If you find yourself rubbing your shoulder after reaching up to take a coffee mug off the shelf, hammering in a nail just over your head or climbing into a pickup cab, you're among millions of Americans — particularly those over 60 — with a shoulder issue. Shoulder pain could be a sign of arthritis, tendonitis, a rotator cuff tear or shoulder instability.

Whatever the cause, you may want to consult with an orthopedic professional. That first meeting will include a health history, physical exam and possibly an X-ray to determine the underlying cause and extent of your shoulder issue. Sometimes additional imaging, such as an MRI, may be needed.

Your orthopedic professional will walk you through treatment options and help you decide what may be the best for you. The first line of treatment can include:

• Taking over-the-counter anti-inflammatory medications.
• Resting of the affected shoulder/arm.
• Icing the shoulder.
• Modifying your activities to avoid further injury.
• Undergoing steroid injections.
• Doing physical therapy to strengthen the muscles of the shoulder and arm.

Many studies show that people with shoulder injuries respond well to these treatments and are able to go about their daily activities. However, if you're still experiencing pain and weakness, your orthopedic professional may recommend surgery.

One cause of pain and weakness is a rotator cuff tear. The rotator cuff is a group of muscles and tendons. It holds the shoulder joint in place and assists in arm motion and strength. If the MRI reveals a tear in the rotator cuff, it may require surgery, although the vast majority don't.

Typically, surgery is outpatient, and you can go home the same day. In this procedure, the surgeon inserts a tiny camera (arthroscope) and tools through small incisions to reattach the torn tendon to the bone. You may need to wear a sling for four to six weeks following surgery to allow your shoulder to heal.

After four to six weeks, you may still have some work restrictions and need to modify your activity. Your orthopedic professional also may recommend physical therapy.

Whether you respond to noninvasive treatments or need surgery, your orthopedic professional's goal is to relieve your aching shoulder so you can go about your daily activities without pain or restrictions.

Mark Wikenheiser, M.D., practices Orthopedics in Fairmont, Minnesota.  

The post Why does my shoulder ache? appeared first on Mayo Clinic News Network.

Applying regenerative medicine to a common shoulder surgery could have an impact on the need for follow-up revision surgery in some patients, according to a Mayo Clinic study of real-world evidence.

Mayo Clinic researchers analyzed the largest set of data available to determine if adding bone marrow aspirate concentrate to repaired tissue after standard rotator cuff surgery would improve outcomes for patients. Bone marrow aspirate is fluid taken from a patient's bone marrow that contains concentrated growth factors, stem cells and other specialized cells that may regenerate tissue and cartilage.

The analysis identified 760 patients who had a regenerative intervention added to augment rotator cuff repair surgery. Those patients were compared to 3,888 patients who did not have any biologic intervention at the time of surgery. The data indicated that 114 patients who opted for bone marrow aspirate concentrate at the time of surgery were less likely to need a second surgery.

The results of the Mayo Clinic study are published in the Orthopaedic Journal of Sports Medicine.

"The data we analyzed suggested a nearly threefold reduction in revision surgery in patients who received bone marrow aspirate concentrate, compared to those who did not," says Bradley Schoch, M.D., an orthopedic surgeon and principal investigator. "This procedure is growing in use throughout the practice of orthopedic surgery and commonly added as a surgical adjunct to rotator cuff tears."

A rotator cuff tear — the separation of tendons from the shoulder joint — is a leading cause of pain and disability for millions of people in the U.S. Arthroscopic surgery is the standard of care for repairing symptomatic rotator cuff tears. However, depending on the size of the tear and quality of the tendon, this surgery can fail, sometimes requiring revision surgery.

Regenerative medicine is an emerging field that is seeking new biotherapeutics to restore damaged cells, tissues and organs. One area of focus is on biologics that use sources from the human body — cells, blood, enzymes, tissues, genes or genetically engineered cells — for use in medicines. Mayo Clinic's Center for Regenerative Biotherapeutics is at the forefront of this movement and supports this study as part of its objective of delivering new regenerative biotherapeutics to the practice.

Studying real-world evidence

Preclinical research suggests potential benefits of orthobiologics, such as bone marrow aspirate concentrate, for healing damaged tendons. A few clinical trials have been conducted to try to establish scientific evidence of healing in humans. However, insurance considers orthobiologics to be experimental and does not reimburse for these procedures.

