Whether you’re throwing a ball on the athletic field, or reaching to pick up your grandchild, your shoulders are key to your body’s mobility. Shoulders consist of several joints that – combined with tendons and muscles – allow a wide range of motion in your arms.
Causes of shoulder pain, strain, stiffness, and other injuries can originate from a multitude of sources, depending on age and activity.
Hendricks's staff is highly skilled in diagnosing and treating shoulder injuries — and ensure your continued care is comfortable and effective.
Listen in as Chad Waits, MD, discusses how at Hendricks, we offer award-winning patient care and shoulder services.
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Do You Suffer from Shoulder Pain?
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Learn more about Dr. Waits
Chad Waits, MD
Dr. Waits is a graduate of Missouri Southern State University and the University of Kansas School of Medicine. He completed his orthopedic surgery residency at the University of Kansas Medical Center in Kansas City. Dr. Waits completed his fellowship training in sports medicine at Wellington Orthopedics and University of Cincinnati. Dr. Waits has provided medical coverage for the Cincinnati Bengals football team, the University of Cincinnati Athletics Department and the Arena Football League’s Kansas City Brigade. He is an inductee in the Alpha Omega Alpha National Medical Honors Society and a recipient of the James R. Olney, M.D. Memorial Award for Academic Achievement in Orthopedic Surgery. Dr. Waits is a member of the American Orthopedic Society for Sports Medicine and the Arthroscopy Association of North America and is board certified from the American Board of Orthopedic Surgery.Learn more about Dr. Waits
Transcription:
Do You Suffer from Shoulder Pain?
Melanie Cole (Host): The shoulder has a wide and versatile range of motion. When something goes wrong with your shoulder, it can hamper your ability to move freely and it can cause a great deal of pain and discomfort. My guest today is Dr. Chad Waits. He's an orthopedic surgeon and sports medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Waits. So, let's talk about some of the things that can go wrong with this incredible joint that is the shoulder joint. What are some of the most common shoulder injuries that you see?
Dr. Chad Waits (Guest): Thank you for having me today. The shoulder, as you say, is a very complex joint. It affects so much of our lives and our activities. Some of the common things that we see, of course, are rotator cuff injuries; there's also shoulder arthritis that we see; shoulder dislocation; various traumas and things that can be injured, but, certainly, the more common things that we see would be issues that involve both the rotator cuff or arthritis of the shoulder.
Melanie: So, there are acute injuries and there's chronic, overuse-type injuries. Tell us about the rotator cuff. People don't know what it is, what it encompasses, and why, so often, people complain of rotator cuff problems.
Dr. Waits: Sure. It's always interesting, people talk about rotary cups and . . . [cross-talk]
Melanie: [cross-talk] I know, they always say “cups”.
Dr. Waits: So, the rotator cuff is a set of four muscles and tendons that attach to and surround the ball of the shoulder joint. Basically, they work together in order to keep the ball centered in the socket so that our larger muscles, such as the deltoid, can help to give power to the shoulder, but the different parts of the rotator cuff have different actions. Part of the rotator cuff helps to rotate the arm in, part of it helps to rotate the arm out and then, part of it helps to simply lift the arm. That portion of the rotator cuff is the portion that, by far, is the most commonly injured or affected.
Melanie: So, how is it most commonly injured or affected? Is this a chronic problem, maybe in an athlete? Baseball pitcher or golfers seem to suffer from this. Or, is this something that's kind of age-related, just everybody sort of gets rotator cuff problems as they get older?
Dr. Waits: There certainly is an age-related component to it. The vast majority of people that we're seeing with rotator cuff problems are over 40. Now, we certainly see groups of folks, depending on their occupation or recreation--the kind of things that they're doing. I mean I've repaired rotator cuff tears in 20 year-olds, but that's very, very rare in relation to the number of folks in their 50s and 60s with rotator cuff problems. So, there's definitely an age component to it. There are patients that tear their rotator cuffs with some specific type of activity-a fall or jerking motion, lifting something too heavy—but, more frequently, the tear is more of an over time, gradual sort of development. There's impingement in the shoulder. It’s kind of a phenomenon where there's an abrasive wear of the rotator cuff up against the roof of the shoulder and that can irritate and wear on that, much like a rope draped over the edge of a cliff that kind of rubs and frets and frays and over time develops enough tearing that it's a problem. So, in many cases, that's the way the rotator cuff problems develop, is more gradual, over time.
Melanie: Now, there are some symptoms, some kind of textbook symptoms. Please describe if somebody is feeling pain when they go to put on a coat or at night or something, and how they know it's a rotator cuff, and then, what would be the first line of defense?
