Biceps and Shoulder Pain

People with shoulder pain often assume they’ve injured their rotator cuff, but sometimes that is not the only culprit. Shoulder specialist and orthopedic surgeon Dr. Marc Kowalsky of ONS notes that an injury to the tendon of the biceps, the prominent muscle in the upper arm that made Popeye and spinach famous, can cause shoulder pain and other uncomfortable symptoms such as clicking or popping.

“The biceps tendon is an often-misunderstood structure of the shoulder and arm,” said Dr. Kowalsky. “We now know that damage to that tendon is often the primary cause of shoulder pain in active people.”

Anatomically, the biceps muscle has two tendons, called heads, that attach it from the elbow to the shoulder. The tendon of the short head attaches to a bone on the shoulder blade outside of the joint. The long head, usually the source of the pain, takes a circuitous path into the shoulder joint and attaches to the top of the socket and the glenoid labrum.

As with any other tendon in the shoulder, the biceps can develop tendonitis and tears as a result of repetitive, strenuous overhead activities. Pain from biceps tendonitis or partial tearing typically occurs over the front of the shoulder, and radiates toward the biceps muscle. If the biceps tendon fully tears or ruptures, patients may notice bruising and a cosmetic deformity as the muscle descends and becomes more prominent, in what is known as a “Popeye sign”. Lastly, the biceps tendon can be affected by instability, particularly in certain overhead athletes including swimmers. Biceps instability can also occur in association with a particular tear of the rotator cuff tendon in the front of the shoulder. When this happens, pain is caused because the biceps has slipped from its bony groove of the upper humerus (head of the arm bone).

Most patients with tendonitis, a partial, or complete rupture of the long head of biceps can be treated conservatively, with a combination of ice, anti-inflammatory medication, physical therapy, and corticosteroid injection, said Dr. Kowalsky. Although the cosmetic deformity from a complete rupture will persist, once the pain from the acute rupture improves, strength and overall function of the shoulder should return to normal. If conservative measures fail to relieve symptoms from biceps problems, surgery may be recommended.  If you experience shoulder pain, consult with a fellowship-trained shoulder  specialist at ONS. 

ONS Dr. Seth Miller is Featured in WAG

Top shoulder surgeon Dr. Seth Miller is featured in an article titled “A (Medical) Shoulder to Lean On” in the October issue of  the Westchester magazine, WAG. The piece, written by Jane Dove, was released online on September 26, 2017.  Ms. Dove delivers a comprehensive view of Dr. Miller’s distinguished career and founding prinicple of ONS, one of the region’s premier orthopedic and neurosurgical practices.  She is also able to capture the unique formula that sets ONS apart from the competition:  the highest standard of care, the collaborative approach among specialists in the practice and patients, and the compassion for patients’ individual conditions and treatment goals.

The entire article is copied below:

A (MEDICAL) Shoulder to Lean On  by Jane Dove

“I am personally very proud of our practice — Orthopaedic & Neurosurgery Specialists (ONS) and the way we treat each patient as an individual,” says Seth R. Miller, an orthopedic surgeon who specializes in arthroscopic shoulder surgery and shoulder replacement.

With offices in Greenwich and Stamford and now Harrison, ONS takes a conservative approach to patient care. “We recommend surgery to only about 10 percent of our patients,” says Miller, who is also a clinical assistant professor of orthopedic surgery at the Hospital for Joint Diseases; a staff orthopedic physician at Greenwich Hospital and an assistant attending physician in orthopedic surgery at New York-Presbyterian Hospital. “We want to make sure it is really needed, because we realize that surgery in any of our subspecialties is a traumatic event for our patients. If it can be avoided, so much the better.”

A leading specialist in shoulder replacement surgery with 1,000 total shoulder and reverse shoulder replacements to his credit, Miller helped found ONS in 1998. There he remains committed to providing excellent orthopedic and neurosurgical care through professional cooperation while showing compassion for patients. By setting the highest of standards, ONS can offer patients a wide range of choices that leads to the best possible outcomes.

“For example, if needed, we will have two surgeons involved in a complicated procedure,” he says. “We do everything we can to ensure the results our patients get are the very best possible. And we deliver those results with compassion and understanding along the way.”

