My shoulder pain isn’t getting better. What can I do about it?
Q. I am a 45-year-old recreational tennis player that has had right shoulder pain for three months. Initially, my shoulder only hurt while serving, but the pain has steadily worsened. Over the last month, I have noticed a progressive loss of motion and night pain that wakes me from my sleep.
I have recently taken a break from tennis. Unfortunately, Ibuprofen has afforded me little relief. What is my next step so I can get some relief?
A. Many patients between 35 and 50 years of age develop shoulder discomfort. The pain may not require an injury to begin, but then it worsens. Usually, there is an overknown use component to the onset of symptoms such as working out, lifting weights or tennis.
There are four muscles in the shoulder that blend together to form a tendon that allows us to rotate the shoulder. This tendon is called the rotator cuff and on top of this tendon sits a layer of tissue called a bursa. When the tendon is inflamed, it becomes irritated and painful and this is referred to as tendinitis. The bursa can also become inflamed and thicker and this is called bursitis.
When both tendinitis and bursitis occur together, these soft tissues can rub or impinge between the ball part of the shoulder and the other bones. This “impingement syndrome” may result in painful motion and weakness.
Some patients in your age group stop moving the shoulder in its full range and scar tissue develops further limiting motion. This condition is as a frozen shoulder and it may be progressive if not treated. This condition is particularly common in women and diabetics.
I recommend you see an orthopedic surgeon for an exam, X-rays, and possibly an MRI scan. Most patients with impingement syndromes and frozen shoulders recover nicely with physical therapy but the recovery can take a number of months.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net
Q. I want to do cool sculpting because I heard it’s a great way to get rid of fat. One of my friends had this done and told me that it actually made her area look worse. Is this possible?
A. Cool sculpting is a great procedure that does improve fat around different areas of the body.
This is not like having liposuction, where you need a significant amount of downtime and many liters of removal.
Essentially, your fat area is cooled, causing lipolysis. Over a period of several months, the fat dissolves and disappears. With the new equipment, there have been few cases of what you are worried about.
The concern you have is a problem called paradoxIt ical adipose hyperplasia (PAH). This is a situation where instead of having the fat being dissolved, it gets hard and appears to be bigger than before your cool sculpting was undertaken.
Fortunately, this problem is rare and may be corrected with traditional liposuction. While this is not ideal, as the patient will have to undergo the recovery and the treatment of a surgical procedure, the company will pay for repairing the problem.
is important that when anyone undergoes any procedure, he or she should ask about the risks and the possibilities of complications.
As a former patient, I did this at least seven to 10 years ago when it first came out, and it was a procedure with minimal downtime and great results.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email questions to him at Cwolf@miamiplasticsurgery.com.