Repetitive and excessive overhead motion or gripping can result in shoulder and elbow injuries.

Trauma from sports activity, like a shoulder dislocation, can often lead to arthritis in the long term, but in the short term can lead to problems with the athlete’s rotator cuff and labrum (cartilage in the shoulder).

Symptoms/common issues

  • Shoulder instability results when the joint is out of position. Associated symptoms include pain that worsens when raising the arm, stiffness, lack of strength and mobility in the shoulder area and the sensation that the shoulder is slipping out of place.
  • A rotator cuff tear (RCT) is usually the result of misuse or overuse of the shoulder. The repetitive force against the tendon is to blame and the aging process factors in as well. Pain, weakness and restriction of activity are usually the RCT symptoms.
  • Tendinosis of the shoulder or elbow results when there isn’t appropriate rehabilitation after an injury or when an overuse injury simply fails to heal properly.
  • Bursitis is inflammation of a bursa – the fluid-filled cushion between bone and muscle or tendon – which creates pain and swelling and is a result of injury to or overuse of a joint.
  • Impingement occurs when the bone on top of the shoulder impinges on the rotator cuff with overhead arm movement, causing pain and irritation.

Diagnosis

A physical exam, X-rays, presence of symptoms (including pain with movement, inflammation, stiffness and restricted ability) and history review are the basis for determining the source of your shoulder pain. An MRI can show inflammation in the rotator cuff and produce good images to determine if there are tears in the rotator cuff or labrum. It helps us understand how extensive the damage is and if surgery is potentially required. CT scans are taken to better understand your specific bone condition and are used for preoperative review by your surgeon.


Physical Therapy and Rehab

Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation

A physical therapist may work with you on a variety of strengthening, flexibility and mobility techniques, post-surgery or as an alternative to surgery. That may include:

Instrument-Assisted Soft Tissue Mobilization

In addition to applying manual muscle therapy, our physical therapists use an instrument-assisted technique to detect scar tissue and restrictions in affected areas of the body. Once detected, the instrumentation is used to break up the scar tissue.

Intramuscular Manual Therapy

Dry needling is an alternative pain relief technique that physical therapists may administer. It involves the insertion of a small, solid filament needle into a stressed muscle’s site of spasm and pain, also known as a trigger point. By doing so, the muscle relaxes and blood flow increases into the area, alleviating pain and improving motion.

Trigger points can often be the result of a different overuse injury, because muscles overcompensate for imbalances and weakness in the injured area. Inflammation and spasm develop and lead to discomfort and pain in the muscle.

Isokinetic Testing

Isokinetic testing uses computerized equipment to isolate muscle groups and test their tolerance. By doing this, our therapists and trainers can identify vulnerable areas and what positions or movements may be causing pain and soreness. This is used as part of a rehab/return-to-sport program or for assessment of the athlete at different stages.

Level Belt

The level belt was developed at Ohio State's Wexner Medical Center. An elastic strap aligned with your pelvis is worn as a phone application detects core stability and mobility. It’s initially used for assessment and then is applied as training support. As an example, a baseball pitcher needs a stable core to perform well and reduce injury to the shoulder and arm. The level belt can help the pitcher isolate pelvic mobility and strengthen the core.

Aquatic Therapy

Aquatic therapy is well-suited for early athletic rehab and for patients experiencing a great deal of pain or a weight-bearing restriction that doesn’t permit land-based rehab. Water provides the resistance for a workout and the buoyancy for low impact. Aquatic therapy helps to restore mechanics and is best suited for lower body injuries, including those of the lower back, postop knee and areas affected by arthritis.

Ask your physical therapist about our locations for aquatic therapy that offer warm water and Olympic-size pools.

Nonsurgical Treatments

Nonsurgical Treatments

When we’re considering treatment options for a shoulder or elbow injury, we first consider how much the pain impacts your quality of life. There are a variety of conservative treatment options that can be a suitable alternative for surgery in the short term or indefinitely.

Osteopathic Manipulation

Osteopathic manipulative therapy, or the use of manual pressure, can be employed to relieve pain for many musculoskeletal issues and repetitive stress injuries. Our osteopathic physician will complete a thorough physical examination and determine the most appropriate stretching, resistance or use of pressure technique that will help ease your pain or heal your injury. Osteopathic manipulation can be a complement to your physical therapy or injection therapy as well.

