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Why does my shoulder hurt when playing tennis?

Shoulder pain with tennis
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On this video, you’ll learn about why your shoulder hurts when you’re playing tennis.

Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine, where we specialize in evaluation and treatment of arthritis, tendonitis injuries, and back pain. Shoulder pains are a common injury and symptom that people who play tennis experience. And the reason why is because of the above the head activity that’s done when you’re serving and hitting overheads.

To understand this you have to first understand the anatomy that’s involved at the shoulder. To begin with, there’s three different joints, the glenohumeral joint, the acromioclavicular joint, and the sternoclavicular joint. These are supported by multiple different layers of soft tissue structures, including the rotator cuff tendons. That’s four different rotator cuff tendons as well as a biceps tendon that help to provide power and support with the shoulder as it goes through a range of motion. There’s also quite a few different ligaments that help to attach the bones together. These ligaments provide stability as your shoulder is moving through that range of motion. There’s quite a few different nerves involved as well that starts with the nerves that come from the neck, then the brachial plexus, and then the peripheral nerves. These nerves help it coordinate and control your range of motion as your shoulder is in action. When all of this is combined together, your shoulders are able to go through a very wide range of motion with strength and stability and without pain.

If you have pain, it’s a sign that one part of that anatomy or process has been injured or is dysfunctional. The concept of biotensegrity, which means that the overall structural unit is stronger than the individual components, would indicate that if you have even one structure that’s not working optimally, it can then cause significant pain and dysfunction throughout the entire shoulder.

To understand why you can develop pain if you’re playing tennis, it’s important to understand the overall injury pattern that classically develops. Typically when you’re swinging above the head, such as when you’re either hitting an overhead, or with a serve, you are putting additional stress on the structures of the shoulder. As an example, if you have a strain in one of the ligaments of the shoulder, in particular the inferior glenohumeral ligament, that can lead to instability in that shoulder joint, which then leads to more stress on the rotator cuff above the ligaments, which then ends up leading to an injury of the rotator cuff tendons. Which can then either just be a mild injury or even a tear. That injury then can then lead to more stress on the acromioclavicular joint which sits even further above the rotator cuff tendon. All that combined together is what then leads to pain and dysfunction. What’s important to understand is that these are layers of tissue on top of each other that move in a coordinated fashion. As one layer gets injured, the layers above and below that can then also be injured and progressively get damaged.

So what should you do if you have an injury to the shoulder as a tennis player? First and foremost, obviously rest. Alter any of the activities that may be aggravating the pain as well. I would strongly recommend also having your serve videotaped, and the reason why is because if there’s any abnormal motion as you’re serving that’s putting more stress on the shoulder, that’s something you’d want to correct, mainly because if you’re putting additional stress on the shoulder in order to develop power or control during your serve, you need to correct the motion that’s driving that, otherwise you’re going to continue to put unwanted stress on the overall shoulder.

If you’re not getting better with just conservative management, as I’ve described you then should get evaluated by an appropriate physician who has experience in treating and evaluating shoulder injuries. A good history and exam is a good first step. I strongly recommend doing a diagnostic musculoskeletal ultrasound at the bedside while you’re actually being evaluated. And the reason why is cause you can actually look at the rotator cuff tendons at rest and in dynamic motion to see if there’s any stress. You can also see if there’s any instability or impingement on the tendons as well, which can then pretty quickly give you a diagnosis and then give you a set of steps for helping to get better. MRI can be useful as well. In particular, if you need to look deeper at the level of the joint to see if there’s a labral tear or other kind of joint pathology as well.

First-line medical treatment for a shoulder injury in particular rotator cuff injury would be physical therapy, where they work on scapular stabilization, which then leads to progressive strengthening of the muscles around the rotator cuff tendon. That combined with changing, altering and improving your overall serve as well as overhead motions will help in terms of letting you get back to physical activity and playing tennis again.

