Every day people head to the doctor's office for a shoulder problem, including shoulder and upper arm sprains and strains.
Shoulder injuries are frequently caused by athletic activities that involve excessive, repetitive, overhead motion, but injuries can also occur during everyday activities.
L. Pearce McCarty III, MD is here today to talk about the most common shoulder injuries, how they are treated and most importantly, how you can avoid shoulder injuries and a trip to the doctor’s office.
Selected Podcast
Understanding Shoulder Discomfort and Injuries
Featured Speaker:
L. Pearce McCarty III, MD - Orthopedic Surgery
L. Pearce McCarty III, MD is a board-certified orthopedic surgeon with additional board certification in orthopedic sports medicine. He practices with Sports & Orthopaedic Specialists and specializes in the treatment of shoulder, elbow and articular cartilage injuries. In addition to seeing patients in the clinic, Dr. McCarty is an orthopedic team physician for the Minnesota Twins as well as Totino-Grace and Minnetonka High Schools and Macalester College. He remains academically active by routinely authoring book chapters, original research articles, and presenting at national meetings. Outside of the office, Dr. McCarty enjoys competing in triathlons, running, music and spending time with his wife and three children. Transcription:
Understanding Shoulder Discomfort and Injuries
Melanie Cole (Host): Every day, people head to the doctor’s office for a shoulder problem including shoulder and upper arm sprains and strains. Shoulder injuries are frequently caused by athletic activities, but it doesn’t always have to be that way. Sometimes these injuries can occur with everyday activities. We’re talking today about the most common shoulder injuries with my guest, Dr. L. Pearce McCarty. He’s a board certified orthopedic surgeon at Allina Health. Welcome to the show, Dr. McCarty. Tell us a little bit about some basic physiology of the shoulder.
Dr. L. Pearce McCarty (Guest): Hey, Melanie. Thanks for having me. Happy to do so. So the shoulder is a wonderful joint. It’s my specialty, and it’s a fairly complex set of tendons, ligaments, and bones. If you want to visualize the shoulder joint, think of a ball and socket joint. It’s one of several ball and socket joints around the body. It’s one that is inherently unstable. The socket is very flat. Think of a golf tee instead of a deep socket. The ball kind of hangs on that golf tee and is held there by a series of ligaments and tendons. For example, the rotator cuff, which is a set of tendons that a lot of people have heard of and tends to be kind of a problem area in the painful shoulder. All these tendons and ligaments have to function together in a very precise way to allow us to have that amazing range of motion that we have in the shoulder joint to allow us to throw and engage in activities such as swimming or other overhead sports that require an extensive range of motion. It’s a very complex joint.
Melanie: Some of the most common injuries that you see—you mentioned the rotator cuff—when do we know that the pain that we might feel in our shoulders is something that we need to have evaluated by a doctor?
Dr. McCarty: Great question, Melanie. In general, whether it’s the shoulder or any other joint, it’s not uncommon for an active individual engaged in sports to have a strain or a few days of discomfort around that joint in the shoulders. The shoulders are really no different. With respect to your question about when is this something we should really be concerned about, when should I phone in, when should I go in and seek medical care, we typically will say that if after three to five days, discomfort that is not resolving with your typical home remedies, such as icing or use of Ibuprofen, rest, modifying your activities, then that’s something you probably want to get checked out. There’s also the instance when you know you’ve done something, Melanie. You’re out in a basketball court or the tennis court, you fall onto an outstretched extremity, or you’re lifting something heavy over the head and you feel a pop or sudden pain in the shoulder that really prevents you from having your normal function, that’s something you probably wouldn’t want to wait that three to five days. In that instance, you’d want to head on in and get that checked out, sooner rather than later.
Melanie: Before we talk about treatment of shoulder injuries, Dr. McCarty, talk about prevention a little bit. How do we keep that very complicated joint that is the shoulder strong so that maybe we don’t have to come see you?
