Gabby Cinnamon (Host): Welcome back to the Well Within Reach podcast. I'm your host, Gabby Cinnamon. And today, I'm very excited to be joined by Danielle Valentino, an orthopedic nurse practitioner at the Riverside Orthopedic and Spine Center to talk about shoulder pain and treatment options. Thank you so much for coming on the podcast, Danielle.

Danielle Valentino: Hi, everybody. I'm happy to be here. Thank you for having me.

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Host: So, this is your first episode with us. Can you tell us a little about yourself, your background, your training, all that good stuff?

Danielle Valentino: So, my name is Danielle Valentino. I am a nurse practitioner in Orthopedic Surgery. I have a doctoral training. I received my degree from Loyola University. I have about five years in Orthopedic experience. And for the previous four years prior to joining Riverside's Orthopedic Specialty Team, I worked at Midwest Orthopedics at Rush.

Host: So, our topic today is shoulder pain. What are some common causes that you see in the clinic of shoulder pain?

Danielle Valentino: So, most of the common causes of shoulder pain that we see in our patient populations are obviously fractures, people come in with an injury. There's a lot of osteoarthritis that we see, a lot of shoulder instability. And a lot of patients present with tendon inflammation which, or tendon tears, which we call a bursitis or tendinitis.

Host: Oh, that sounds very painful.

Danielle Valentino: Very painful.

Host: Can you explain the difference between certain shoulder conditions like rotator cuff tears, shoulder impingement, kind of the other ones that you talked about? I think sometimes, you know, people are like, "Oh, my shoulder hurts," and they're really not sure what it is. And they might not find out obviously until they come and see someone like you. But can you kind of talk about those differences for maybe someone who is experiencing shoulder pain?

Danielle Valentino: Right. So when patients come in, they're complaining of shoulder pain. It can be non-specific. If we're targeting such pathology as rotator cuff disease or shoulder impingement, when we start with the rotator cuff disease, it's a broad term that really encompasses different manifestations of rotator cuff pathology, so it can range from like a partial rotator cuff tear or a full thickness tear. Sometimes, people can have cuff tendinitis, which is inflammation of the rotator cuff itself, or a condition that's called calcific tendinitis, where calcium deposits actually form on the rotator cuff. There are actually four muscles that make up the rotator cuff. There's the subscapularis, the teres minor, the supraspinatus, and the infraspinatus. And these muscles are important for stabilizing the shoulder and providing certain shoulder movements. So, rotator cuff tears are a very common source of shoulder pain. And that usually manifest as, "Oh, I have this pain in my shoulder or decreased motion where a patient might come in and say, "You know, I used to be able to reach my top cabinet. And now, I can only reach like to the sink to fill up water. What's going on?" And these injuries can be traumatic, like somebody got an accident or was jutted in the shoulder. Or they can be degenerative like in elderly patients, a lot of times patients will have severe osteoarthritis in the shoulder. And over time, that will degenerate the rotator cuff.

Host: Are there certain genetic risk factors or activities that increase your risk of developing a shoulder condition? I know you mentioned older adults can develop these issues, but is anyone else more predisposed to that?

Danielle Valentino: So, there are genetic individuals that may inherit traits such as collagen structure abnormalities and variations in bone sizes and shapes or muscle fiber compositions that predispose them to injuries, like dislocations and rotator cuff tears or degenerative shoulder disease. A lot of the patients that come in that have rotator cuff injuries, usually those are the younger athletes or sometimes it's those weekend warriors, like middle-aged people that don't really work out during the week and they go out on the weekend and they get like all of their exercise in in two days and then they come in with like, you know, an injured shoulder. So, we see those things a lot too.

Host: So, let's say someone listening is an athlete, weekend warrior, and they are doing these activities. I kind of think of like pitching or swinging things, that kind of thing. They still want to do these activities. How can they prevent these shoulder issues from happening while still enjoying those activities?

Danielle Valentino: Some of the things that we recommend, first and foremost is stretching. A lot of people don't stretch. They go out and do these activities. They're not stretching, the athletes, strengthening the muscles in the shoulder to make sure that they're all working properly. When something is aggravating your shoulder refraining from that aggravating agent is the most important thing. And a lot of times, that's what people find the hardest because they they're pitchers or, you know, paid basketball players. They're like, "Well, I want to keep doing that," and don't understand that you have to rest that because, you know inflammation in the joint can persist for several weeks and it can be painful.

So, we have them do those things. Simple rest, over-the-counter medications, topicals, anti-inflammatories. Sometimes, we'll recommend something that has lidocaine in it, like a Salonpas gel or patch. And then, if all else fails, we don't really like doing this in younger athletes, but sometimes we'll consider shoulder injection with an interarticular steroid.

Host: We're going to take a quick break to talk about primary care at Riverside.

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Now, back to our episode with Danielle. So, you mentioned less invasive treatments, like lidocaine, anti-inflammatories. Can you talk about, you know, what treatment options are available for patients that aren't surgery? You know, maybe like, "Hey, the Tylenol wasn't working or these other options weren't working." What should someone expect?

