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Posted June 22, 2022 by Ryan Urchek, M.D.
Listen to this episode of the Healthy Vitals Podcast.
Dr. Ryan Urchek gives an overview of shoulder pain from common causes, injuries, and treatment options.
Ryan Urchek, M.D.
A native of Warren, OH, Ryan J. Urchek, M.D., is a fellowship-trained orthopedic surgeon who specializes in shoulder, knee, elbow, sports medicine and arthroscopic surgery. His robust areas of interest include rotator cuff tendon tears, rotator cuff tendinitis, shoulder impingement, shoulder instability and dislocation, labral tears, bicep tears, tricep tears, pec tears, AC joint pain, frozen shoulder, cartilage injuries, acl tears, meniscus tears, ligament injuries, knee instability, shoulder pain, knee pain, and elbow pain. Dr. Urchek completed his undergraduate studies and obtained his medical degree from The Ohio State University. After graduating from Summa Health’s orthopedic surgery residency program, he pursued fellowship training in sports medicine at Emory University in Atlanta, GA. His experience included caring for athletes at Georgia Tech, as well as working with the Atlanta Falcons. In his free time, Dr. Urchek enjoys spending time with his wife and three children, barbecuing and Cleveland sports.
Scott Webb: Shoulder pain and injuries can resolve from landing and hitting in sports. And they can also, you know, just sort of happen. And in either event, it's good that we have experts like my guest today to help with these injuries. And I'm joined today by Dr. Ryan Urchek. He's an orthopedic surgeon who specializes in sports medicine with Summa Health.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So doctor, thanks so much for your time today. I was thinking about this topic and thinking, you know, most of us probably have had some shoulder pain along the way, whether it just sort of happens while you're maybe shampooing in the shower or playing sports or whatever it is. So it's great to have your advice. And as we get rolling here, who typically experiences shoulder pain?
Dr. Ryan Urchek: So unfortunately, shoulder pain can happen just with our normal day activities. In general, patients with labor-intensive activities are more prone to shoulder injuries, or just repeated everyday use of your shoulders. In general, older patients are prone to rotator cuff injuries of the tendons and the shoulder. And in younger patients, typically they injure their labrum or biceps, which is cartilage in the shoulders that helps keep their shoulder stable.
Scott Webb: Yeah. And I've been surprised to hear that before. I think of rotator cuff as being a younger sports injury, but I've heard that before that, generally, it seems to be older folks who get that. And of course, both of my kids were athletes, so I was always worried about the labrum, you know, and that type of injury for them. So let's talk more about that when we think about the specific sort of activities or sports that are the sort of causes of the shoulder pain that you see.
Dr. Ryan Urchek: Yeah. Typically, overhead athletes like baseball pitchers or volleyball players are more prone to the chronic injuries in the shoulder, and that could include the rotator cuff. But thankfully, that's more a tendonitis or overuse rather than a true tear. And then certainly, your contact sports such as lacrosse or football, where patients or athletes are landing on their shoulders or hitting each other, they're prone to the shoulder dislocations, which typically injure the labrum like you talked about.
Scott Webb: Yeah, the landing and the hitting is definitely one of the culprits there. So let's talk about "normal shoulder pain," right? So if you're not landing and hitting and, you know, throwing a baseball at 90 miles an hour, what's normal for us? And maybe, what's the duration of those types of injuries?
Dr. Ryan Urchek: Yeah, that's a good question. Unfortunately, almost all of us will probably experience some sort of shoulder pain over the years. Any sort of pain that could be from maybe gardening or shoveling snow or raking leaves is typical and can be normal. That may last anywhere from a week to three weeks in general. And typically, it's better once you avoid the activities that caused it in the first place. And then you can always add some anti-inflammatory medications, like Aleve or ibuprofen, and rest.
Scott Webb: You know, it occurs to me I've always been telling my kids, you know, to stretch. Whatever sports they were playing, "Oh, make sure you stretch." "Yeah right, dad. Sure." But dad doesn't really stretch before I go shoveling snow, some of these things you're talking about, the daily activities. Would that help us to avoid these types of injuries?
Dr. Ryan Urchek: Yeah, it certainly would. As we get older, we know that patients again can get rotator cuff tendon tears just from living their life and as we get older. So one of the main treatments for those kinds of patients would be a home exercise program where a physical therapist, or we even give patients information about strengthening their rotator cuff. And I tell patients and even encourage them to do a home exercise program, meaning even if they feel like they're a hundred percent, even if they're feeling really well, maybe two to three times a week, do a little shoulder program for 10 to 20 minutes and certainly do it before raking the leaves or shoveling snow as we get older.
I see a lot of patients in my office, even after they've completed a formal physical therapy or even a rotator cuff surgery. Unfortunately, I tell them once they have shoulder issues, they kind of always have shoulder issues. So I always encourage those patients to keep up with their home maintenance program and encourage them to do that for the rest of their life. And usually those patients are the ones that say, "Yeah. You know what? My shoulder pain doesn't hurt as much anymore when I rake the leaves and shovel snow," and they notice that really does help them.
Scott Webb: Yeah, definitely some benefits. Like I hurt my left shoulder at some point. I don't know, coaching sports with my kids or whatever I was doing a few years ago. And, as you say, like once you have a shoulder issue, you kind of always do and maybe unless you, you know, really want to have surgery or something like that.
So I think my natural followup here is when should we see a doctor? So let's say we're raking leaves or whatever we're doing. And we have that shoulder pain and we tried some OTCs to relieve the pain and maybe it doesn't go away, you know, in a timely fashion. So at what point do we say, "You know what? I don't think this one's going to work itself out." I'm actually making that motion right now. I don't know why I'm doing that for you, but I'm sort of rotating my shoulder. You know how that is like? "You know, this one's not going to go away." So when should we maybe seek someone like yourself or at least reach out to our primary?