Dr. Waits: There's a lot of overlap in symptoms related to rotator cuff or several other things. There are some characteristics. Typically rotator cuff problems affect people more as they are lifting the arm. The higher the arm is, the bigger of an issue it is. Most of the time, people talk about if they're doing things down with their arm at their side, kind of lower level stuff, it doesn't typically bother them nearly as much; whereas, reaching out in front of them or certainly up above shoulder level tends to be more bothersome. Weakness is also a common complaint. If they're trying to reach and lift, they'll oftentimes complain of some weakness. Now, a little bit of weakness can take place just with some tendonitis or early stages of inflammation of the rotator cuff, just the pain itself can make a person lift weaker, but certainly on our exam, when we look, if there's a more pronounced weakness with portions of the rotator cuff, that can be indicative of a problem. Many times, people will complain about they're unable to sleep on that side at night with the direct compression. That's another common complaint.
Melanie: Okay. So, then what? If somebody comes to you, they've got shoulder pain: icing, wrapping, bracing. What do we do as the first line of defense before we would ask for any kind of interventions?
Dr. Waits: Sure. Well, many times, I mean, if somebody comes in and they've truly done nothing yet then, in many cases, some level of anti-inflammatory medication will be prescribed, potentially a period of rest, sometimes some physical therapy to try to strengthen portions of it. Many of the times though, when I see patients, they've already been taking some ibuprofen for a while before they come in, they've already cut back on some of their activities, trying to rest it, and the pain has persisted, leading to the office encounter. So, we're usually kind of ramping up what we're doing. For me, in terms of determining what level of intervention we go to next is really largely based on the exam. If I see an exam that looks like they've still got pretty good motion, their strength seems to be reasonably maintained, they're just sore and painful in and around their rotator cuff, then many times, something like a steroid injection in the office can be enough to settle that down for a good, long while. If there's a more pronounced weakness right up front, then oftentimes, we will proceed with an MRI which allows me to get a good look at the rotator cuff tissue itself and see if there's a tear and, if so, to what degree is it torn? Is it partially torn? Is it a full thickness tear? How much of the rotator cuff does it involve? Those kinds of things are largely what dictate how we proceed. Now, that's also under the assumption that there's enough pain and symptoms. Sometimes I'll see patients that are 75 and really don't have much occasion to do a lot overhead and on the occasions that they do, it's a little sore, but they tolerate it well and if they've got a relatively small rotator cuff, they might do well with that. But, patients that are higher demand, wanting, needing, expecting more out of their shoulder, sometimes even a small rotator cuff tear is something that we ought to operate on and it's really tailored to an individual patient and their exam and their level of discomfort.
Melanie: Does it ever heal itself?
Dr. Waits: It can. With a partial thickness tear, there's a thickness to the substance of the rotator cuff and much like the rope draped over the cliff that I described earlier, when that starts to fret and fray and snarl a little bit, but the overall bulk of the tendon substance is still attached, then that's something that can heal, if we can give it enough opportunity for the inflammation to settle down, modify some of those activities. Now, there are obstacles to that healing. Some patients develop spurring, arthritis around their collarbone joint and various things that can lead to less space for the rotator cuff and more of that abrasive wear that can contribute to rotator cuff tears. So, for those patients, if I see somebody with a little partial thickness tear and good space around the rotator cuff, then I'm a lot more optimistic for that to heal on its own. If they've got significant pinch points and spurring and so on that's digging into their rotator cuff, then the likelihood of being able to get the rotator cuff to heal in that setting is far more limited.
Melanie: So, in just the last few minutes, Dr. Waits, because we really could talk about this for a very long time and do just a whole segment on the surgical interventions, give your best advice for people suffering from shoulder pain, what you really want them to know, and why they should come to Hendricks Regional Health for their care?
Dr. Waits: I'm a pretty conservative guy when it comes to surgical interventions in most of the things that we're dealing with. I've never twisted an arm for someone to have a surgery that it didn't bother them, but, at the same time, most of the folks that I'm seeing are there because of some degree of discomfort. There are certainly risks with surgery, and so we take those into account and consideration, whenever we're dealing with individual patients and what the remainder of their health status is. Really, it's twofold. I think even more so with the shoulder than some of the other joints that we deal with, not only is the pain a big part of what drives the level of intervention that we do, but also the level of function. We're just so dependent on our arms and shoulders and we might be using our hand, but our shoulder is needed to get our hand wherever it needs to be in space, and so that combination of pain and dysfunction is ultimately what pushes us down the path for the intervention that we're doing. The vast, vast majority of the rotator cuff--almost all the rotator cuff work that we do--I do arthroscopically, so little, small incisions as opposed to larger, open types of incisions. We're still doing the same work on the inside, but the less trauma that we can cause to the muscles surrounding the shoulder and just the less soft tissue trauma that we can cause, not only do people feel better quicker, but the overall recovery is certainly improved, as well. My fellowship training subsequent to my orthopedics training, the bulk of that time was centered around the shoulder and so I feel confident in the things that we're accustomed to seeing with regards to shoulder pain and dealing with that.
