Immediate relief of pain can be accomplished through the application of heat or ice for comfort. Ice is usually used for recent injuries (within 48 hours). For chronic conditions, ice is usually used after an activity that causes discomfort. Heat treatments can be used for chronic conditions before participating in activities. Heat stimulates blood flow and helps to relax and loosen the tissues in the area. Heat and or ice should never be used for more than 20 minutes at a time.

Extended use of ice can cause frostbite of the skin and heat can cause burning. One should never use a heating pad while sleeping.

 

Shoulder Shrugs

PRESCRIPTION MEDICATIONS:

Your physician may advise any of the above treatments for shoulder pain. Certain test or exams may be performed to determine the diagnosis of the shoulder problem. Narcotic pain medications may be prescribed by your physician and should be taken as prescribed and with caution. Other prescriptions may include nonsteroidal anti-inflammatory (NSAIDS) medications.

NSAIDS are used to reduce inflammation and relieve pain, chronic and acute. There are a variety of NSAIDS available and no one is guaranteed to work. Your physician may try several different ones to find the one that works for you. These are reasonably safe medicines but can have potentially serious side effects. Stomach pain and heartburn are the most common. However, bleeding tendencies can increase and some patients develop ulcers while taking this medicine. Allergic reactions can occur and result in rashes, wheezing, and throat swelling. Patients with liver or kidney disease should use caution in taking these medicines. Discontinue the medication and consult your physician immediately for the following: fluid retention, unusual weight gain, and occurrence of dark stools, vomiting, especially with blood present.

CORTISONE INJECTION

Your physician may offer an intra-articular corticosteroid injection for relief of pain. It is important to remember the type and length of relief received from the injection. Steroids reduce pain by reducing inflammation. Injecting cortisone into a joint enables high concentrations of the medicine to be given with minimal side effects. Symptoms can be relieved for days to weeks to months. The injection is given with a small needle and with skilled hands is usually well tolerated. Side effects can occur but are not very common. Patients with diabetes may experience an increase in their blood sugar and should monitor it closely for a few days. As with any injection, a localized infection can occur but your provider should take necessary precautions to prevent this. Some patients experience a slight flushing of the face or heart palpitations with these injections. These affects can be diminished with a pre-medication of over-the-counter Benadryl. Whitening of the skin can occur at the area of the injection and is not harmful but may be of concern in patients with darker skin. Some studies have shown tendon weakening and cartilage softening with repeated cortisone injections. There is no specific number of cortisone injections a patient may safely receive. Some experts believe 3-4 injections per year in a single joint can be done providing the patient gets adequate relief of pain.

PHYSICAL THERAPY

Your physician may prescribe physical therapy for improved motion and pain relief. The therapist will teach specific exercises to be done. It is important to do these exercises for motion and strength. These exercises can usually be learned and performed at home after proper instruction.

TREATMENT OF SHOULDER ARTHRITIS:

Conservative treatment of over-the counter medications, NSAIDS prescription, exercises, physical therapy and cortisone injections are usually used for shoulder arthritis. Surgical treatment is usually not offered until these have failed. A surgical procedure called an arthroscopic debridement may be offered by your physician to remove inflamed tissue. There is no guarantee that this will alleviate the pain and will not cure the arthritis. However, some pain control may be achieved and thus postpone a shoulder replacement. In shoulder replacement surgery, the joint surfaces are resurfaced and replaced with a metal stem and ball, and sometimes a plastic socket. A 4-6 inch incision is made in the front of the shoulder.

TREATMENT OF ADHESIVE CAPSULITIS/FROZEN SHOULDER:

Adhesive capsulitis is treated according to its severity. Pain is relieved by ice/heat, over-the-counter medicines, prescribed NSAIDS, and cortisone injections.*Asterist each of these??? Motion is treated after pain relief with aggressive physical therapy and exercises. In severe cases, surgery may be needed to "break up" the scar formation. This is done under general anesthesia* and without an incision. The physician manipulates the shoulder while the patient is asleep. Exercises must still be done to maintain the motion gained during manipulation.