Dr. McCarty: Great. Definitely with respect to the shoulder, an ounce of prevention is worth a pound of cure, especially as we get older. I see increasingly in my practice a number of individuals well into their 40s, 50s, and even 60s are maintaining incredibly active lifestyles. And as we get older, we require more maintenance to allow us to do the same things that we could do with very little effort when we were younger. I encourage all of my patients to come in and see me for any sort of shoulder issue to engage in a regular—and by regular I mean just two to three times a week—routine, both rotator cuff strengthening and strengthening the muscles around the shoulder blade. That latter group of exercises, strengthening the muscles around the shoulder blade, helps to not only position the shoulder normally so that we have better strength and less pain but also helps with posture. There are added benefits of typically decreasing discomfort in the upper thoracic spine to the upper back area as well as the neck area, because there are a lot of muscles that are shared between the neck and the shoulders, such as the trapezius, the kite-shaped muscle that spans all the way from the shoulder to the neck, and the upper thoracic spine and several others as well.
Melanie: I do love those scapular stabilizing exercises. They are so good for posture and, as you say, keeping that shoulder good and strong. When we’re talking about all of these different exercises, do we use these exercises as rehab as well if somebody has hurt their shoulder?
Dr. McCarty: Absolutely, Melanie. But when we have an injury, we’re going to follow a very predictable series of phases in terms of rehab. The first thing we’re going to do is simply get the inflammation under control, the discomfort under control, and that’s going to probably take a week or two to do that if the injury has been anything serious. We don’t want to engage in strengthening exercises before we have that inflammation under control. The next thing that we’re going to do is we’re going to focus on range of motion. We’ve gone from decreasing inflammation to focusing on range of motion, restoring our full range of motion, and only then will progress on to strengthening exercises. But definitely, once we reach that point, those postural or periscapular strengthening exercises as well as rotator cuff strengthening exercises are going to play a very important role of getting us to the next phase and the final phase of rehab, which is returning to sports-specific exercises. That’s when we’re going to really get into the types of lifts or exercises that are going to rebuild the strength we need to engage in the type of work that we were doing prior to the injury or engage in the type of sporting activity in which we were participating prior to the injury.
Melanie: When does a shoulder injury or just some kind of chronic shoulder condition require cortisone shots, Dr. McCarty? When does something that actually happens to your shoulder require surgery?
Dr. McCarty: To answer the first question, I get a lot of questions about cortisone shots in the office. I think there are a lot of myths about cortisone out in the lay public. Cortisone injection, first of all, when used in the appropriate indications, is not a dangerous tool. I’ll say that with one caveat or warning that in a diabetic population, a cortisone injection will cause blood sugars to increase, and sometimes dangerously high. So anyone who is in particular a type 1 diabetic or a type 2 diabetic on insulin should be very wary about receiving a cortisone injection and should probably -- at least in our office, we’ll typically contact their primary care physician if they fall under one of those two groups so that they are on board and can increase the insulin dosage if needed to control those spikes in blood sugar. That population aside, when used appropriately, it’s a very safe tool. When should someone get a cortisone injection? Typically, when they have an inflammatory type condition that involves the shoulder joints. That could be bursitis. That is inflammation involving a structure that sits on top of the rotator cuff and is very commonly irritated with overhead or repetitive overhead activities, or another -itis or inflammatory condition known as adhesive capsulitis. The lay name for adhesive capsulitis is frozen shoulder, and frozen shoulder is an excellent indication for a cortisone injection because the fundamental aspect of a frozen shoulder is inflammation. That cortisone is going to knock that inflammation out. As far as surgery is concerned, typically we reserve surgical intervention for injuries around the shoulders that involve something being torn or broken. Now, the shoulder is a very what we’ll call soft tissue-focused joint. We see soft tissue injuries in the shoulder much frequently than we see bony injuries in the shoulder. Soft tissue injuries include tearing of tendons, tearing of the rotator cuff, which is the most common injury requiring surgery that we see in the shoulder, or tearing of a ligament inside the joint called the labrum. The labrum is a gasket-type of ligament that runs around the circumference of the socket and helps provide stability to the shoulder joint. Those would be two instances of when we might indicate someone for surgical intervention.
