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Ask the Doctor – Theodore Gregorius, M.D.

Q: I’m experiencing shoulder pain – will I need surgery?

A: Everyone in their life will experience some shoulder pain at some point, whether by lifting something incorrectly, throwing something or an impact to their shoulder. Shoulder injuries affect patients from 10 years old to 91 years old because the shoulder affects daily function from combing our hair, brushing our teeth and we take it for granted until we have difficulty performing these basic activities. Statistically, by age 60, about 30% of people can have an asymptomatic tear in their rotator cuff (which is a group of muscles in your shoulder), meaning they may feel pain but not be aware of how severe their injury is.

We send approximately 80% of shoulder patients go to physical therapy first for 4-6 months to strengthen their shoulder and rotator cuff before we consider surgery. However, if you hear a “pop” in your shoulder, you need to be seen immediately by an orthopedic specialist to determine how severe the tear or dislocation in your shoulder is. Surgery is typically only considered with an acute tear, which occurs when you hear a “pop” and can no longer lift your arm. If you go from super high-functioning to immediately losing motion in your shoulder, then you will likely need surgery.

There are two standard types of surgical repair, and one emerging surgical technique that we are performing more regularly for the shoulder. The first is arthroscopic shoulder repair, a minimally invasive surgery where we “scope” the ball and socket to repair and tighten the rotator cuff. The second most common surgery is shoulder replacement, which we typically use with patients who have severe arthritis and badly torn rotator cuff injuries.

Another emerging surgery that we are well positioned to do at Hoag Orthopedic Institute (HOI), over the past 3-5 years, called Superior Capsular Reconstruction (SCR). HOI is one of the only locations with surgeons experienced in arthroscopic superior capsule reconstruction (SCR) surgery, and we have hundreds of successful outcomes every year. During SCR, we take a skin graft and arthroscopically transplant that onto the socket instead of a full shoulder replacement. We have patients who have been diagnosed with an “irreparable cuff” and with SCR, they can return to a high level of function.

One of the benefits of seeking care with experts at Hoag Orthopedic Institute is that you have experts dedicated specifically to different areas of orthopedics, including shoulder specialists. Each staff member and physician at HOI knows what they are doing inside and out and it’s the team approach that makes HOI unique. Our staff are so well trained in their respective areas that the surgeries are seamless, which is why we have low complication rates.