Injection Therapy

Cortisone/steroid injections, also called corticosteroid injections, are used to reduce joint pain and inflammation caused by rotator cuff issues, tendonitis or bursitis. Steroid injection can help improve function, and for less complicated first-time injuries, can be effective as part of a nonsurgical treatment program, which may also include participating in physical therapy.

You should discuss with your primary care physician whether injection therapy is right for you.

The sports medicine physicians at The Ohio State University Wexner Medical Center use musculoskeletal ultrasound for accuracy in treating you with steroid injections in-office. This technique uses sound waves to create images of the internal structure of the injured area. The image also shows the steroid needle, helping the physician guide it to the affected area. This is an in-office procedure and it does not expose you to any radiation.

Platelet Rich Plasma Therapy

Platelet-rich plasma (PRP) therapy is a treatment that uses your own blood to stimulate healing in shoulder tendon and ligament injuries. Your blood is drawn, and the part that contains growth factors is separated from the rest of the blood. This platelet-rich part of your blood is then injected into the injury site.

PRP treatment promotes long-term healing and is often prescribed after physical therapy, anti-inflammatory medications and/or steroid injections have produced little or no improvement. PRP can be considered after three to six months of other therapies have failed.

PRP treatment has a high success rate, especially for medial (golf) and lateral (tennis) tendonitis. The greatest results come in three to four months. Talk to your primary provider to see if you’re a candidate for this therapy.

Intramuscular Manual Therapy

Dry needling is an alternative pain relief technique that physical therapists may administer for rotator cuff muscle pain. It involves the insertion of a small, solid filament into a stressed muscle’s site of spasm and pain, also known as a trigger point. By doing so, the muscle relaxes and blood flow increases into the area, alleviating pain and improving motion.

Trigger points are often the result of an injury to a different part of the body, because other muscles overcompensate for imbalances and weakness in the injured area. Because of this overcompensation, muscle spasm occurs, causing discomfort and pain in the muscle.

Once dry needling resets the tone of muscle, your physical therapist works on correcting strength and mobility deficits in the muscle, which allows healing and prevents injury.
  • Results can be immediate or take up to 72 hours
  • One to five treatments is the expected course
  • Rehab exercises are part of the treatment

Lifestyle Modification

Many rotator cuff injuries, such as impingement or tendonitis, can be successfully treated with physical therapy and home exercise. We may prescribe progressive exercises to strengthen your shoulder muscles and tendons and expand your shoulder’s range of motion. If you have a lifestyle or job that demands higher levels of physical activity, taking breaks and/or resting frequently may be required.

Anti-inflammatory medications may be used to reduce pain and swelling.

Making changes to your technique and to the frequency of play can help chronic tendonitis. You may also want to consider changing the equipment you use to see if that helps. The way you grip a tennis racket or the actual grip size of the racket itself, for instance, can be affecting your condition. Also, using a brace on your forearm may provide support during play.

Surgical Treatments

Surgical Treatments

Ohio State’s Wexner Medical Center recommends exhausting other treatment options before deciding on surgery. Treatment is personalized for each patient, and in some cases surgery can be avoided for patients with injuries like rotator cuff tears. But when there is great discomfort or you desire to get back to your sport, and other methods haven’t produced the desired results, surgery can diminish pain and improve function.

Instability Surgery

Shoulder dislocations are a common injury that we frequently treat. If you dislocate your shoulder, it is very likely you have a tear in your glenoid labrum, a soft tissue that helps stabilize your shoulder joint. We correct this through minimally invasive arthroscopic surgery, where we reattach the labrum to the socket.

Along with a general anesthetic, a nerve block is usually injected into your shoulder to numb your shoulder and arm and to help reduce postsurgical pain. Your surgeon will make small incisions in your shoulder for the scope (arthroscope) that projects images of your shoulder and other instruments used to repair the labrum tear.

Most arthroscopic procedures are on an outpatient basis and take less than an hour, but the length of your surgery will depend on the extent of repair needed. Recovery usually takes up to three to six months, depending on the amount of surgical repair.

Revision Instability Surgery

If you’ve had an unsuccessful instability surgery, or have another instance of the same injury, our surgeons are specialists at revision instability surgery.

