When a patient tells me they have shoulder pain at night, they will often ask if it’s because they tend to sleep on their side. Prolonged pressure on the shoulder from sleeping on your side can become painful, especially if there is an underlying condition in the shoulder joint or upper arm. Pain at night is not normal and it’s certainly a red flag that something needs to be addressed. ...

Ask the Orthopedist

 

QUESTION

Why does my shoulder hurt when I lay on my side?

 

ANSWER

The shoulder is a complex joint. It encompasses the union of bones, muscles, ligaments and tendons. Inside the shoulder is also bursa, tiny sacs of fluid that help reduce the friction between moving parts around the shoulder. Bursa serve as a cushion for the moving rotator cuff tendons. The bursa can become painful when inflamed due to an injury, overuse or condition such as rheumatoid arthritis or osteoarthritis.

 

Certain movements may be more painful than others. Patients in our office typically complain of pain when lying on their side, pain when they lift their arm, open a door or carry a heavy object. There may also be some swelling in the area that hurts.

 

Shoulder bursitis can happen to anyone, but those at a higher risk tend to be athletes, farmers, carpenters, gardeners, factory workers and others who perform a specific shoulder movement on a frequent basis.

 

The first step in care for bursitis pain is simply to rest the shoulder and avoid the motions that cause pain as much as you can.

 

Some patients find that wearing a shoulder sling helps make sure they are resting the arm. Ice the area when painful and take over-the-counter pain relievers such as ibuprofen or naproxen. Stretching may also help if the bursitis is caused by muscle tightness or a strength imbalance. Your doctor may also give you a localized corticosteroid injection to manage the pain and to control inflammation.

 

When these conservative measures do not provide relief, you may consider regenerative medicine treatments using your own body cells. This treatment works by activating the body’s natural healing process to reduce painful inflammation and activate healing. It involves a relatively simple procedure that takes plasma-rich platelets (PRP) from your own blood and injects them into the shoulder joint after separating them in a centrifuge.

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QUESTION

I suffer from constant, dull lower back pain. Is surgery my only option for relief?

ANSWER

Back and neck pain are, unfortunately, one of the most common reasons patients visit our office. There are many causes of neck and back pain, and about 95 percent of patients can manage conservatively with physical therapy, cortisone injections, massage, osteopathic or chiropractic manipulation, medications and time.

When these treatments have failed to alleviate the pain, conventional treatment may turn to surgery to take away the pain. In many cases, however, surgery is not the best answer and sometimes may not even help a patient.

Advanced Stem Cell Treatments Can Help

Early research has shown that treatment with non-surgical regenerative therapies such as bone marrow concentrate (stem cell) injections and prolotherapy have been helpful for treating a number of conditions for the spine. Regenerative medicine treatments activate your body’s own adult stem cells and blood platelets to stimulate healing and speed repair for bone, muscle, joint, soft tissue and nerve injuries.

We all have healing stem cells in our bodies. Primarily found in bone marrow and fatty tissue, these cells act as repairmen and can regenerate into the type of cell that is needed when injected into an injured area. There are several kinds of stem cells. Mesenchymal stem cells (MSC) are the type that we use in orthopedic treatments.

MSCs have the strongest potential to repair muscle, bone, joint and soft tissue injuries.

These cells have the ability to self-replicate, reduce inflammation and differentiate into cartilage, bone, muscle and fat cells to help the body regenerate the lost tissue in the injured area.

They can activate your body’s ability to heal itself.

Healing Back Pain

For example, when these cells are placed in an injured environment, such as a degenerated disc of the back, the cells will recognize that the disc cells have started to break down and will help to regenerate them to give the discs more water content and volume.

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Arthritis Pain

What to Do, When to Get it Done

 

By Reuben Gobezie, MD

 

Question

I have bone-on-bone arthritis. Does that disqualify me from treatment?  

 

Answer

No, we have helped many with bone-on-bone, or stage four, arthritis. Regenerative medicine procedures are used to stimulate healing and speed up repair for a wide range of painful bone, muscle and joint conditions. We have found it is especially helpful for patients with osteoarthritis.

 

Regenerative treatments work by activating the body’s natural healing process through injections of the body’s own healthy stem cells to stimulate tissue regeneration and natural healing. Using our own stem cells for therapy is the standard of care for this sort of treatment, and is what has been regulated by the FDA.

 

We all carry stem cells that act as the body’s “repairmen.” With arthritis, the body’s ability to sustain healthy cartilage may have diminished. The Regen procedure takes healthy, regenerative cells from an area of your body, typically your hip bone, in which these cells are more abundant and injects them into the affected area. When stem cells are concentrated and injected into a joint with arthritis, this can help restart a new healing response that will eventually help ease pain and may also stimulate the growth of new cartilage in that area.

 

For many patients, these treatments have allowed them to avoid surgery or ongoing steroid injections, or lets them stop taking regular pain medications. Our patients walk out of the procedure and can return to normal activities in just a couple days after rest. Most patients find their mobility greatly improved with pain relief lasting for as long as two to eight years. The treatments are non-surgical and are outpatient, performed in one office visit, and result in little downtime for the patient.

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Ask the Orthopedist

By REUBEN GOBEZIE, MD

QUESTION

Is it possible to have shoulder replacement surgery as an outpatient procedure?

ANSWER

Yes. Orthopedic surgeons who specialize in shoulder surgery are now providing patients with the outpatient option when it applies to their condition. People love the outpatient experience and recover better when they are at home.

When provided by a specialist, the surgery may only take 35 minutes in a highly controlled environment and results in little blood loss. The less time that you are under anesthesia, the better the recovery. There is less risk of infection, increased patient satisfaction and higher quality outcomes based on function and pain with a home recovery. Patients walk out with their arm in a sling and are home the same day.

In the weeks leading up to surgery, each patient and their caregiver should be provided with educational information and a prescription for physical therapy. For example, our practice offers a series of physical therapy videos that patients study before the surgery and work on at home post-surgery. The videos illustrate the exercises, and the education offers very specific goals that each patient needs to meet to recover faster.

The outpatient surgery and home rehabilitation option saves patients considerable time and money. Most patients are able to use their arm enough to care for themselves within a week after the procedure. After three months of follow-up appointments, the patient no longer requires office visits, but the atrophy from the initial injury could take up to a year to fully improve.

While a large percentage of patients are candidates for outpatient shoulder surgery, it’s not for everyone. Patients with complicated medical histories may not qualify. Each patient should be carefully examined to determine the procedure that will work best for them.

All shoulder conditions should be evaluated by a shoulder specialist with a thorough history and physical examination including imaging studies.

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