Melanie: Do rotator cuffs heal themselves, Dr. McCarty? Because people ask me this all the time. If they don’t have surgery, will they get better as time goes on, or do they get worse?
Dr. McCarty: Really two different questions there, Melanie. One is, will a rotator cuff tear heal itself. The second is, will they get better, because sometimes patients get better without the rotator cuff healing. To answer your first question—and I’ll explain what I mean by that—but to answer your first question, a torn rotator cuff will not heal without surgical intervention, period. That’s been established by a number of studies that have followed groups of patients along either with ultrasound or with MRI serial ultrasound or serial MRI, and we know that for a variety of different biological reasons, that that will not happen. Now, there are times when a patient who may have a small partial tear of the rotator cuff or even a small full-thickness tear of the rotator cuff, may, through rehabilitation, become asymptomatic and choose not to have surgery. They are getting better in that their pain is resolving and their function is improving, but the rotator cuff is not healing. In most younger active individuals, we will recommend surgical repair of the rotator cuff so that down the line, we won’t have to deal with a larger tear when we could have successfully repaired a smaller tear at the outset.
Melanie: In just the last minute, would you please give your best advice for people suffering from shoulder discomfort or injuries? Really, your best advice for possibly preventing or treating these injuries.
Dr. McCarty: The advice I give to all patients who ask me that question is simply don’t ignore the symptoms. It’s much easier for us to treat small issues than it is for us to treat larger issues. To be more specific, for example, if one has a small injury to the rotator cuff, as I mentioned, it’s much easier to address that early on in the process when it maybe solvable through non-operative means, such is physical therapy or activity modification, than it is to address that once it has progressed on to a full-thickness tear or a large tear which would require surgery and may not even have a good outcome even after surgical intervention. So, pay attention to the signal your body is giving you. Pay attention to the function that you’re noticing in your shoulder. If you observe that function, the decrease, if you have those symptoms of pain and discomfort, particularly if you have them at night, if you have pain that prevents you from getting a sound night sleep in your shoulder, seek medical attention. Go see a board-certified orthopedic surgeon, in particular, one who is fellowship-trained in the treatment of shoulder and elbow disorders and have that shoulder evaluated. In most of the time, the vast majority of time, that too can be solved if caught early through non-operative means.
Melanie: Thank you so much. What great information. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening, and have a great day.
Understanding Shoulder Discomfort and Injuries
Melanie Cole (Host): Every day, people head to the doctor’s office for a shoulder problem including shoulder and upper arm sprains and strains. Shoulder injuries are frequently caused by athletic activities, but it doesn’t always have to be that way. Sometimes these injuries can occur with everyday activities. We’re talking today about the most common shoulder injuries with my guest, Dr. L. Pearce McCarty. He’s a board certified orthopedic surgeon at Allina Health. Welcome to the show, Dr. McCarty. Tell us a little bit about some basic physiology of the shoulder.
Dr. L. Pearce McCarty (Guest): Hey, Melanie. Thanks for having me. Happy to do so. So the shoulder is a wonderful joint. It’s my specialty, and it’s a fairly complex set of tendons, ligaments, and bones. If you want to visualize the shoulder joint, think of a ball and socket joint. It’s one of several ball and socket joints around the body. It’s one that is inherently unstable. The socket is very flat. Think of a golf tee instead of a deep socket. The ball kind of hangs on that golf tee and is held there by a series of ligaments and tendons. For example, the rotator cuff, which is a set of tendons that a lot of people have heard of and tends to be kind of a problem area in the painful shoulder. All these tendons and ligaments have to function together in a very precise way to allow us to have that amazing range of motion that we have in the shoulder joint to allow us to throw and engage in activities such as swimming or other overhead sports that require an extensive range of motion. It’s a very complex joint.