TREATMENT OF BURSITIS/IMPINGEMENT/TENDONITIS

Bursitis and tendonitis can usually be treated with ice/heat application, avoidance of activities that cause pain, over-the-counter medications, short-term prescribed NSAIDS, or a single cortisone injection. These conditions are usually self-limiting and only short-term treatment is necessary. Impingement is usually the result of chronic problems and can result in rotator cuff tears. Cortisone injections are usually very limited in use due to potential weakening of the tissue. Decreasing inflammation by avoidance of activities that cause pain is encouraged. Surgical intervention may be warranted to repair small tears and sometimes an acromioplasty* is performed to prevent future impingement.

TREATMENT OF DISLOCATION

A dislocated shoulder requires medical attention for diagnosis and treatment. The shoulder joint must be manipulated to correct the alignment. This can usually been done with minimal sedation and local anesthesia. Sometimes it is necessary to use general anesthesia* to perform the reduction.

TREATMENT OF INSTABILITY:

Shoulder instability can sometimes be treated with physical therapy for strengthening of the shoulder joint. However some problems must be surgically corrected. If the shoulder joint capsule is loose, tightening can be done through arthroscopic* capsular shrinkage. If the problem is due to a tear of the labrum, an arthroscopic repair can be done

TREATMENT OF SHOULDER SEPARATION:

The severity of the shoulder separation determines the treatment. Pain and inflammation can be controlled with the use of ice, anti-inflammatory medicines, and a sling to rest the joint. Very rarely is surgery needed to correct the joint disruption.

TREATMENT OF ROTATOR CUFF TEARS:

Surgery is usually indicated for known rotator cuff tears after failure of conservative treatment for shoulder pain, motion, and strength. The goals of the surgery are to repair tears to restore proper strength and movement and to assure smooth movement of the tendons under the acromion. This surgery can be done arthroscopically, by an open repair, or a combination of the two. An open repair requires a small 3-4 inch incision in the front of the shoulder. Arthroscopic* repair requires 3-5 small ½ inch incisions in the front, side, and back of the shoulder. Either procedure allows the surgeon to remove debris, or debridement, make more room in the subacromial space by shaving away bone, or acromioplasty, and sew torn edges of the tendons together, or rotator cuff repair.

Arthroscopy is a type of surgery that allows the surgeon to insert a small camera, an arthroscope, into the joint, project the image on a monitor and visualize and repair tendons and ligaments.

DIAGNOSTICS:

Your physician will use many things to determine the diagnosis of your shoulder problem. A thorough history will be done to determine possible injury or cause of the pain. A physical exam will be done to determine shoulder motion and strength. An initial X ray will be done to rule out any joint or bone problems.

X RAY is a form of radiation that produces a picture for your physician to see. Dense tissues, such a bone, appear white on film and less dense tissues appear in shades of gray. Problems such as torn ligaments or tendons cannot be seen on X ray. *If you think you could be pregnant and X ray should be avoided.

A Bone Scan is a nuclear scanning test that can evaluate bone damage, detect cancer that has spread tot eh bones, and to monitor conditions that affect the bone, such as trauma or infection. A bone scan can often detect a problem earlier than a regular X ray. A radioactive tracer is injected into a vein in the arm and approximately 3 hours later pictures are taken by the scanner which moves slowly over the body area. Bone problems will absorb more tracer and appear as "hot" spots on the picture. Before a bone scan you should let your physician know if you think you might be pregnant, are breastfeeding, have had an X ray test involving contrast dye or have been taking Pepto-Bismol in the past 4 days. There is a wait time involved between the injection and the scanning, so you should bring something to do during this time. You will be asked to lie still during the scanning procedure. You will also be asked to empty your bladder prior to the scanning.

Ultrasound uses reflected sound waves to produce images of body tissues. It does not use X ray or any harmful radiation. A gel is applied to the area viewed and a small handheld instrument or transducer is passed back and forth over the area of the body being examined. The sound waves are converted to a picture and projected on a screen for viewing.

CT or CAT Scan (computerized axial tomography) is a special X ray that scans the body area one slice at a time. This slicing creates a 3-dimensional cross sectional view to provide detailed images. The patient must lie still and be placed inside the machine for about 15 mins?