Melanie: Thank you so much, Dr. Waits, for being with us today. What great information. You're listening to Health Talks with HRH, and for more information, you can go to hendricks.org. That's hendricks.org. This is Melanie Cole. Thanks so much for listening.
Do You Suffer from Shoulder Pain?
Melanie Cole (Host): The shoulder has a wide and versatile range of motion. When something goes wrong with your shoulder, it can hamper your ability to move freely and it can cause a great deal of pain and discomfort. My guest today is Dr. Chad Waits. He's an orthopedic surgeon and sports medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Waits. So, let's talk about some of the things that can go wrong with this incredible joint that is the shoulder joint. What are some of the most common shoulder injuries that you see?
Dr. Chad Waits (Guest): Thank you for having me today. The shoulder, as you say, is a very complex joint. It affects so much of our lives and our activities. Some of the common things that we see, of course, are rotator cuff injuries; there's also shoulder arthritis that we see; shoulder dislocation; various traumas and things that can be injured, but, certainly, the more common things that we see would be issues that involve both the rotator cuff or arthritis of the shoulder.
Melanie: So, there are acute injuries and there's chronic, overuse-type injuries. Tell us about the rotator cuff. People don't know what it is, what it encompasses, and why, so often, people complain of rotator cuff problems.
Dr. Waits: Sure. It's always interesting, people talk about rotary cups and . . . [cross-talk]
Melanie: [cross-talk] I know, they always say “cups”.
Dr. Waits: So, the rotator cuff is a set of four muscles and tendons that attach to and surround the ball of the shoulder joint. Basically, they work together in order to keep the ball centered in the socket so that our larger muscles, such as the deltoid, can help to give power to the shoulder, but the different parts of the rotator cuff have different actions. Part of the rotator cuff helps to rotate the arm in, part of it helps to rotate the arm out and then, part of it helps to simply lift the arm. That portion of the rotator cuff is the portion that, by far, is the most commonly injured or affected.
Melanie: So, how is it most commonly injured or affected? Is this a chronic problem, maybe in an athlete? Baseball pitcher or golfers seem to suffer from this. Or, is this something that's kind of age-related, just everybody sort of gets rotator cuff problems as they get older?
Dr. Waits: There certainly is an age-related component to it. The vast majority of people that we're seeing with rotator cuff problems are over 40. Now, we certainly see groups of folks, depending on their occupation or recreation--the kind of things that they're doing. I mean I've repaired rotator cuff tears in 20 year-olds, but that's very, very rare in relation to the number of folks in their 50s and 60s with rotator cuff problems. So, there's definitely an age component to it. There are patients that tear their rotator cuffs with some specific type of activity-a fall or jerking motion, lifting something too heavy—but, more frequently, the tear is more of an over time, gradual sort of development. There's impingement in the shoulder. It’s kind of a phenomenon where there's an abrasive wear of the rotator cuff up against the roof of the shoulder and that can irritate and wear on that, much like a rope draped over the edge of a cliff that kind of rubs and frets and frays and over time develops enough tearing that it's a problem. So, in many cases, that's the way the rotator cuff problems develop, is more gradual, over time.
Melanie: Now, there are some symptoms, some kind of textbook symptoms. Please describe if somebody is feeling pain when they go to put on a coat or at night or something, and how they know it's a rotator cuff, and then, what would be the first line of defense?
Dr. Waits: There's a lot of overlap in symptoms related to rotator cuff or several other things. There are some characteristics. Typically rotator cuff problems affect people more as they are lifting the arm. The higher the arm is, the bigger of an issue it is. Most of the time, people talk about if they're doing things down with their arm at their side, kind of lower level stuff, it doesn't typically bother them nearly as much; whereas, reaching out in front of them or certainly up above shoulder level tends to be more bothersome. Weakness is also a common complaint. If they're trying to reach and lift, they'll oftentimes complain of some weakness. Now, a little bit of weakness can take place just with some tendonitis or early stages of inflammation of the rotator cuff, just the pain itself can make a person lift weaker, but certainly on our exam, when we look, if there's a more pronounced weakness with portions of the rotator cuff, that can be indicative of a problem. Many times, people will complain about they're unable to sleep on that side at night with the direct compression. That's another common complaint.