If you’re not improving adequately with just that next step of medical care, I would then recommend an injection treatment. I don’t recommend steroid injections in general for shoulder issues because it can damage some of the soft tissue. Appropriate other options would include dextrose prolotherapy, platelet-rich plasma, or bone marrow derived stem cells. The keys there are that they should be treating not only the tissue that’s been injured. For example, let’s say the rotator cuff tendon, but they then should be also treating the other soft tissue and other structures that may be implicated in your pain and overall injury pattern as well. So for example, in that prior injury pattern that I described, they should be treating not only the tendon that’s been injured or torn or that’s causing pain, but they should also be treating that were ligaments originally injured leading to instability in the shoulder to begin with.

Lastly, if your injury is too severe, for example if the rotator cuff tendon is fully torn and blown out, surgery would be an important and next step to consider as well. Keep in mind that even after any kind of reparative process and recovery from that injury, if you haven’t fixed what’s actually driving the pain to begin with, the overall movement pattern or the overall generalized weakness that may be driving that, that you will be prone to that kind of injury again unless you fix what was originally causing the problem.

Thank you for your time. If you found this content to be educational, interesting or useful, please give us a like or follow us. And until we meet again, have a good day and live well, bye-bye.


 

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MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.
 
***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses why you have shoulder pain when playing tennis.
 

Issues with Shoulder Impingement Surgery

shoulder impingement surgery

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Issues with Shoulder Impingement surgery

Shoulder impingement results in pain with lifting your arm above your head. The typical surgery for this involves shaving the acromion bone to make more room for the rotator cuff to more freely move. But does this surgery work?

A recent article from the British Journal of Sports Medicine shows that shoulder impingement surgery is no better than physical therapy alone or a diagnostic procedure where no intervention is done.

What does this mean to you if you have shoulder impingement?
-You can likely skip surgery and maximize the nonsurgical alternatives for your shoulder pain.
-Get a specific and accurate diagnosis from a physician who focuses on shoulder and musculoskeletal issues.
-Have a diagnostic musculoskeletal ultrasound of your shoulder to evaluate for rotator cuff tear and instability.
-Maximize exercise options including physical therapy.
-If inadequate, consider a regenerative medicine treatment to improve stability of the shoulder that is causing impingement. Also improve the shoulder by optimizing it’s biologic health, reduce inflammation, and improve the neuromuscular components.

Paavola M, Kanto K, Ranstam J, et al Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial British Journal of Sports Medicine  Published Online First: 05 October 2020.


***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
https://chicagoarthritis.com/schedule-a-telemedicine-appointment/