Dr. Ryan Urchek: Of course, I think that's a good point. You know, you always want to start with avoiding activities that hurt it, give it a couple of weeks, try your OTC medications like you notice. But after three to four weeks, I think it's certainly reasonable to reach out to the PCP or a physician like myself and get evaluated certainly with an examination, maybe a set of x-rays. A lot of times patients come in and they say the same thing and they don't know if it was warranted to come in or not. But certainly I think once shoulder pain starts to affect your everyday activities, whether that's working, doing your everyday activities, if those things start to get involved with your shoulder pain and having issues, I think it's certainly reasonable to reach out to a professional. And then the most common symptom that patients come to see me for is night pain. So once patients start having shoulder pain at night, it's waking them up or it's waking up their spouse or significant others, that's when patients come to see me and that's the most common reason patients come to see me for shoulder pain.
Scott Webb: Yeah, that's interesting. And I can definitely identify with that, that, you know, it's one thing if it hurts while you're shoveling or raking or whatever, but when you can't lay on that side, when you can't lay on one of your shoulders, you can't sleep on one of your shoulders, as you say, that's probably a good time to reach out.
When we think about treatment options be they non-surgical or surgical options, what are the most common things, common tools in your tool belt?
Dr. Ryan Urchek: Sure. Thankfully, almost 90% of shoulder pain is treated without surgery, which most patients appreciate. And we definitely get patients back as soon as they can. So thankfully, a lot of times, some of the treatment options we've already talked about, whether that be avoiding those things that hurt for a period of time until we heal up, over-the-counter medications, rest and then certainly the next line would be those anti-inflammatory medications, whether they're over-the-counter or they're prescribed. And then unfortunately, sometimes shoulder pain can still linger. So that's when we typically go to the next level. And that usually is an injection of some sort. Typically, it's a cortisone injection, which is basically an anti-inflammatory or I tell patients it's like chewing up Aleve or ibuprofen and putting it right the shoulder to decrease that inflammation, which that tendonitis or bursitis that's what that is.
And then the most important thing is what we've already been talking about. And that's physical therapy, whether that's a home exercise program. We hand out to patients in the office with a set of bands, or they go to a therapist for a few visits. And thankfully, that treats the majority initially,
Scott Webb: Yeah. And so then assuming if surgery is a last resort, a last option, which is always interesting when I speak with surgeons and it's like the last thing they want to turn to, right? But when is a shoulder injury bad enough or when is it indicated that maybe we're out of options and we need to look at surgery?
Dr. Ryan Urchek: That's a good question. So in that same patient we just talked about where he came from shoveling snow, raking leaves and they tried all those other options we talked about. And if those haven't worked, then certainly we started going down the routes of MRIs and potentially considering surgery. But more importantly, if they've had a significant injury, if they fell off the step ladder, putting up Christmas lights and fell, whether it was a couple of days ago or a couple of weeks ago, if they've lost motion and function dramatically and fairly quickly where now they can't even raise their arm over their head, that's pretty concerning. And those are the scenarios where sometimes we go straight to MRIs and seeing if surgery's indicated if they truly tore their rotator cuff tendons or dislocated their shoulder in that fashion versus overtime or overuse shoulder injuries.
Scott Webb: This has been really educational, doctor. As we wrap up here, what can happen, you know, if we get one of these injuries and we don't reach out right away, we don't treat right away, what are the long-term effects? You know, is it a situation where if "Geez, if you'd come in earlier, you know, I could have helped you and your shoulder would have been like mostly okay. But since you waited three months or six months or five years, there's not a whole lot I can do at this point." So when is it too long?
Dr. Ryan Urchek: Yeah. Unfortunately, we see those patients more frequently than we would like. Thankfully, it's not usually in the scenario of three to six months, although that's possible. It's usually six months a year or even longer than that. But if patients have been dealing with rotator cuff tendon tears, or other issues in the shoulder, overtime, unfortunately, those tendons may not be repairable or we can't get them back to the bone. Sometimes I tell patients it's like an old rubber band and it just won't go back to the bone where it needs to do, because that's what tendons are. They attach muscles to bone. And if those tendon tears go on for years, a lot of times we can't fix them. And then if patients do require surgery after initial conservative treatment. Sometimes you're talking about the shoulder replacement versus where we could have fixed those rotator cuff tendons in the first place, and then again, back to the kind of patient that had that traumatic fall and loss of function, we know that outcomes and surgery for patients are better when they are fixed and treated within the first couple of months or three to six months, rather than years down the road. That tendon just is not as healthy and less likely to heal and give the patients that is the outcome they want. So certainly something to consider as your shoulder pain's evolving and seeking a medical professional.
Scott Webb: Yeah, it sure does seem like one of those just quality of life things, that people sort of hurt themselves, or it's a cumulative effect over time. And then it's a question of whether we reach out, whether we speak up and I think maybe the thought of surgery scares people off. But as you've said here today, there's a lot of options, there's a lot of things to go through before you'd ever get there. But if you get there, at least get there while you can, while the shoulder can still be saved. I totally get that analogy. The rubber band that's just been stretched so much that it's no longer really a rubber band. It's just a piece of rubber, you know, the banding part perhaps is gone.
Dr. Ryan Urchek: You got it.
Scott Webb: Yeah. I appreciate all of this. Very educational stuff. Thanks so much, doctor, and you stay well.
Dr. Ryan Urchek: All right. You as well. Thanks for your time.
Scott Webb: And for more information, visit summahealth.org/orthopedics. If you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.