SPOTLIGHT ON SHOULDERS

After graduating from Harvard University in 1978, Miller went on to get his M.D. at the Mount Sinai School of Medicine, followed by a residency in general surgery and then a sought-after one-year residency in shoulder surgery at Columbia-Presbyterian Medical Center.

“I studied under the renowned Dr. Charles S. Neer, who offered me this wonderful opportunity,” he says. “I was always interested in the shoulder and had a great year with him, from l988 to 1989. At about the same time, I met another shoulder specialist who invited me to join him at Greenwich Hospital.”

Miller says Greenwich had many orthopedic surgeons on staff but most practiced in the general area. “I did my share of general orthopedic surgery but really wanted to do as much shoulder surgery as possible. I spoke with several other subspecialists who, like me, wanted to improve patient care by combining several of our doctor’s groups into one entity.”

In 1998, the group took the plunge and founded ONS, starting with only eight physicians.

EXPANSION

ONS now has 22 subspecialty physicians trained in orthopedic surgery, sports medicine, physical medicine and rehabilitation.

“Things really took off when patients realized they could get specialty care of the highest quality right in Greenwich. We now have two specialists for every part of the body.”

The successful reception ONS earned from the local patient community there led to its expansion, first to Stamford and then to a new facility in Harrison.

Miller says he believed one of the keys to the success of ONS has been the one-stop approach the practice offers.

“Our patients just love that we can provide so much under one roof,” he says. “Everything is right here and there is no need to trek from outside office to outside office for tests, scans and blood work. We function as a team of doctors and other medical professionals, working closely and seamlessly together.”

If a question about care or a procedure that can best be answered by another specialist comes up, Miller says, “All we have to do is walk down the hall. Patients find this very comforting and we pride ourselves as working as a collaborative team. At ONS you get the best possible care all under one roof. While our practice is large, it is very effective and attuned to the patient, what he or she really needs.”

SATISFIED PATIENTS

He believes ONS is well-served, as are its patients, by not being a part of a larger patient care “network system.” The proof is in the response. “We get positive feedback in the 96 to 97 percent range,” he says.

“As a result, we are not controlled so much by cost-cutting to enhance the bottom line of the network. As a private practice, we control our own destiny and even have our own foundation. We are free and now big enough to control our financial destiny on our own.”

Double Shoulder Replacement Restores Mobility

Shoulder replacement regains his active lifestyle just months following surgery.

Arthritis had taken its toll on Dave’s shoulders. He was in constant pain. Sleeping was difficult and it was nearly impossible for him to take part in activities that he loves.  Then, two friends with similar shoulder issuesD.Hapke in Kayak referred Dave to shoulder surgeon, Dr. Seth Miller at ONS.  “When I met him, I immediately knew he was the doctor I wanted to care for me. He was thorough, thoughtful and patient. He has a great bedside manner and took the time to completely answer all my questions,” he recalled. 

Dave had his first shoulder replacement in January, 2013; the second one was done a year later. In both instances, the therapists had him doing exercises the day after surgery, which he continued at home within the week. Through a physical therapy program over the next few months, Dave was able to build muscle mass to help support his new shoulders.

Just 16 weeks after surgery, Dave was back on the water kayaking pain free. These days, he goes to the gym 2- 3 times a week and kayaks quite a bit on ponds, lakes and streams. He can even carry his  kayak.

“I am so grateful to have my active life back, thanks to ONS!” he said.

Shoulder replacement surgery and reverse shoulder replacement surgery is not for everyone. In many cases, treatment such as icing, anti-inflammatory medication and physical therapy can help get shoulder pain from arthritis under control. However, if pain persists, as it did with Dave, it may be time to consider a surgical option, notes Dr. Miller.

With arthritis and some fractures and injuries, the cartilage of the shoulder gradually wears away, creating a situation where bone is rubbing against bone. The resulting inflammation is extremely painful and makes shoulder mobility progressively more difficult. This condition typically develops later in life and gets worse over time.

