction. Some patients are able to accommodate for the loss of one tendon if the injury occurs over a long period of time. Acute injuries are more drastic and easier to identify; therefore, they tend to occur in overhead activity or trauma. For that reason, rotator cuff injuries can occur in the young or old. By the age of 50, studies show that 25 percent of the population have asymptomatic partial tears and 25 percent more have asymptomatic complete tears in the rotator cuff tendons.
Diagnosis is made following an examination by an orthopedic surgeon. X-rays and an MRI will provide additional information. Once a diagnosis has been confirmed, treatment may be conservative as mentioned earlier or may include surgery. Conservative treatment has been successful in 80 percent of full thickness tears. If symptoms do not improve, surgery can be considered.
There are two basic approaches to shoulder surgery: (1) arthroscopic and (2) open. The overall outcome between both approaches are similar. However, in paired studies, there was less pain, higher satisfaction and earlier return to activity with arthroscopic surgery. The healing process and post-operative treatment progress are similar for both techniques. With the numerous advances in minimally invasive surgery, the arthroscopic approach has gained wide popularity. The surgical instruments and new repair techniques have improved the outcome for arthroscopic surgery. I have performed both open and arthroscopic rotator cuff surgery in several hundred patients with good outcomes. Over the last 10 years, I have utilized the newer techniques in arthroscopy to assist my patients in the healing process.
These surgical procedures are done on an outpatient basis and take about an hour and a half to complete. No sutures are required for the three to four incisions and therapy begins two to three weeks after the procedure. At Southeastern Regional Medical Center, we are able to perform this surgery and are experiencing good results. With the help of physical therapy, we have been able to get patients back to work and back to their daily activities.
Dr. David Dalsimer is a board certified, fellowship-trained upper extremity orthopedic surgeon with over 15 years of experience. He is affiliated with Southeastern Orthopedics which is located at 730 Oakridge Blvd, Suite B, in Lumberton. To learn more about shoulder pain or schedule an appointment, call (910) 738-1065.
- 10/02/2012 - CFO Thomas Johnson: Positioning Southeastern Regional for Success
- 10/02/2012 - SRMC, in Partnership with the North Carolina Healthy Start Foundation, to Honor SIDS Awareness Month
- 09/18/2012 - SRMC and Life Line Screening partner to promote healthier communities
- 08/28/2012 - Fibromyalgia 101
- 08/10/2012 - SRMC awarded an "A" for patient safety
- 07/17/2012 - Making health care more convenient
- 06/28/2012 - Laparoscopic surgery to remove adrenal gland now offered at SRMC
- 04/27/2012 - Ankle Pain and Strains
- 04/16/2012 - Survivorship
- 03/27/2012 - Dr. Harvey Allen on WMBF