To accelerate Food and Drug Administration (FDA) approval of promising therapies, Congress passed the 21st Century Act in 2016 that allows data from real-world evidence to support regulatory decision-making. The FDA may now consider data from sources other than clinical trials, such as risks and benefits documented in electronic health records, lab reports and billing activities. In this Mayo Clinic study, researchers examined data from large insurance billing codes.

"The primary purpose of this study was to utilize a national administrative database to determine the association of bone marrow aspirate concentrate applied at the time of rotator cuff repair on revision surgery rates, compared to matched controls. It offers additional support to randomize control trials that often take years to complete and often are not definitive," says Shane Shapiro, M.D., an orthopedist and medical director at Mayo Clinic's Regenerative Medicine Therapeutic Suites in Florida. "This type of study allows stakeholders and health insurance companies to assess the risks, benefits and economic value of emerging medical interventions."

"Our results suggest patients undergoing rotator cuff repair surgery may benefit from the addition of bone marrow aspirate cells to surgically repair tissue," says Christopher Camp, M.D., a Mayo Clinic orthopedic surgeon and co-author of the study. "However, the exact therapeutic mechanisms of its action are still somewhat unclear."

The study team also analyzed the results of 646 patients who chose platelet-rich plasma at the time of rotator cuff repair surgery and found no measurable difference, compared to patients with no regenerative interventions. Platelet-rich plasma, also known as PRP, is an orthobiologic procedure in which platelets containing growth factors and healing potential are spun from blood and given back to the patient at the point of injury. Platelet-rich plasma has shown potential to ease other conditions, such as knee arthritis.

Clinical trials may offer more robust documentation of the benefits of orthobiologics for rotator cuff injuries. Higher-level clinical studies focusing on surgical factors will be needed to confirm whether bone marrow aspirate concentrate can prevent the need for a second rotator cuff repair surgery.

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Dr. Joaquin Sanchez-Sotelo, a Mayo Clinic shoulder surgeon, explains a new balloon procedure that's helping some patients with irreparable rotator cuff tears recover faster with less pain.

Watch: How a new rotator cuff balloon procedure helps some patients get better

Journalists: Broadcast-quality video (1:33) is in the downloads at the end of this post. Please "Courtesy: Mayo Clinic News Network." Read the script.

"When there is a tear of the rotator cuff, in many individuals, it is possible to do a primary repair of the tendons. However, in some individuals, there is such extensive damage to the tendons that the tendons cannot be fixed primarily," explains Dr. Sanchez-Sotelo.

That condition is called an irreparable rotator cuff tear, and while operations can fix it, they can be invasive. However, for some of these patients, a new less-invasive balloon procedure could be the answer.

"This procedure basically tries to place a temporary spacer between the humeral head and the rest of the scapula (shoulder blade). In a normal shoulder, when the rotator cuff is intact, the head of the humerus remains centered on the socket. When the tendons are torn, what happens is that the humeral head will migrate up and then the bones contact abnormally. And we think that that contact becomes painful also. The joint is now 'out of socket,' and then the other remaining muscles cannot really work well," he explains.

"We place an inflatable device that occupies the space where the rotator cuff tendons are supposed to be. The humeral head is now prevented from contacting with the acromion And because the head remains more centered, it is easier for patients to do rehabilitation and retrain the muscles that are still intact to maintain a healthy and functional joint."

The saline-filled balloon eventually dissolves in the body in about a year. The benefits are that the operation can be performed through a minimally invasive technique, and recovery is fast.

"For the right patient, I think it is possible that this could be a game-changer in the treatment of this condition."

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Regenerative Medicine Minnesota, a statewide bipartisan initiative, has awarded five grants to Mayo Clinic investigators to advance new therapeutic options for osteoarthritis, liver disease, rotator cuff injuries and neurological birth defects.

People in Minnesota and beyond struggle with chronic diseases such as heart disease, arthritis and diabetes, and standard care doesn't always ease the symptoms.

Regenerative Medicine Minnesota awards approximately $4.35 in funding statewide every year to advance new treatment options that are safe and effective through regenerative medicine research, technology and patient care. This year, more than $1.47 million will go to Mayo investigators who seek new ways to tap the body's ability to regenerate itself.

Regenerative Medicine Minnesota grant award winners at Mayo Clinic are:

Clinical Trial Awards

Aaron Krych, M.D.