– Hello, this is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. It’s October 12th, 2020. Welcome to our weekly educational meeting. This is live streaming currently. And on this meeting, weekly, I’m discussing concepts related to what we do here at Chicago Arthritis and Regenerative Medicine, answering questions that I frequently get from staff and patients, and also discussing just general big picture musculoskeletal concepts in terms of how we’re trying to treat people and get people better here. As a reminder, we’re focused on nonsurgical management of arthritis, tendonitis injuries, and back pain. And so it’s an interesting time because there’s a ton of information that’s coming out progressively about comparative studies, what works, what doesn’t work. There’s an interesting article that came out in the British Journal of Sports Medicine recently about shoulder impingement surgery. So shoulder impingement essentially means that when you’re trying to lift your arm up, that it catches and causes pain and dysfunction. So the traditional surgical approach to that was to do what’s called subacromial decompression or acromioplasty, and what that means is going to the bone, the acomion that sits over the rotator cuff, shaving it down to, in theory, put a little bit of more space for the rotator cuff to flow a little bit easier. It’s an interesting idea. May make sense from a surgical and structural standpoint, but in the last few years, there’s been progressive evidence that that may not be better than physical therapy. So in the British Journal of Sports Medicine, an article recently published by a group of physicians from Finland basically compared the effectiveness of this surgery in a interesting and unique way. They essentially took 175 patients who had shoulder impingement, and that was defined by reduced range of motion with abduction, internal rotation, and that was diagnosed clinically. They made sure that they took out patients who already had a significant rotator cuff tear or a significant osteoarthritis. They gave them a diagnostic injection meaning injecting some local anesthetic into the shoulder bursa space. And if they had a significant improvement in pain indicated that they had shoulder impingement and then included them in this study. The idea being that they wanted to kind of exclude out people that may have neck issues or some other issues, and really focused in on this category of patients. They split them up into three different groups. The first one being patients who progressed with shoulder acromioplasty, the surgery. The second were patients that had a diagnostic arthroscopy. And that means that they had a surgical procedure, but it was strictly one that was looking at what’s actually going on in the shoulder, not one that was actually doing any additional intervention. And number three, they also looked at a group of patients that also had just physical therapy. So in all of these patients had already failed some kind of exercise therapy and they excluded out those other patients that I mentioned and they then compared the effectiveness of the interventions. And so the patients that had surgery, subacromial decompression, they found that there was no significant improvement compared to the patients who just had the diagnostic arthroscopy or the patients that had just physical therapy. And they followed them out over five years and found that there was no difference during that time. Really interesting. Why is this important? Number one, if you compare surgery to nonsurgical treatments, there’s higher risk associated with surgery, whether that’s due to anesthetic risk, conscious sedation risk, nerve block risk, bleeding, tissue damage, other kinds of issues like that. There’s just higher risk than anything that’s nonsurgical. So if surgery is not more useful, then why go that route, right? Always consider other options. The other interesting component here is that the structural model of musculoskeletal care, which says look at your x-ray, you may have a little bone spur. We need to shave that off, but that does not seem to play out as well as people think it does. It may make some intuitive sense but that’s not actually how the body works. Understand that arthritis, tendonitis, is more of a biologic functional issue, and not as much of a strictly structural model of care is important. And it’s likely the reason why in this study that even though they did an intervention, the subacromial acromioplasty, the surgery, there was no additional benefit compared to just a diagnostic procedure and compared to just physical therapy. So super, super important to understand that. And so then it comes down to, what are your nonsurgical options and alternatives for shoulder pain from impingement? So number one absolutely, you need to maximize physical therapy. Exercise therapy is humongous. Doing the right exercises is really important. If that fails, however, number two, you then need to determine, do you have some other cause for this kind of problem? Do you have a rotator cuff tear? Do you have any significant arthritis involved? I would recommend getting that evaluated with a diagnostic musculoskeletal ultrasound. Under a trained hand you can really find some very fine details in this regard. Number three, you want to then also determine is there any kind of neck issue going on? And the reason why is because if you have a neck issue, it can really look a lot like a shoulder issue as well. So you want to make sure you’re not possibly confusing these. And then number four is if there’s no other significant rotator cuff or osteoarthritic process that I would recommend a treatment like platelet rich plasma treatment if you’re still having pain. The key here to understand is that you don’t want to just inject that into the bursa around the rotator cuff. You want to do better than that. Number one, if there’s any even mild fraying of the rotator cuff, you want to make sure to treat that. Number two, if there’s any evidence of strain on the AC joint, essentially the joint where the rotator cuff runs underneath. If there’s any evidence of strain on that, either on examination where you’re having symptoms or an ultrasound, you would then want to inject into that joint as well, your own platelets. And then lastly and likely most importantly is that you also want to treat all the ligaments that are leading to that instability as well. Instability is really what this is about and that’s what’s causing the impingement. And so if you have that space where the rotator cuff is running is getting impinged and squeezed down upon, you want to make sure that you appropriately treat all the ligaments that are leading to that instability. And the reason why is because if you do, you’ll give your shoulder a better chance of recovering from that injury. You’ll give your shoulder and rotator cuff a better chance of not getting progressively damaged, and you’ll give your AC joint above your shoulder a better chance of not becoming arthritic as well. So shoulder impingement surgery- no better than just physical therapy or just a diagnostic evaluation. Maximize your nonsurgical alternative options. And if you’ve already done that, then instead of proceeding with a surgery that shaves off the bone, that is no better than just physical therapy, I would recommend proceeding with the regenerative medicine treatment in a proper manner where you’re treating the whole structure, the whole functional unit to get that better. Great. Thank you very much. As a reminder, I’m doing this twice per week, Mondays and Wednesdays. In addition, this Wednesday evening, I’m also doing a webinar on regenerative medicine treatments for lower back issues. And until we talk again, have a good day and live well. Bye bye.


MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

 

Weekly Live Replay- 20200722

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Weekly Live Replay- 20200722
Topics:
Advanced imaging for arthritis and tendinitis: Pros and Cons. How to use smartly.

Examples:
-Joint instability.
-Joint inflammation/early rheumatoid arthritis.
-Targeting treatment in shoulder arthritis.

Chicago Arthritis and Regenerative Medicine Weekly Live broadcast.
Check us out live on Instagram, Facebook, or Youtube every Wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.Youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

Listen to the Regenerative Medicine Report podcast:
https://chicagoarthritis.com/regenerative-medicine-report/

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:

Candidate Form

Contact us for more information or to schedule an appointment:
https://chicagoarthritis.com/contact-us/

MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses musculoskeletal imaging for arthritis and tendinitis, shoulder pain, shoulder arthritis, joint instability, early rheumatoid arthritis.

Our Weekly Live Live broadcast 2020-07-22

Dr. Siddharth Tambar of Chicago Arthritis

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Our Weekly Live Live broadcast 2020-07-22
Topics:
Advanced imaging for arthritis and tendinitis: Pros and Cons. How to use smartly.

Examples:
-Joint instability.
-Joint inflammation/early rheumatoid arthritis.
-Targeting treatment in shoulder arthritis.

Chicago Arthritis and Regenerative Medicine Weekly Live broadcast.
Check us out live on Instagram, Facebook, or Youtube every Wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.Youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

Listen to the Regenerative Medicine Report podcast:
https://chicagoarthritis.com/regenerative-medicine-report/

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:

Candidate Form

Contact us for more information or to schedule an appointment:
https://chicagoarthritis.com/contact-us/

MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses musculoskeletal imaging for arthritis and tendinitis, shoulder pain, shoulder arthritis, joint instability, early rheumatoid arthritis.

Weekly Education Broadcast live- 20200720

Weekly Education- 20200720

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Weekly Education Broadcast live- 20200720

-Bone Spurs, when are they significant?
-Instability and Regenerative medicine.
-Cases where bone spurs are not significant and can just be followed.
-Cases where treating can be helpful- calcific tendinitis, tendon impingement.

Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain.
Watch live on FB/IG/Youtube Monday at 9am cst.
https://www.Instagram.com/ChicagoArthritis
https://www.Facebook.com/ChicagoArthritis
https://www.youtube.com/c/chicagoarthritis

***For more educational content:
Sign up for our email newsletter:

Subscribe to our Newsletter

See our blog:

Chicago Arthritis Blog

Listen to the Regenerative Medicine Report podcast:
https://chicagoarthritis.com/regenerative-medicine-report/

***For evaluation and treatment at Chicago Arthritis and Regenerative Medicine:
Determine if you are a Regenerative Medicine treatment candidate:

Candidate Form

Contact us for more information or to schedule an appointment:
https://chicagoarthritis.com/contact-us/

MEDICAL ADVICE DISCLAIMER: All content in this message/video/audio broadcast and description including: infor­ma­tion, opinions, con­tent, ref­er­ences and links is for infor­ma­tional pur­poses only. The Author does not pro­vide any med­ical advice on the Site. Access­ing, viewing, read­ing or oth­er­wise using this content does NOT cre­ate a physician-patient rela­tion­ship between you and it’s author. Pro­vid­ing per­sonal or med­ical infor­ma­tion to the Principal author does not cre­ate a physician-patient rela­tion­ship between you and the Principal author or authors. Noth­ing con­tained in this video or it’s description is intended to estab­lish a physician-patient rela­tion­ship, to replace the ser­vices of a trained physi­cian or health care pro­fes­sional, or oth­er­wise to be a sub­sti­tute for pro­fes­sional med­ical advice, diag­no­sis, or treatment. You should con­sult a licensed physi­cian or appropriately-credentialed health care worker in your com­munity in all mat­ters relat­ing to your health.

***About this video***
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses bone spurs and pain.