On Tuesday Evening, November 15, Navigating the Medical System featured Dr. Kevin Jang, orthopedic surgeon at the NewYork-Presbyterian Queens Hospital and assistant professor of clinical orthopedic surgery at Weill Cornell Medical Center, on the topic of common shoulder injuries diagnosis and treatment. The virtual session was hosted by Congregation Etz Chaim.
Dr. Mel Breite, Director and Founder of the lecture series, introduced the program. Dr. Jang began with an illustration and explanation of the basic biology of the shoulder. He explained that the shoulder has lots of ligaments and soft tissue to keep it in place and so it doesn’t dislocate. The shoulder joint has a capsule surrounding it that gives it stability and keeps the joint fluid within it. The rotator cuff muscles surround the shoulder and help it move in many directions.
Dr. Jang taught that the most important aspect of diagnosis for a shoulder injury is the history and the physical exam, and that 80-90 percent of the time the physician can diagnosis what part is injured from these two things. X-rays help determine if there is a fracture or arthritis or a misalignment. An MRI shows if muscles or tendons or ligaments are injured. He said that treatment options include rest from aggravating the shoulder, anti-inflammatories, physical therapy, injections like corticosteroid, viscos supplementation injections, and platelet injection. The last option is surgery. Arthroscopic surgery is recommended when conservative treatment fails.
Comon shoulder injuries include frozen shoulder, rotator cuff injuries, shoulder osteoarthritis, and rotator cuff arthritis.
One of the most common injuries is frozen shoulder, which occurs usually between ages 40-60. It has a slow onset and it’s painful and stiff. This is associated with diabetes, thyroid, kidney, and heart problems. Diagnosis for frozen shoulder includes taking the patient’s history to see if there was a slow onset of pain with no injury. Also, there is a loss of both passive and active motion. Passive motion means that another person can’t move it for the patient, and active motion means he can’t move it himself. If there is stiffness when the patient tries to move it and when someone else tries to move it, this is a sign of frozen shoulder. With frozen shoulder, there is no change in strength. The patient can’t reach out. An x-ray and MRI are usually key in the treatment of a frozen shoulder. Daily physical therapy and stretching exercises help. Also, intraarticular steroid injection given two times can help. Surgery is needed if there is no improvement. Dr. Jang recommends receiving the steroid injection right away if the diagnosis is frozen shoulder.
Next, he showed a video of the types of exercise you can do to stretch your shoulder and to restore range of motion.
Then, he spoke about shoulder dislocation. It can self-reduce if the patient relaxes. However, the dislocation can be a recurring issue. The diagnosis includes a physical exam. The patient can’t move his shoulder and he may have apprehension, which means he is afraid it will happen again. An x-ray or MRI will help the physician search for labral tears. Treatment for recurring shoulder dislocation includes arthroscopic repair of the labrum. If you have just one dislocation, then you can try physical therapy. Multiple dislocations require surgery.
After this, he spoke about rotator cuff injuries. Rotator cuff includes deep muscles that help move the arm. Tendinitis and bursitis cause pain at night when you lie down.
For tendinitis, the treatment is to strengthen the rotator cuff with physical therapy. Also, anti-inflammatory injections of corticosteroids can help, but you shouldn’t have more than two of these injections. More than two to this same area would not be good for the tendon. There are two types of rotator cuff injuries. The rotator cuff traumatic is due to a fall or injury. Rotator cuff atraumatic just develops over time.
If a rotator cuff tears, there is weakness and difficulty lifting the arm. The patient needs an MRI to see if there is partial or full thickness of a tear. Traumatic needs to be repaired. Atraumatic can be treated conservatively. An unrepaired rotator cuff can lead to arthritis, muscle atrophy, and inability to lift the arm. Treatment to reverse this is shoulder replacement with a metal implant. The rotator cuff problems can occur because of normal wear and tear for people who do a lot of lifting, like construction workers. The constant lifting wears down the cartilage. Cortisone injections and physical therapy can help. If this doesn’t help, then anatomic shoulder replacement with metal and plastic will correct it.
He shared that zero percent of shoulder injuries improve with rest, physical therapy, and anti-inflammatories. Try to avoid unnecessary MRIs. Surgery should be an option only when conservative treatments failed.
This informative, comprehensive talk was followed by a lively Q&A session.
Thank you, Dr. Breite, Etz Chaim, and NewYork-Presbyterian for these informative, helpful lectures.
By Susie Garber