With the second and third dislocation after a prior surgery, there is typically more damage to the joint. This requires a more complex surgery that involves more bone reconstruction, versus soft tissue labral reconstruction, using techniques such as rebuilding your socket with your own bone or bone grafting.

With this surgery, a general anesthetic is administered, and since revision surgery is typically more extensive, it may require an overnight stay. Two hours or more may be required to complete your surgery, depending on the amount of damage and repair necessary.

After surgery, you may be required to wear a sling for six weeks or more to avoid using the shoulder and aggravating the injury. Recovery will depend on the extent of your surgery and can take up to six months or more.

Arthoplasty or Reverse Arthroplasty

Traditional, total shoulder arthroplasty replaces the shoulder joint by resurfacing the socket with synthetic components and replacing the ball of the shoulder’s ball-and-socket joint with a metal ball. The new socket is attached to the existing socket with medical adhesives or screws. The procedure takes about two hours.

Trauma from sports activity, like a dislocation, can at times lead to long-term tears of the rotator cuff, which can subsequently lead to shoulder arthritis. Historically, athletes with this condition could not have a traditional shoulder replacement, as the rotator cuff was not in good condition. A traditional shoulder replacement will not be successful without a good functioning rotator cuff.

However, by reversing certain components used in regular arthroplasty, it is now possible for those suffering with this condition to have a shoulder replacement. This is called the reverse total shoulder and is the solution for those with arthritis and a poor quality rotator cuff.

Near-full recovery takes about three months, partly because of a tendon that requires repair as a result of surgery. Physical therapy starts during the hospital stay, which is usually 48 hours. In spite of residual pain from the surgery, there often are signs of improvement at the first postoperative visit, generally at two weeks. A sling is worn for up to six weeks to avoid misuse of your arm during the critical healing phase.

Arthroscopy

Arthroscopy is commonly performed to repair a rotator cuff tear. Less invasive than other surgeries, it requires smaller incisions instead of larger, open ones. With arthroscopy there is less surgery-related pain and trauma.

Patients wear a sling for about six weeks after surgery. Physical therapy is a major part of recovery and is immediately started with passive exercise, followed by more active exercise for six to 12 weeks. The focus then turns to strengthening the shoulder. Overall, recovery is expected to take about five to six months.

Our surgeons have extensive arthroscopic experience, treating hundreds of patients annually, including pro athletes. Most of our patients find that arthroscopy leads to effective repair and prevents long-term complications. Many athletes regain strength and are able to return to sports.

Why Ohio State

Why choose The Ohio State University Wexner Medical Center for treatment of sports-related shoulder pain?

Expertise: Our surgeons treat patients with all types of shoulder and elbow disorders. Revision shoulder instability procedures, especially dislocations due to bone loss, are a specific focus.

Ongoing research: Our surgeons have also participated in the largest study to date on the nonoperative treatment of full-thickness rotator cuff tears, which has won two Neer Awards – the most prestigious international award recognition for shoulder research.

Highly educated: We offer fellowship-level physician care and physical therapy. That means our providers have completed up to two years of intense, specialized experiential training in the field, which translates to extensive proficiency in patient care.

High-level training: In addition to our prestigious orthopedic sports medicine fellowship, The Ohio State University Wexner Medical Center is the first in the country to offer a credentialed Upper Extremity Athlete Fellowship Program. This is a 12-month program in partnership with the Cleveland Indians and their Triple-A affiliate, the Columbus Clippers.

A Closer Look at Shoulder Injuries and Surgery

Labral Tears

Dr. Grant Jones outlines how research gained from a multi-center study group found that a majority of labral and rotator cuff tears do not require surgery.

Labral Repair Surgery

Shoulder specialist, Dr. Julie Bishop, provides an overview of what happens during a labral repair surgery.

Platelet Rich Plasma Therapy

Dr. Grant Jones provides an overview of the promising technique of Platelet Rich Plasma Therapy to treat many orthopedic injuries.

Rotator Cuff Repair Surgery

Shoulder specialist, Dr. Julie Bishop, provides an overview of what happens during a rotator cuff repair surgery.

Treatment Options for Shoulder Arthritis

Dr. Bishop shares treatment options for shoulder arthritis, from rest to shoulder replacement when conservative treatments no longer succeed.

Our Doctors