There are a lot of causes of shoulder pain. Fortunately, the minority of these causes are surgical. Most of the reasons you may have shoulder pain can be treated without surgery. The first thing we have to do is make a diagnosis. Usually that is made from a physical exam. We also listen to you talk about your shoulder, how it started hurting and how it feels. That can give us a lot of clues. Then we proceed with imaging, starting with a plain x-ray, usually the most basic test we do. We get that x-ray back and we can tell if someone has severe arthritis, though a lot of the time shoulder x-rays look fine.

The next step after that would be an ultrasound, which we can do in office, to see if there’s a rotator cuff tear or a labrum tear. If we need more detailed information, we will order an MRI. We may inject dye into the shoulder to get the MRI, or sometimes we get what’s called a plain MRI. An MRI can give a lot of detail in the shoulder. We can see rotator cuff tears, whether a full or partial tear. When we see the patient back after the MRI to review the results, we can give a series of options.

Most of the time, the first option would be some sort of injection, either a steroid injection or a regenerative medicine treatment, such as a PRP or platelet-rich plasma injection. Sometimes, the patient will only need some physical therapy or a home therapy program. Less than 50% of the time, we’ll see something on the MRI that says the patient is probably going to need surgery and won’t improve without it.
We’ll give people percentages for success. For instance, we’ll state we think therapy will have a 20%, or 50%, or 80% chance of working. We’re not going to prescribe therapy or an injection if we don’t think it’s going do any good or if it’s a waste of time. If there is a tear on that MRI that needs surgery for instance, then we’ll have that conversation with the patient. The vast majority of the time surgery is not the only option.