Thursday, 17 of January of 2019

Tag » Shoulder Injections

Shoulder Replacement

For people with severe shoulder pain, shoulder replacement surgery is usually the right choice once more conversation options such as injections and physical therapy fail to provide relief. Although not as common hip or knee replacement (about 900,000 patients every year versus 53,000 per year according to the Agency for Healthcare Research and Quality), shoulder replacement is a very successful and effective procedure.

Who is  a candidate?

The typical candidate for shoulder replacement is someone whose shoulder joint has been severely damaged with osteoarthritis. Symptoms include shoulder weakness and loss of motion, pain that wakes them up at night and difficulty with even simple daily activities that require you to lift or use your arm.

What exactly is replaced?

The shoulder joint includes two bones: the upper arm bone, called the humerus, and the shoulder bone, or scapula. The tip of the humerus, which is shaped like a ball, fits into the part of the scapula that is shaped like a socket. During surgery, the ball of the humerus is replaced with a metal implant, and a plastic “cup” is inserted into the shoulder socket of the scapula. 

As the American Academy of Orthopedic Surgeons points out, patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for this procedure.

But patients who have osteoarthritis and a large rotator cuff tear that can’t be repaired by other methods, may find that traditional shoulder replacement may not be as effective. They may continue to have pain when they try to use their shoulder because of the poor condition of the rotator cuff muscles. Instead, those patients may benefit from a newer procedure called reverse shoulder replacement.

What is a reverse shoulder replacement?

Granted FDA approval in 2004, reverse shoulder replacement is done by “reversing” the implants.  This means attaching the metal ball implant to the shoulder socket and fixing the plastic socket to the end of the arm bone — the exact opposite of the traditional method.

Reverse shoulder replacement allows the shoulder joint to function using the deltoid muscles instead of relying oh the damaged rotator cuff muscles. The “delts” are the triangular muscles that form the rounded outer area on the upper arm.

Deciding who is a good candidate for shoulder replacement or reverse shoulder replacement requires the skill and knowledge of an experienced orthopedic surgeon, one who remains current with the latest technology. If you are having shoulder pain and would benefit from a consultation, call Dr. John Kagan at 239-936-6778 or go to

Rotator Cuff Injury

It’s not surprising that Baltimore Ravens wide receiver Anquan Boldin and San Francisco 49ers wide receiver Mario Manningham complained of shoulder pain in the weeks prior to Super Bowl XLVII. A reported 11 players from both teams were “nursing” shoulder injuries before the big game this past Sunday.

High-impact sports like football can damage the shoulder joint, causing a number of injuries, including damage to the rotator cuff, a group of muscles and tendons that cover the head of the shoulder bone and hold it in place in the socket. 

But it’s not just football players who feel the pain and stiffness of shoulder problems. Golfers and tennis players often have similar complaints.

Any sport that requires repetitive use of the shoulder joint – think of the overhead serve in tennis and the swing required in golf – can stress the rotator cuff and lead to tendinitis (inflammation of the tendons), bursitis (inflammation of the bursa sack) and tears to the ligaments or muscle.

Because the rotator cuff helps keep the shoulder stable and allows for full range of motion, injury causes pain, stiffness and loss of mobility. Generally the pain will be felt along the outside portion or side of the shoulder, rather than deep inside the joint as is the case with osteoarthritis. The pain may wake you up at night and it may hurt to reach overhead.

The first step in treatment is usually conservative. Rest the shoulder, apply ice and take anti-inflammatory medication.  Your doctor may prescribe physical therapy with gentle stretching and strengthening exercises.  Injections with cortisone or other medications can be helpful, too.

More serious injuries, such as a full rotator cuff tear, will not heal by itself and may require surgery.  For more information about the rotator cuff, along with a diagram of the shoulder anatomy, go to

Shoulders Injections to Control Pain

Depending on the diagnosis, often the first step in treating shoulder pain and stiffness may be an injection with a mix of pain-relieving anesthesia and cortisone, a powerful anti-inflammatory medication. Here are some of the ways injections can be helpful:

1) Reducing the pain and swelling from bursitis – an inflammation of the small fluid-filled sacs located in the shoulder joint.

2) Decreasing the discomfort from rotator cuff tendonitis, an inflammation of the tendons and muscles in the shoulder.

3) Treatment for early stage osteoarthritis, a degenerative disease of the cartilage that covers the joint.

4) Eliminating the pain from trigger points, small, hypersensitive knots in the muscles or connective tissue that form when the muscles do not relax.

Injections are a non-surgical intervention that can be very effective with relatively little downtime required. The physician may use a numbing medication that is applied to the skin to reduce any discomfort associated with the injection. The inject site may be tender for a few days but icing the area will help. Injections can be repeated over time as needed to control pain and inflammation. Unlike taking oral steroid medication, there are no long-term side effects from a cortisone injection.

For more information on common treatment options for shoulder pain, go to

Shoulder Injections for Pain

When it comes to acute or chronic shoulder pain, many patients want to know about nonsurgical treatment options before they consider surgery. Injections with an anesthetic and steroid solution are one of the most common nonsurgical treatments for shoulder pain. It can be a very effective solution for reducing inflammation, improving range of motion and relieving pain.

Injections are done on an outpatient basis with only local anesthesia so you will go home the same day. Depending on the procedure, X-ray and a contrast dye may be used to help guide the physician in correct placement of the needle into the shoulder joint.

 A variety of shoulder conditions respond well to treatment with injection. For example, it is useful for bursitis, which is an inflammation of the bursa, a small fluid-filled sac that serves as a cushion and reduces friction between the bones and muscles in the shoulder joint. When the bursa becomes inflamed, moving the shoulder can be very painful, even to comb your hair. A corticosteroid medication injected into the bursa will reduce inflammation and discomfort.

Injections can also be effective for nonsurgical treatment of rotator cuff injury, frozen shoulder, early-stage arthritis and for trigger points, the small knots that can form in the muscles and connective tissue around the shoulder and upper back.

In addition, a nerve block is often used to treat pain and inflammation from impingement of the nerves in the shoulder joint. A corticosteroid solution is injected into the nerve to soothe the tissues and reduce inflammation.

For more information about treating shoulder pain with nonsurgical options, go to

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