Repetitive and excessive overhead motion or gripping can result in shoulder and elbow injuries.
- 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 – that 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.
DiagnosisA 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
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
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.
Ask your physical therapist about our locations for aquatic therapy that offer warm water and Olympic-size pools.
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
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
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
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.
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
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
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.
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?
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
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.
What is Tommy John?
Dr. Jonathan Barlow gives more details on acute and chronic instances of a tear of the ulnar collateral ligament on the inner part of the elbow.
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.