The shoulder replacement procedure replaces the damaged joint with a highly-polished metal ball attached to a stem and a plastic socket. As long as a patient has an intact functioning rotator cuff, it can be an extremely successful procedure.

However, there is a group of patients that not only have significant cartilage damage in their shoulder, but also have a torn rotator cuff that is beyond repair. The rotator cuff is a group of muscles that run from the shoulder blade to the upper arm and allows patient to elevate their arm. Twenty years ago, treatment options were limited. In 2004, the FDA approved a reverse shoulder replacement procedure that was being used successfully overseas.

The surgery takes about two hours and involves a small incision, usually about three to four inches in length. Patients can expect to stay in the hospital somewhere from one to three days. Patients will be released with their arm in a sling, and undergo exercises to reestablish range of motion with the joint.

Between four and eight weeks after surgery, patients should be able to raise their arms above their heads without pain. Three to four months after surgery, patients are gradually resuming the activities of daily living. Many patients remark after recovery that they feel like they’ve been given their life back.

ONS’ Dr. Seth Miller was one of the first in the metropolitan area to perform reverse shoulder replacement surgery. He will take part in a Joint Replacement Symposium at Greenwich Hospital with ONS colleagues and joint replacement surgeons Drs. Frank Ennis and Brian Kavanagh.

The event will be held on Wed. May 11 starting at 6 p.m.  To register, call 203-863-4277 or online.

Shoulder Pain? (Part II)

Shoulder_Pain_blogRemember last week’s post? Dr. Kowalsky ended the last installment with listing a multiple options one could take to repair a rotator cuff tear due to the fact that it is very unlikely for the condition to heal on its own. The following is a more in depth description of what makes up this part of the body and what to do after the symptoms of arthritis of the shoulder appear.

The glenohumeral joint of the shoulder includes the humeral head, or ball, and the glenoid, or shallow socket.  Both joint surfaces are coated with articular cartilage, the pearly-white, smooth surface that allows near friction-free, painless movement of one surface on another.  Typical wear-and-tear osteoarthritis occurs due to the degeneration of the joint surface.  As the articular cartilage erodes, the underlying bone can become exposed, change in shape, and create symptoms.  Patients typically present with pain deep within the joint.  The pain can be associated with mechanical symptoms, such as catching, clicking, or grinding, as well as loss of motion.  For some patients, typically those with mild or moderate arthritis, there is a role for conservative management.

However, the most reliable means for pain relief, improved motion and function for patients with moderate or severe arthritis is shoulder replacement.  This procedure is performed by removing and replacing the arthritic ball with a metal implant, and by resurfacing the socket with a plastic implant, restoring low-friction, pain-free motion. Implant design and surgical technique for the treatment of both rotator cuff tears and shoulder arthritis continue to evolve.   These innovations empower shoulder and elbow surgeons to individualize the treatment plan to a specific patient and problem.

Tonight, March 12 at 6:30 pm at Greenwich Hospital,  Dr. Kowalsky will give a health talk on “Common Causes and Solutions to Chronic Shoulder Pain” will discuss the causes, symptoms, and treatment of rotator cuff tears and shoulder arthritis.  The event will highlight important recent advances in the management of these conditions that have been associated with improved long-term outcomes.

The program is free and open to the public.
Registration Requested. Call (203) 863-4277, or register online at www.greenhosp.org.

Talk on Shoulder Injuries and Treatments at Greenwich Hospital

The shoulder is the most mobile joint in the human body, with a range of motion of nearly 360 degrees.

Orthopedic Surgeon Tim Greene, MD of ONS on Valley Drive

The complex mechanics of the shoulder make it vulnerable to certain injuries.  Sports medicine specialist Tim Greene, MD, will discuss shoulder injuries, the common causes of shoulder pain and the most effective treatments from physical therapy to minimally invasive surgeries.

DETAILS

Speaker:  Tim Greene, MD Orthopaedic & Neurosurgery Specialists
Date:  Tuesday, October 4, 2011
Time:       6:00pm – 7:30pm
Location:  Noble Conference Center
Contact phone number:  203-863-4277 or 888-305-9253 or register online atwww.greenwichhospital.org
Fee:  None