Did you know the shoulder is the most flexible joint in your body? Unfortunately, as a result, shoulder pain is an extremely common problem that many adults suffer from on a daily basis. Muscle tears, bicep tendonitis, shoulder arthritis, shoulder osteoarthritis, and, mostly commonly, rotator cuff issues affect millions of people in the U.S. every year. Before getting on a operating table, non-surgical procedures need to be considered. We’re here to answer your FAQs on non-surgical alternatives to shoulder pain:
Why are non-surgical procedures effective for shoulder pain? Why should people consider non-surgical procedures before resorting to surgery?
A better question to ask is when is surgery necessary for shoulder pain? In the absence of a life-threatening condition, there are very few conditions that require surgery.
In general, for all conditions, non-surgical options should be exhausted prior to considering surgeryOnly in very rare situations, such as malignant tumors, should surgery for shoulder pain be required immediately rather than evaluated alongside other non-surgical options. Nevertheless, there are situations where surgery will be required to achieve acceptable functional improvement increases. These include:
- Large labral tears, especially those involving the biceps anchor, that have not responded to physical – therapy (PT) and regenerative interventions.
- Large rotator cuff tears that are clearly limiting the function of the rotator cuff and have not responded to PT or regenerative interventions.
- End-stage osteoarthritis of the shoulder when PT and regenerative interventions have failed to provide relief.
Is there a “typical client” who comes in to receive shoulder pain relief? What activities can lead to shoulder pain?
There is no typical person who suffers from shoulder pain. Most people coming to our clinic with shoulder pain have difficulty identifying a specific single injury that caused it. Younger people tend to experience shoulder injury through sports, especially overhead sports, defined as any sport during which the upper arm and shoulder arc over the head, such as baseball and volleyball. Older people have a wider spectrum of pain presentation, including completely spontaneous onset of pain with no identifiable injury.
Most people that we see suffer from one of the following shoulder issues: osteoarthritis, labral tear, biceps tendon disease, frozen shoulder, rotator cuff syndrome, tendinosis to tendon tear spectrum, AC joint injury and bursitis, a painful condition affecting the sacs that cushion the bones, tendons and muscles near your joints – all of which we could potentially be fixed or managed by platelet-rich plasma therapy (PRP) or bone marrow/adipose tissue (BMAC) therapy.
PRP and BMAC therapy can also help tremendously with shoulder instabilities and joint laxity with targeted treatment of the joint capsule and glenohumeral (shoulder) ligaments. In less common cases, patients with Ehlers Danlos, mixed connective tissue disease, or those that suffer from non-defined hypermobility may benefit from these regenerative medicine injections directed at the soft tissue stabilizers discussed above.
When would you recommend BMAC therapy vs. PRP therapy to treat shoulder pain?
BMAC treatments are a more powerful tool, but also more expensive. In nearly every scenario, the more effective therapy is BMAC. However, many times PRP will work very well, though it usually takes multiple PRP injections, compared with the results of a single BMAC procedure. In addition to cost, other things to consider when looking at BMAC vs PRP therapy, include:
- BMAC acquisition is much more invasive than simply drawing blood from the vein for PRP therapy. – For BMAC therapy, cells must be removed via bone marrow biopsy or liposuction.
- The more severe the condition, the more likely it is that BMAC theropy will be required.
- Less severe anatomic injuries may do better with serial PRP injections over time in conjunction with PT, home exercise, education, behavior management and nutritional changes.
- Bursitis of the shoulder, hips, tendinosis and tenosynovitis respond better to hyper-concentrated PRP injections.
- Tears, partial or small full thickness without retraction of the rotator cuff can heal better, faster and with more durability with BMAC cells.
For BMAC therapy, how long is the average treatment plan, how many appointments are there and what is the cost approximately?
We often need one to three visits for diagnosis and treatment planning, then the injection occurs over one-half day, including the bone marrow or adipose tissue acquisition process. The entire process ranges from $5,500-$10,000, which depends on complexity of issue and the sedation costs.
For PRP therapy for shoulder pain, how long is the average treatment plan, how many appointments are there and what is the cost approximately?
Like BMAC therapy, we often need one to three visits for diagnosis and treatment planning. An injection take just a few minutes for simple procedures and as long as an hour for complex cases. The entire process ranges from $1,500-$3,000, which again depends on complexity of issue and the sedation costs.
What would surprise the average person about non-surgical treatment for shoulder pain?
Unfortunately, many medical care treatments are palliative, relieving the pain without curing the cause of the condition. Our non-surgical treatments can heal injuries and compared to most shoulder surgery, there is very little pain. There is a brief active recovery time of not using the shoulder or arm. Often times the patient is in a sling for 24-48 hours, then slowly begins using the limb/shoulder, gradually increasing range of motion and weight. Physical therapy starts within 1-2 weeks following the procedure.
What are five tips for people suffering from shoulder pain that you would offer?
- 1. Come see us early: You have more options early in the process.
- 2. Avoid sedentary behavior: Sit less and exercise more.
- 3. Practice better posture
- 4. Be aware of persistent night pain: This may indicate calcium buildup in the rotator cuff and is a common source of shoulder pain in the middle aged.
- 5. Get a real diagnosis: Shoulder pain is not a diagnosis, it’s a symptom. Through our evaluation process discussed above, the patient will get a diagnosis before getting treatments. We often see this done backwards as patients get treatment for shoulder pain from providers of all types without a real diagnosis. Some folks get lucky and get better, and others waste a lot of time before getting to someone that knows what they are doing.
Through BMAC and PRP therapy, we’ve helped thousands of patients manage and resolve their shoulder pain – without hospital stays, drug prescriptions and the recovery time that accompanies surgery. To see how a non-surgical treatment could help your pain, schedule a consultation today.