The number of patients presenting with shoulder-generated complaints has dramatically increased in the past several months. Some complaints follow a single trauma, while others are the result of cumulative injury. Then there is osteoarthritis, inflammatory arthritis, and causation by metabolic disorders; and as in any joint, there is the possibility of a congenital predisposition.
When the patient presents to me with a chief complaint related to the shoulder, my initial focus is to make sure the symptoms are not referred from a cervical spine abnormality. Then a health assessment adds information about possible metabolic disorders and inflammatory causation. Once the examination of the neck is completed, my attention is directed to the shoulder. A visual inspection allows me to determine if there is muscle atrophy, both front and back. The physical examination includes a determination of whether adhesive capsulitis is playing a role or whether the range of shoulder motion has been limited by the underlying pathology within the shoulder. Manual muscle testing helps determine whether the problem is basically symptom-generating or function-limiting. There are several standard examination techniques available to help narrow the possible causes resulting in pain and altered shoulder function. A simple tape measure allows for the measurement of arm and forearm atrophy. The final information that helps to determine if the shoulder impairment is joint, muscle, tendon, or bone based is the X-ray. If the latter is “negative”, an MRI is indicated.
As far as treatment is concerned, the recommendation is based on the diagnosis. In most instances, physical therapy is the starting point. At times, a one-time steroid injection may be prescribed; I emphasize, it only once. In general, at reevaluation, a review of the initial assessment, and a review of imaging will allow me to determine if the problem is the rotator cuff or osteoarthritis. Treatment modalities after Physical Therapy include Micro-fractured adipose tissue (fat recovered by an office-based mini-liposuction containing stem cells and Growth Factor Proteins) for rotator cuff abnormality and Bone Marrow Concentrate (containing stem cells and Growth Factor Proteins) for osteoarthritis, and patient outcomes will be measured.
My disclaimer, the aforementioned is a general overview of shoulder-generated symptoms and altered function. As described, there are many possible causes contributing to shoulder disease. In the same way, there are many potential treatment options ranging from surgery when indicated to using a needle instead of a knife. Only an office visit and review of imaging will allow me to make an evidence-based recommendation for care; and only after informed consent from the patient will the two of us make the definitive decision for the best treatment option.
To learn more, visit my website at www.sheinkopmd.com. To schedule a consultation call (312) 475-1893.