Stemcelldoc's Weblog

October 12, 2011

When in Doubt, Cut it Out

Patients are seeking alternatives to shoulder replacement surgery with increasing frequency.  Patients are concerned with complicationsdeath and signficant downtime associated with shoulder replacements. 

The shoulder is a complex joint composed of tendons, ligaments, muscles and cartilage on the articulating surfaces.  Pain can arise from any or all of these structures.  At the Centeno-Schultz Clinic we are committed to identifying the principal source of pain in patients so a successful treatment regimen can be implemented.  Regrettably this is a universal practice.  DS is a case in point.

DS is an active 62 y/o rancher who sought a second opinion.  He had a 6 month history of left shoulder pain which was constant in duration, progressive in duration, principally located in the posterior shoulder without any radiations.  Aggravating factors including lifting whereas alleviating factors included rest and sleep.  DS had been evaluated by a surgeon and was identified as a suitable candidate for total shoulder replacement. DS had not undergone any conservative to date: no physical therapy, massage or myofasical deactivation.  X-ray was signficant for narrowing of the joint space.

DS and I were concerned that no conservative therapy had been undertaken.  Additionally the only study to date was an x-ray which examines bone and does not evaluate tendon, ligament or cartilage.  An MRI was ordered which was signficant for severe tendinosis of two of the rotator cuff tendons and arthritis of the shoulder joint.  DS declined the replacement and underwent two MSK US guided injections into the rotator cuff tendons and reports 65% improvement to date.  He is scheduled for additional treatment but remains active on his ranch without signficant limitations. 

Bottom Line:  Pain can arise from many different structures and can often times be treated successfully with non surgical regenerative treatments.

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