Dr. Krych was awarded $470,224 for "Mesenchymal Stem Cells-Facilitated Cartilage Recycling for Hip Defect."

Hip cartilage damage is a painful condition with few therapeutic options beyond a total prosthetic replacement. Left untreated, hip injuries lead to osteoarthritis and deterioration of the entire joint. This grant will fund a phase 1 safety study of cell-based cartilage regeneration at Mayo Clinic for hip injuries.

A patient's damaged cartilage will be extracted and mixed with mesenchymal stem cells and implanted back into the hip in a single arthroscopic procedure. Mesenchymal stem cells are adult stem cells with growth factors and healing potential.

The trial brings together a team of experts in orthopedic surgery, sports medicine, cell therapy, molecular biology and radiology to explore a minimally invasive potential treatment for hip cartilage defects.

Discovery Science Awards

Qiuying Liu, Ph.D.

Dr. Liu was awarded $250,000 for "Mechanistic Studies on a Congenital Hydrocephalus Causing Mutation in TRIM71."

Congenital hydrocephalus is a buildup of cerebrospinal fluid on the brain at birth that affects 1 of every 1,000 births. Pressure on the brain can cause brain damage or physical disabilities.

This rare condition has been linked to mutations in the Trim71 protein coding gene. However, the molecular basis for disease progression related to this genetic mutation remains poorly understood.

The Regenerative Medicine Minnesota grant will fund research into how the molecular mechanism of Trim 71 produces congenital hydrocephalus.

Rory Smoot, M.D.

Dr. Smoot was awarded $250,000 for "Augmenting Liver Regeneration at the Single Cell Level."

The goal of this research is to find ways to prevent and treat liver failure due to impaired liver regeneration. The research team will investigate how the molecule YAP can be targeted with medications that can activate a regenerative pathway and speed liver regeneration.

The findings could provide new treatments that trigger liver regeneration in patients, which is an important need, as no medications exist for these patients. 

Jennifer Westendorf, Ph.D.

Dr. Westendorf was awarded $250,000 for "Development of Novel Proteolytic Targeting Chimeras That Promote Cartilage Regeneration."

Osteoarthritis is a leading cause of disability that occurs when cartilage that cushions joints breaks down due to injury, age or inflammation. Once that happens, no approved treatment is available to reverse cartilage loss or stop the progression.

Dr. Westendorf's team will probe on a molecular level how cartilage cells form and the role that plays in cartilage regeneration. The team will study proteins PHLPP1/2 that block the repair of cartilage to better understand the molecular mechanisms of cartilage degeneration.

The goal is to apply the findings to targeted therapies for cartilage regeneration that modify osteoarthritis.

Translational Research Awards

Chunfeng Zhao, M.D.

Dr. Zhao was awarded $250,000 for "Purified Exosome Product for Rotator Cuff Repair and Regeneration."

A rotator cuff tear is a common shoulder injury that affects up to half of people over 50, and the prognosis for healing is poor. Between 20% and 90% of those who have surgery to repair shoulder damage will retear their tendons.

This grant will fund research into a possible biologic treatment derived from human blood known as purified exosome products, which are extra cellular vesicles that send targeted healing messages into exact cells in need of repair.

Dr. Zhao's team will mix the biologic with fibrin glue used to close wounds and test in animal models to understand its potential to regenerate rotator cuff injuries.

Regenerative Medicine Minnesota has made 214 grants totaling $34.5 million since 2014 to advance regenerative medicine in research, biobusiness and education.

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DEAR MAYO CLINIC: Our family recently moved to a state that has plenty of cold, ice and snow during the winter. While my children are excited, I have heard stories about how common shoulder injuries are during the winter due to shoveling snow and other activities. I have arthritis in one of my shoulders. What advice do you have for how to avoid injuring my shoulder?

ANSWER: Unfortunately, the numbers don't lie. In Mayo Clinic's orthopedics practice, the number of people who need care due to shoulder injuries increases substantially during the winter. While wrist fractures, and other hand and arm injuries, are common, too, during the winter, the burden of work that falls on the shoulder increases the risk of injury.

Shoveling snow is one activity that can really strain the shoulder. Lifting and throwing heavy piles of snow, or accidentally hitting hard ice hidden beneath the snow with a shovel, can result in shoulder damage, especially in someone who already has a delicate shoulder. People who have been diagnosed with shoulder arthritis and those who have even a small rotator cuff tear need to take extra care in the snow and ice. Lifting too much snow with a shovel can aggravate the arthritis or further damage the rotator cuff.