Melanie: Some of the most common injuries that you see—you mentioned the rotator cuff—when do we know that the pain that we might feel in our shoulders is something that we need to have evaluated by a doctor?
Dr. McCarty: Great question, Melanie. In general, whether it’s the shoulder or any other joint, it’s not uncommon for an active individual engaged in sports to have a strain or a few days of discomfort around that joint in the shoulders. The shoulders are really no different. With respect to your question about when is this something we should really be concerned about, when should I phone in, when should I go in and seek medical care, we typically will say that if after three to five days, discomfort that is not resolving with your typical home remedies, such as icing or use of Ibuprofen, rest, modifying your activities, then that’s something you probably want to get checked out. There’s also the instance when you know you’ve done something, Melanie. You’re out in a basketball court or the tennis court, you fall onto an outstretched extremity, or you’re lifting something heavy over the head and you feel a pop or sudden pain in the shoulder that really prevents you from having your normal function, that’s something you probably wouldn’t want to wait that three to five days. In that instance, you’d want to head on in and get that checked out, sooner rather than later.
Melanie: Before we talk about treatment of shoulder injuries, Dr. McCarty, talk about prevention a little bit. How do we keep that very complicated joint that is the shoulder strong so that maybe we don’t have to come see you?
Dr. McCarty: Great. Definitely with respect to the shoulder, an ounce of prevention is worth a pound of cure, especially as we get older. I see increasingly in my practice a number of individuals well into their 40s, 50s, and even 60s are maintaining incredibly active lifestyles. And as we get older, we require more maintenance to allow us to do the same things that we could do with very little effort when we were younger. I encourage all of my patients to come in and see me for any sort of shoulder issue to engage in a regular—and by regular I mean just two to three times a week—routine, both rotator cuff strengthening and strengthening the muscles around the shoulder blade. That latter group of exercises, strengthening the muscles around the shoulder blade, helps to not only position the shoulder normally so that we have better strength and less pain but also helps with posture. There are added benefits of typically decreasing discomfort in the upper thoracic spine to the upper back area as well as the neck area, because there are a lot of muscles that are shared between the neck and the shoulders, such as the trapezius, the kite-shaped muscle that spans all the way from the shoulder to the neck, and the upper thoracic spine and several others as well.
Melanie: I do love those scapular stabilizing exercises. They are so good for posture and, as you say, keeping that shoulder good and strong. When we’re talking about all of these different exercises, do we use these exercises as rehab as well if somebody has hurt their shoulder?
Dr. McCarty: Absolutely, Melanie. But when we have an injury, we’re going to follow a very predictable series of phases in terms of rehab. The first thing we’re going to do is simply get the inflammation under control, the discomfort under control, and that’s going to probably take a week or two to do that if the injury has been anything serious. We don’t want to engage in strengthening exercises before we have that inflammation under control. The next thing that we’re going to do is we’re going to focus on range of motion. We’ve gone from decreasing inflammation to focusing on range of motion, restoring our full range of motion, and only then will progress on to strengthening exercises. But definitely, once we reach that point, those postural or periscapular strengthening exercises as well as rotator cuff strengthening exercises are going to play a very important role of getting us to the next phase and the final phase of rehab, which is returning to sports-specific exercises. That’s when we’re going to really get into the types of lifts or exercises that are going to rebuild the strength we need to engage in the type of work that we were doing prior to the injury or engage in the type of sporting activity in which we were participating prior to the injury.
Melanie: When does a shoulder injury or just some kind of chronic shoulder condition require cortisone shots, Dr. McCarty? When does something that actually happens to your shoulder require surgery?
