By Laura Freeman
Shoulder injuries can bring even the most stoic tough guys to tears. A simple dislocation can be righted quickly, leaving only the fading memory of pain. However, years of work, play, and injuries tend to take their toll, and eventually the discomfort becomes too much to shrug off.
“We usually start with conservative measure if the damage isn’t too severe. Physical therapy, injections, medications, icing and rest may be enough to promote healing,” orthopaedic surgeon Jonathan Isbell, MD, a shoulder, elbow, hip and knee specialist at Southlake Orthopaedics, Sports Medicine & Spine Center PC, said. “However, if trauma, tears or other damage is too extensive, it may be time to talk about surgery.”
The big question is what type of surgery is likely to be most beneficial to the patient.
“When a rotator cuff tear is smaller and the patient is young, with good circulation and plenty of healthy tissue for anchoring, the odds are better that a repair will be successful,” Isbell said. “However, even under the best conditions, the blood supply in the area is less robust than in other parts of the body, so complete healing is going to take longer than surgery in other parts of the body. It can take up to six months, depending on the patient’s condition and the types of demands their work places on them. Even if the outer part of the shoulder feels fine, patients should listen to their surgeon and not put too much demand on their shoulder too soon or the repair may fail.”
The wait for full healing can be difficult for people whose livelihood depends on physical work, and those eager to return to sports or their favorite activities. Likewise, remembering not to pick up a grandchild who wants to play isn’t easy.
“In older patients or in anyone with diminished circulation or poor tissue quality that offers few good anchor points, it’s difficult to make lasting repairs that bring long-term relief,” Isbell said.
Even in younger patients, there are cases in which one surgery to replace the joint may offer advantages over attempting repairs that may need to be repeated, ultimately leading to a joint replacement anyway.
“In the last few years, there have been advances in techniques and prosthetics that have expanded the number of situations where replacement may offer clear advantages,” Isbell said.
“Some surgeries can be done on an outpatient basis, depending on whether the patient has other health issues that need to be monitored. Rehab is highly recommended to achieve optimum range of motion and build strength to help the shoulder heal and avoid reinjury.
“We also recommend that patients stop smoking. Maintaining good circulation is critical to healing, and in an area where maintaining an adequate flow is already challenging, there’s no margin for diminishing blood supply.
Sleep is another consideration that may be difficult when there’s shoulder pain, or when recovering from surgery. Patients may find sleeping in a recliner easier for a while.”
Although aging is a primary factor that contributes to the need for shoulder repairs and replacement, and an aging population is increasing the number of surgeries that are being done, more young people are finding their way into the shoulder specialist’s office due to sports injuries and accidents that happen when active young people have an unfortunate encounter with gravity.
“Due to the nature of the movement, we’re seeing a lot of baseball injuries in high school and college athletes, and dislocations and injuries in other sports that involve falls, impacts and sudden changes in motion,” Isbell said. “A shoulder that begins to repeatedly pop out can be very painful for young athletes. When there is damage, the research shows that it is better to fix the shoulder the first time rather than allow the damage to accumulate.”
To help patients avoid the need for surgery or delay the time when it becomes necessary, it helps to identify which patients are most likely at risk. Aside from age and genetics, some occupations and activities put people at greater risk.
“If a job involves a lot of lifting or repetitive movement of the shoulder such as turning a crank or throwing a fast ball, or if there’s a lot of reaching overhead as a carpenter would reach up with a hammer to nail boards, the risk for shoulder problems increases,” Isbell said.
Physician can help by monitoring for symptoms, and suggesting protective equipment, strengthening exercises and anti-inflammatory and self-care management strategies to help keep the weight of the work-day world off of patients’ shoulders.