Melanie: Okay. So, then what? If somebody comes to you, they've got shoulder pain: icing, wrapping, bracing. What do we do as the first line of defense before we would ask for any kind of interventions?
Dr. Waits: Sure. Well, many times, I mean, if somebody comes in and they've truly done nothing yet then, in many cases, some level of anti-inflammatory medication will be prescribed, potentially a period of rest, sometimes some physical therapy to try to strengthen portions of it. Many of the times though, when I see patients, they've already been taking some ibuprofen for a while before they come in, they've already cut back on some of their activities, trying to rest it, and the pain has persisted, leading to the office encounter. So, we're usually kind of ramping up what we're doing. For me, in terms of determining what level of intervention we go to next is really largely based on the exam. If I see an exam that looks like they've still got pretty good motion, their strength seems to be reasonably maintained, they're just sore and painful in and around their rotator cuff, then many times, something like a steroid injection in the office can be enough to settle that down for a good, long while. If there's a more pronounced weakness right up front, then oftentimes, we will proceed with an MRI which allows me to get a good look at the rotator cuff tissue itself and see if there's a tear and, if so, to what degree is it torn? Is it partially torn? Is it a full thickness tear? How much of the rotator cuff does it involve? Those kinds of things are largely what dictate how we proceed. Now, that's also under the assumption that there's enough pain and symptoms. Sometimes I'll see patients that are 75 and really don't have much occasion to do a lot overhead and on the occasions that they do, it's a little sore, but they tolerate it well and if they've got a relatively small rotator cuff, they might do well with that. But, patients that are higher demand, wanting, needing, expecting more out of their shoulder, sometimes even a small rotator cuff tear is something that we ought to operate on and it's really tailored to an individual patient and their exam and their level of discomfort.
Melanie: Does it ever heal itself?
Dr. Waits: It can. With a partial thickness tear, there's a thickness to the substance of the rotator cuff and much like the rope draped over the cliff that I described earlier, when that starts to fret and fray and snarl a little bit, but the overall bulk of the tendon substance is still attached, then that's something that can heal, if we can give it enough opportunity for the inflammation to settle down, modify some of those activities. Now, there are obstacles to that healing. Some patients develop spurring, arthritis around their collarbone joint and various things that can lead to less space for the rotator cuff and more of that abrasive wear that can contribute to rotator cuff tears. So, for those patients, if I see somebody with a little partial thickness tear and good space around the rotator cuff, then I'm a lot more optimistic for that to heal on its own. If they've got significant pinch points and spurring and so on that's digging into their rotator cuff, then the likelihood of being able to get the rotator cuff to heal in that setting is far more limited.
Melanie: So, in just the last few minutes, Dr. Waits, because we really could talk about this for a very long time and do just a whole segment on the surgical interventions, give your best advice for people suffering from shoulder pain, what you really want them to know, and why they should come to Hendricks Regional Health for their care?
Dr. Waits: I'm a pretty conservative guy when it comes to surgical interventions in most of the things that we're dealing with. I've never twisted an arm for someone to have a surgery that it didn't bother them, but, at the same time, most of the folks that I'm seeing are there because of some degree of discomfort. There are certainly risks with surgery, and so we take those into account and consideration, whenever we're dealing with individual patients and what the remainder of their health status is. Really, it's twofold. I think even more so with the shoulder than some of the other joints that we deal with, not only is the pain a big part of what drives the level of intervention that we do, but also the level of function. We're just so dependent on our arms and shoulders and we might be using our hand, but our shoulder is needed to get our hand wherever it needs to be in space, and so that combination of pain and dysfunction is ultimately what pushes us down the path for the intervention that we're doing. The vast, vast majority of the rotator cuff--almost all the rotator cuff work that we do--I do arthroscopically, so little, small incisions as opposed to larger, open types of incisions. We're still doing the same work on the inside, but the less trauma that we can cause to the muscles surrounding the shoulder and just the less soft tissue trauma that we can cause, not only do people feel better quicker, but the overall recovery is certainly improved, as well. My fellowship training subsequent to my orthopedics training, the bulk of that time was centered around the shoulder and so I feel confident in the things that we're accustomed to seeing with regards to shoulder pain and dealing with that.
Melanie: Thank you so much, Dr. Waits, for being with us today. What great information. You're listening to Health Talks with HRH, and for more information, you can go to hendricks.org. That's hendricks.org. This is Melanie Cole. Thanks so much for listening.