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Walter....
Without an
actual examination and looking at your x-rays I can't be certain of the exact
diagnosis.
If it is as
stated, then I think you have been given good advice already by your doctor as
well as the physical therapist.
Not all of
these shoulder problems get better. Of course the very LAST resort is
surgery. I wouldn't consider that unless all else fails and there is a
definite surgical target such as a degenerated and torn rotator
cuff.
A degenerated
cuff doesn't show up well on any study other than an MRI coupled with an
arthrogram. That is done with an injection of contrast material into the
shoulder joint which outlines the soft tissues including cartilage . These
injured tissues usually don't appear on a standard plane radiograph.
Magnetic resonance studies show these soft tissues well.
The advice
you were given is OK even if you do have a rotator cuff degeneration, at this
stage of the game.
The rotator
cuff is a conjoint tendon made up of three major muscles which go from the
shoulder blade to the upper/outer edge of the humerus bone right at the, "tip"
of the shoulder. These muscles act in unison to turn the arm and to abduct
the shoulder joint.
If actually
torn, the cuff can be repaired in most cases with arthroscopic
surgery.
A complete
tear is not common as a result of degeneration. If you had that, you would
not be able to raise your arm up and out to the side.
Sometimes
shoulder pain can be referred pain from a pinched nerve in the neck. The
fact that your nerve/neck pain left after treatment is evidence that that is not
the problem you are having now, but it doesn't entirely rule it out.
Rarely does this require surgery. I've had many patients who have
recovered from that with shoulder shrugging exercises.
For most of
these problems, we often prescribe a specific set of non- resistive shoulder
exercises including rotating pendulum exercise and, "wall climbing" abduction
exercises. Your therapist will know exactly what these are.
These maneuvers help prevent a major complication called frozen shoulder
syndrome.
Best,
Gordy
Gordy -
On a
personal note I just want to pick your brain a bit. I'm not looking for
treatment advice but due to your
background
I thought you might have a deeper knowledge of treatment options than my
family doctor. He's
quite good but somewhat
busy and orthopedics is not his area of
expertise.
The
background on my shoulder is that I've had recurring problems for several
years starting when I was
a
competitive weight lifter as a teenager. In recent years I've had chiropractic
treatment a number times
because
the pain in the shoulder was compounded with neck pain. The chiropractic
treatment was
quite
effective on the neck pain and as a result my shoulder pain would also be
reduced.
Xrays of
my shoulder taken a couple of weeks ago show that I have some buildup (of
bone?) on the end
of my
collar bone which leads to irritation of the surrounding tissue when I'm
performing overhead movements
such as
presses and casting. This has manifested as tendonitis in the nerve from my
shoulder to my
bicep and
inflammation of surrounding tissue.
At this
point I've continued the chiropractic treatement even though it does nothing
directly for my shoulder it does
improve
flexibility in my neck and back. Massage therapy has brought some relief to
the shoulder.
Since the
xrays my doctor has prescribed novo-naproxyn which also provides some relief.
I've also been to a
physiotherapist, which seems to be the most promising thing so far
- specific massage to the area,
ultrasound,
muscle
activation, exercises targetting the shoulder area, work on posture. The
physiotherapist tells me that
full
recovery could be several weeks and also that there is probably a fair amount
of scar tissue built up
over the
years - all of which seems logical to
me.
My
question to you is - are there other possible forms of treatment that could
help in recovery and to prevent
further
injury? I'm not a candidate for surgery and I'm willing to accept that
complete recovery could take
several
weeks or even months. What I'm mostly concerned about is ensuring that I've
looked at every
reasonable
option to get maximum recovery and to prevent recurrence. At my age (54) I
realize that my
body's
natural healing processes are only going to get slower so I want to make sure
I do it right this time.
Any
information you could provide on viable treatment options would be greatly
appreciated. Again, I'm not
looking
for specific recommendations because I realize you would require a lot more
information and actual
examination for that. I'm just looking for information on treatment
options and, if you are comfortable
with it,
some of your personal observations regarding the effectiveness of the
options.
Thanks in
advance!
Walter
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