In general, before shoveling snow, most people should perform shoulder exercises to stretch and warm up. And if you feel pain building up in your shoulder, consider that a sign that it's time to take a break instead of ignoring the warning. Go inside, get some coffee, tea or hot chocolate, and let your shoulder recover.

If your shoulder is painful — and to reduce risk for injury — you may be better off looking to alternatives, such as hiring a snow removal service, using a snowblower, or, at a minimum, taking your time and shoveling smaller piles of snow one at a time. And, again, be mindful of any increased pain, as that is a sign your body needs attention.

More often, bad shoulder injuries occur in winter because of a fall. Those who live in colder climates know how slippery ice can be. It is so easy to fall with one misstep. And, typically, no one sees it coming. Fortunately, many people are left with a bruise that will be painful for a while, but they will have no lasting consequences. However, it is easy to suffer an acute rotator cuff tear. When that happens, it is important to seek prompt medical attention.

Tears of the rotator cuff fall into two major categories: sudden injury and injuries over time due to chronic wear. Most rotator cuff tears are due to chronic wear, and many people respond to physical therapy as far as treatment to regain range of motion. However, when the rotator cuff tears as a consequence of a sudden injury, surgery is oftentimes necessary and more importantly time-sensitive. Surgical repair of these so-called acute tears can restore normal shoulder function, provided the repair is performed almost right away. However, if an acute tear is missed, and surgical repair is attempted later, the chances of success decrease as the torn tendons retract and stiffen, and the muscle fibers degenerate into fat.

But how would you know if you tore your rotator cuff? Loss of motion is key. If you fall only to realize you cannot move your shoulder when you stand up from the ground, you should be concerned. The following two to seven days will be important in terms of seeking care and treatment. If you cannot lift your arm much, even after a week, it is time to see your primary care provider and be evaluated with radiographs and, most likely, an MRI or ultrasound. If your cuff tendons are found to be torn because of an injury, you should be referred to a shoulder specialist right away.

In some cases, however, a fall on the ice will lead to substantial injuries, including fracture of the collarbone or humerus, dislocation of the shoulder joint, and a shoulder separation. In those circumstances, pain is severe, and most people should choose to go to the emergency department right away.

The best advice for avoiding an injury is to always be cautious when walking outside, use proper footwear, make sure walkways and driveways are clear of ice and snow, use salt on your walkways frequently, and do not walk in a rush. It is easy to take a fall and injure your shoulder. In the event that you do suffer shoulder pain or an injury, seek out a shoulder specialist who can guide you to the best treatment. — Dr. Joaquin Sanchez-Sotelo, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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Related Articles 

• Mayo Clinic Q and A: Rotator cuff injuries and surgery published 8/4/21
• Shoveling snow safely published 2/1/21

The post Mayo Clinic Q and A: Shoulder injuries and winter weather safety tips appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I am 48, and I have been playing tennis for years. I also swim regularly. Recently, I have been experiencing pain in my right shoulder every time I hit the court and when I try to lift objects at home. How do I know if I tore my rotator cuff? What are the options for treatment, and can I get back to playing?

ANSWER: People can injure their rotator cuff in several ways. Accordingly, it can be hard to know if that is the primary source of your shoulder problems. For some people, a distinct injury or accident results in a rotator cuff tear. For others, it could be a slow, gradual increase in pain over time. For those with distinct injuries, these usually occur when trying to lift heavy objects overhead or lifting things away from the body. You also can injure your rotator cuff during traumatic falls or accidents.

Generally speaking, rotator cuff problems tend to produce three main symptoms: shoulder pain, decreased shoulder motion and weakness. Although most patients will have some level of each of these symptoms, not everyone with a rotator cuff tear will have all three symptoms.

In terms of the pain, if you have a rotator cuff injury, you typically have pain over the lateral, or outside, portion of the shoulder, around the deltoid muscle. This pain generally worsens when you try to lift your arm overhead or lift objects away from your body.

Other injuries around the shoulder can result in similar symptoms. Some of the more common injuries are biceps tendinitis, acromioclavicular joint injuries or arthritis. Patients with biceps tendinitis tend to have pain in the front of the shoulder, and those with acromioclavicular joint injuries tend to have pain on top of the shoulder.