Danielle Valentino: So, in non-surgical treatment, we aim at anti-inflammatories, rest, avoiding aggravating activities. And then, we will send them to physical therapy to work on stretching and straightening exercises of the rotator cuff. If a patient is a surgical candidate, then those treatments do vary. It really depends on where the tear is, the type of tear, whether it's full, whether it's partial, whether or not it can be repaired or atheroscopically cleaned up. Or sometimes, if it's a bad enough tear and they have terrible arthritis, then those are fixed with like a reverse total shoulder replacement. So, it's not a straightforward answer for anybody out there who has shoulder pain. But most times, when somebody comes in with an acute shoulder injury, the first thing that we always do is have them rest, shut that shoulder down, anti-inflammatories, ice, physical therapy. So, that's what most people can expect when they first come to see us.

Host: And kind of like what you just talked about, every person is different. But you know, let's say someone goes through a round of physical therapy and they've been taking some anti-inflammatories and resting their shoulder and, you know, it's just not helping. When would surgery be recommended for that person? At what point?

Danielle Valentino: So if we send somebody to physical therapy and we're taking them down the road of conservative treatment and it's been six weeks, eight weeks, 12 weeks. Anytime about a couple months later if it's ineffective, then we'll start looking at advanced imaging such as an MRI, possibly a CT scan and then see what that shows. If it shows some kind of pathology that we could go in and clean up arthroscopically, then we would schedule them for an arthroscopic procedure.

Host: So, what does a shoulder surgery entail? You kind of mentioned some different options. You kind of talk about too the recovery process for those surgical options.

Danielle Valentino: So, it depends on the type of surgery that the patient undergoes. If it is an arthroscopic procedure, then typically a patient will go under general anesthesia. In some cases, we do a nerve block just to give them some relief of that limb. In some cases, we don't do a nerve block. Then, the surgeon will make little incisions or cuts in four different parts of the shoulder, sometimes five. And then, he will insert a camera that shows images of the shoulder that are projected on a video screen. And then, he uses these images to find what problem is going on in the shoulder and then uses the other incision sites to insert little tiny instruments to perhaps either clean up the area that's in the shoulder or possibly repair something if it's torn in the shoulder, if they're a candidate for that. And then, the incisions are closed with stitches that we remove two weeks later. We place a waterproof dressing on that the patient will keep on for a couple weeks until they see us for followup. And then, we do let them shower the night of surgery because they have that waterproof dressing. Depending on the arthroscopic procedure, most patients will go home with a sling. But if nothing is repaired and the joint is just cleaned up, as we say arthroscopically, then we let them start moving fairly quickly. If they have some kind of repair, like a rotator cuff repair or any other repair of ligamentous structure inside the joint of the shoulder, then they're in a sling and you're looking at about a 12-week recovery period, depending on what exactly was repaired.

Host: You touched on this earlier. But when should someone seek professional help if they have shoulder pain? I think you know, we all tend to, "Oh, it's been bothering me for a couple of weeks. It'll probably go away on its own." When should someone be like, "Maybe this is not going away on its own"?

Danielle Valentino: If you're at home and it's been two or three weeks and you're still having this terrible pain, you're trying over-the-counter treatments, you're trying ice, you're trying to rest it, it's not getting any better, or if ever it's accompanied by like weakness or numbness, red flags, then you need to call your orthopedic provider and get an evaluation.

Host: Right. And I think too, unfortunately, the longer you wait and if you're not resting, it just gets worse. And you're only making things worse for yourself, unfortunately.

Danielle Valentino: It does, because especially if it's something that's inflammatory, it just doesn't calm down. Like, I tell patients all the time, "If you pick up a gallon of milk, and you're moving your arm back and forth, and pumping that gallon of milk, like you were lifting weights, and you did it a hundred times, your arm's going to be pretty sore, right?" And they're all like, "Yes." And I said, "Well, that's what happens when you hurt that affected joint, and you just keep using it. You're not letting it rest, so it's not calming down."

Host: Yeah. I know that makes sense. How can a listener schedule an appointment with an orthopedic specialist to get to the bottom of their shoulder pain if it's been, you know, bugging them for a little bit?

Danielle Valentino: So, if they're already an established patient, they can schedule through myChart or you can call Riverside at 815-802-7090.

Host: Before we go today, is there anything else you would like to add?

Danielle Valentino: I would just encourage people, if they have any questions or concerns about one of their joints, to come in sooner rather than later because if there's something underlying that is a simple fix, then we can evaluate them and hopefully successfully treat them and get them moving right away versus if there is some kind of underlying tear and they wait, you know, we can go from something that's very simple, that's conservative treatment to something that progresses to surgical treatment. It's always better to avoid surgery if you can at all costs.

Host: That is great advice. I think that's all we have for today. Thank you so much, Danielle, for coming.

Danielle Valentino: Thank you, ladies. It's very nice to be here.

Host: And thank you listeners for tuning in to Well Within Reach, brought to you by Riverside Healthcare. To learn more about orthopedics at Riverside, visit riversidehealthcare.org. Also, make sure to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you listen to podcasts.