Dr. McCarty: To answer the first question, I get a lot of questions about cortisone shots in the office. I think there are a lot of myths about cortisone out in the lay public. Cortisone injection, first of all, when used in the appropriate indications, is not a dangerous tool. I’ll say that with one caveat or warning that in a diabetic population, a cortisone injection will cause blood sugars to increase, and sometimes dangerously high. So anyone who is in particular a type 1 diabetic or a type 2 diabetic on insulin should be very wary about receiving a cortisone injection and should probably -- at least in our office, we’ll typically contact their primary care physician if they fall under one of those two groups so that they are on board and can increase the insulin dosage if needed to control those spikes in blood sugar. That population aside, when used appropriately, it’s a very safe tool. When should someone get a cortisone injection? Typically, when they have an inflammatory type condition that involves the shoulder joints. That could be bursitis. That is inflammation involving a structure that sits on top of the rotator cuff and is very commonly irritated with overhead or repetitive overhead activities, or another -itis or inflammatory condition known as adhesive capsulitis. The lay name for adhesive capsulitis is frozen shoulder, and frozen shoulder is an excellent indication for a cortisone injection because the fundamental aspect of a frozen shoulder is inflammation. That cortisone is going to knock that inflammation out. As far as surgery is concerned, typically we reserve surgical intervention for injuries around the shoulders that involve something being torn or broken. Now, the shoulder is a very what we’ll call soft tissue-focused joint. We see soft tissue injuries in the shoulder much frequently than we see bony injuries in the shoulder. Soft tissue injuries include tearing of tendons, tearing of the rotator cuff, which is the most common injury requiring surgery that we see in the shoulder, or tearing of a ligament inside the joint called the labrum. The labrum is a gasket-type of ligament that runs around the circumference of the socket and helps provide stability to the shoulder joint. Those would be two instances of when we might indicate someone for surgical intervention.
Melanie: Do rotator cuffs heal themselves, Dr. McCarty? Because people ask me this all the time. If they don’t have surgery, will they get better as time goes on, or do they get worse?
Dr. McCarty: Really two different questions there, Melanie. One is, will a rotator cuff tear heal itself. The second is, will they get better, because sometimes patients get better without the rotator cuff healing. To answer your first question—and I’ll explain what I mean by that—but to answer your first question, a torn rotator cuff will not heal without surgical intervention, period. That’s been established by a number of studies that have followed groups of patients along either with ultrasound or with MRI serial ultrasound or serial MRI, and we know that for a variety of different biological reasons, that that will not happen. Now, there are times when a patient who may have a small partial tear of the rotator cuff or even a small full-thickness tear of the rotator cuff, may, through rehabilitation, become asymptomatic and choose not to have surgery. They are getting better in that their pain is resolving and their function is improving, but the rotator cuff is not healing. In most younger active individuals, we will recommend surgical repair of the rotator cuff so that down the line, we won’t have to deal with a larger tear when we could have successfully repaired a smaller tear at the outset.
Melanie: In just the last minute, would you please give your best advice for people suffering from shoulder discomfort or injuries? Really, your best advice for possibly preventing or treating these injuries.
Dr. McCarty: The advice I give to all patients who ask me that question is simply don’t ignore the symptoms. It’s much easier for us to treat small issues than it is for us to treat larger issues. To be more specific, for example, if one has a small injury to the rotator cuff, as I mentioned, it’s much easier to address that early on in the process when it maybe solvable through non-operative means, such is physical therapy or activity modification, than it is to address that once it has progressed on to a full-thickness tear or a large tear which would require surgery and may not even have a good outcome even after surgical intervention. So, pay attention to the signal your body is giving you. Pay attention to the function that you’re noticing in your shoulder. If you observe that function, the decrease, if you have those symptoms of pain and discomfort, particularly if you have them at night, if you have pain that prevents you from getting a sound night sleep in your shoulder, seek medical attention. Go see a board-certified orthopedic surgeon, in particular, one who is fellowship-trained in the treatment of shoulder and elbow disorders and have that shoulder evaluated. In most of the time, the vast majority of time, that too can be solved if caught early through non-operative means.
Melanie: Thank you so much. What great information. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening, and have a great day.