MRI or magnetic resonance imaging produces detailed pictures of the body without the use of X ray. It uses a large magnet, radio waves, and a computer to produce the images. Certain metal implants in the body make the exam inadvisable and the patient should notify the physician of these conditions. The patient needs to let the physician know if she thinks she might be pregnant. Becoming nervous in confined spaces may also pose a problem. There are "open" MRI machines available and prescriptions can be given to alleviate these symptoms. The patient will be asked to lie very still during the exam. The patient will hear a fan and air moving as well as hear tapping noises during the exam. Sometimes ear plugs or headsets with music are provided to reduce these noises. The procedure lasts about 30-45 minutes.

DECISION FOR SURGERY:

The decision for surgery is made between the patient and the physician. Usually after failed conservative treatment and appropriate diagnostic studies, the physician may recommend surgery. Considerations for surgery include the approach of surgery, type of surgery needed, anesthesia for surgery, and postoperative care and rehabilitation.

Approaches of surgery include a manipulation, an open procedure*, an arthroscopic procedure*, or a combination of the two.

Types of surgery include: manipulation for adhesive capsulitis* or dislocation*, repair of instability*, shoulder replacement*, AC joint resection*, acomioplasty*, and rotator cuff repair*.

Anesthesia includes general* and interscalene block* or combination of the two. General anesthesia is the most powerful form of anesthesia and uses medications to make the patient unconscious and stops pain from being felt during surgery. An IV is inserted into a vein in the arm and medications are given for sedation. Patient’s vital signs are closely monitored during the procedure. Once the patient is asleep, an endotracheal tube is inserted into the windpipe and connected to a ventilator to provide oxygen to the lungs. After general anesthesia, nausea is a common side effect. Someone will need to drive and stay with the patient 24 hours after the procedure. An interscalene block is an injection of local anesthesia into the neck area that will numb the arm. An IV is inserted into a vein in the arm and sedation is usually given prior to the scalene block. It takes a few minutes to inject and about 20 minutes to lose the feeling and movement of the arm. After the procedure the arm will be numb and a sling will be used. It is important to not come into contact with extreme heat or cold will the arm is numb to prevent injury. Sometimes difficulty is felt in taking a deep breath after the block. Your oxygen levels will be closely monitored and oxygen will be administered during and immediately after the procedure. The combination of these two anesthesias provides excellent pain relief as well as relaxation of the shoulder joint for surgeon visibility and repair. Certain risks are involved in receiving anesthesia and will be discussed prior to surgery and informed consent will be obtained.

Postoperative care and rehabilitation are important aspects of surgery. One needs to consider trips or vacations already planned when choosing the date of surgery. Immediate (24 hour) postoperative care should be provided by an adult. Depending on the age of the patient, other medical conditions, and whether the dominant hand is being operated on will determine the length of care needed. Someone will need to be with the patient during the first few showerings for safety reasons. Meal preparation may be difficult depending on hand dominance for the first 1-2 weeks after surgery. Overall, the patient needs to devote a year to regaining full rehabilitation of the shoulder.

SCHEDULING OF SURGERY:

Once the decision for surgery has been made, a date is chosen by the patient and physician. This date can be chosen on the day of the appointment or the patient can call back to schedule (910-235-4666). A preoperative history and physical will be done. At this time, it is determined that the patient is medically and physically ready for surgery. Certain conditions such as heart disease, high blood pressure, diabetes or combination of these require medical clearance from your primary care physician or specialist. These appointments will be made through the office personnel. Preoperative laboratory studies and possibly and EKG will be done prior to surgery. Surgery will be performed at the ASC and interview and registration is required before the day of surgery. The patient will be given a phone number (910-295-0209) to call after 2pm on the day before surgery to receive their arrival time for surgery. The patient cannot have anything to eat or drink after midnight before surgery. Blood pressure medications can be taken with a sip of water on the morning of surgery. A large button up the front shirt will be needed to wear home after surgery and worn until the first follow-up visit. Button up shirts are recommended for wear for up to 2months after surgery for ease of dressing. Someone will need to drive the patient home and stay with the patient for 24 hours. TED (thromboembolytic devices) hose are applied prior to surgery to aid in the prevention of blood clots in the legs, or DVT, and recommended to wear until the patient has regained a normal activity level.*