Understanding where your pain is originating from can help differentiate these problems from pain caused by your rotator cuff. If you have pain on the lateral, or outside, part of your shoulder with decreased range of motion and difficulty lifting objects, you may have a rotator cuff injury. Oftentimes, this can be some mild tendinitis that will improve with a few days of rest. However, if your symptoms are severe or they persist for more than one or two weeks, it makes sense to talk to your health care provider. He or she can typically diagnose a rotator cuff tear based on your symptoms, a physical exam, and potentially imaging, such as X-rays and an MRI.

When I diagnose a patient with a rotator cuff injury, the most common question I get is whether surgery is necessary. If you have been diagnosed with a rotator cuff injury, treatment may vary depending on the severity.

For most patients with tendinitis, which is inflammation of the rotator cuff tendon without a complete tear, as well as pain and other symptoms, they generally improve without surgical intervention. The most common forms of treatments for this are anti-inflammatory medications; icing the shoulder regularly; modifying your activities, including avoiding heavy lifting and overhead lifting; and physical therapy.

For patients with complete tears of the tendon, the situation is a little bit more complex. If the tear is small or the patient is relatively low risk, some patients with complete tears may still be able to avoid surgery. The treatment plan for them would be the same options listed for tendinitis above. Although physical therapy won't heal the small tears, it can help optimize the other muscles around the shoulder that are still intact, which allows them to compensate for the tendon that has the small tear in it.

For active patients with a complete tear of the tendon, surgery may be optimal because it offers the most predictable and successful way of restoring function.

Rotator cuff repair surgery typically is done as an outpatient procedure through a minimally invasive, or arthroscopic, approach. Using these small incisions can reduce pain and improve recovery long term.

After undergoing rotator cuff repair, the arm is kept in a sling for approximately six weeks after surgery to allow things to heal. After this time, the sling is slowly discontinued, and formal physical therapy is initiated. The early focus of physical therapy is on restoring range of motion. This typically takes three or four months from the date of surgery. Around two or three months after surgery, gentle strengthening exercises are introduced. Then patients will progress to additional rehabilitation.

While there is significant variability, the average overall recovery time following rotator cuff repair is approximately six months. Once everything is healed, we generally allow patients to get back to all activities as tolerated. However, it is a good idea to avoid any unnecessary overhead lifting over the long term. This reduces the risk of having recurrent problems and injuries down the road. — Dr. Christopher Camp, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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Related Articles 

• Mayo Clinic Q and A: Rotator cuff tears — treatment and recovery published 9/25/20
• Mayo Clinic Minute: When should you have rotator cuff surgery? published 9/3/19

The post Mayo Clinic Q and A: Rotator cuff injuries and surgery appeared first on Mayo Clinic News Network.

Learn more about sports medicine. 
Other health tip infographics:
mayohealthhighlights.startribune.com 

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On the next Mayo Clinic Radio program, Dr. John Sperling, an orthopedic surgeon at Mayo Clinic, will cover common shoulder injuries and treatment options including reverse shoulder arthroplasty. Also on the program, Dr. Bart Clarke, an endocrinologist at Mayo Clinic, will discuss osteoporosis. And Dr. Dawn Davis, a dermatologist at Mayo Clinic, will explain why cellulite appears and what can be done about it.

Here's your Mayo Clinic Radio podcast.

The post Common shoulder problems: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. John Sperling, an orthopedic surgeon at Mayo Clinic, will cover common shoulder injuries and treatment options including reverse shoulder arthroplasty. Also on the program, Dr. Bart Clarke, an endocrinologist at Mayo Clinic, will discuss osteoporosis. And Dr. Dawn Davis, a dermatologist at Mayo Clinic, will explain why cellulite appears and what can be done about it.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Common shoulder problems appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. John Sperling, an orthopedic surgeon at Mayo Clinic, will cover common shoulder injuries and treatment options including reverse shoulder arthroplasty. Also on the program, Dr. Bart Clarke, an endocrinologist at Mayo Clinic, will discuss osteoporosis. And Dr. Dawn Davis, a dermatologist at Mayo Clinic, will explain why cellulite appears and what can be done about it.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Common shoulder problems / Osteoporosis / Cellulite appeared first on Mayo Clinic News Network.