Why Is It Important for a Shoulder Specialist to Use Ultrasound?

Injections, Platelet Rich Plasma, Rotator Cuff, Shoulder, Shoulder Arthritis, Shoulder Pain, Shoulder Surgeon, Shoulder Surgery, Sports Injuries, Ultrasound

Why Is It Important for a Shoulder Specialist to Use Ultrasound?

If you are reading this, it is likely that you or someone you know has shoulder pain. It is possible that you tried treatments to improve your shoulder pain without success and are considering a visit with an orthopedic shoulder specialist.

This is certainly a good place to start.

An orthopedic shoulder specialist is expert in the evaluation, diagnosis, and treatment of all shoulder problems including rotator cuff tears, bursitis, instability, and biceps problems. An orthopedic specialist can order and read x-rays, CT scans, MRI studies and has more in-depth knowledge of the shoulder and shoulder problems than any other healthcare provider, including primary care physicians, physical therapists, chiropractors, and nonsurgical sports medicine doctors. Not only can an orthopedic shoulder specialist evaluate your shoulder, but they also provide treatment. It is also important to know that a visit with an orthopedic shoulder specialist does not always mean you will have surgery.

But there are many options out there! It is important that you see a shoulder specialist that uses ultrasound as part of evaluation and treatment of shoulder pain.

If you live in North Carolina, you are in luck! Dr. Johnny T. Nelson, MD is one of those shoulder specialists!

At The Bone and Joint Surgery Clinic, Dr. Johnny Nelson has state-of-the-art ultrasound equipment that allows a high-resolution scan of the rotator cuff and other structures in the shoulder. Along with a physical exam, x-rays, and a short discussion, Dr. Nelson can give you important information about the cause of your shoulder pain.

Doctors that do not use ultrasound are not able to see or evaluate the rotator cuff at the time of evaluation. This often requires an MRI study, which insurance companies will often deny, are expensive, require complicated scheduling, and multiple other visits to obtain. As a result, patients with big rotator cuff tears may possibly be treated with physical therapy, injections, or observation when they should be undergoing rotator cuff repair.

Dr. Johnny T. Nelson is also able to use ultrasound to perform targeted injections that are not possible without ultrasound. These include biceps injections and suprascapular nerve injections, which can be very helpful and more effective than “traditional” blind injections performed without ultrasound.

Do you have shoulder pain? Are you worried that you have a rotator cuff tear? Call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, Raleigh North Carolina shoulder specialist.

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What Is Platelet Rich Plasma (PRP) Therapy?

Injections, Platelet Rich Plasma, Regenerative, Shoulder Pain, Tendonitis, Ultrasound

platelet rich plasma diagr upd 237x300 What is platelet rich plasma (PRP) therapy?

Platelet rich plasma is an emerging technology. This means that it is a new medical technology that is gaining acceptance in the medical world. As more research comes out, we have more information about how platelet rich plasma helps patients.

What is the “treatment gap”?

The treatment gap refers to the fact that for many orthopedic conditions, there is not a good “middle” treatment. Consider rotator cuff tears, bursitis, biceps tendinitis, impingement syndrome, tendinitis of the elbow, or arthritis of the shoulder. On one side there are non-surgery options. These are watchful waiting, physical therapy, chiropractic care, injections with steroid, oral medicines and anti-inflammatories.

On the other side of the treatment gap are more invasive surgical options. These are good options but may not be right for all patients. There is risk to surgery, it requires time away from work, and can be expensive.

Some patients are in the middle. They try all non-surgery options, but these do not provide real or lasting relief from pain. But they are also not able to have surgery either.

This is where Platelet Rich Plasma (PRP) steps in.

Platelet rich plasma therapy can “fill the treatment gap.” Platelet rich plasma is a substance made from your own blood containing a very high level of platelets. Platelets contain many special proteins that can cause a healing process where they are injected.

To make platelet rich plasma, a nurse will draw a sample of blood. Special equipment brings out the platelet rich part. It is then injected either into a joint or other problem area under ultrasound guidance.

All of the special proteins in the platelets send signals to the body. This begins a healing response. After a period of 2 to 4 weeks, patients experience relief from their pain which previously did not respond to other options.

The Bone & Joint Surgery Clinic offers the most advanced non-surgical regenerative options for your pain. Dr. Johnny T. Nelson MD applies advanced ultrasound techniques to ensure proper application of your platelet rich plasma therapy.

Do you want to learn more about platelet rich plasma therapy and orthobiologics? Please call 919-872-5296 to make a visit with Dr. Johnny T. Nelson, MD. Dr. Nelson offers platelet rich plasma therapy for multiple orthopedic conditions.

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When Are Injections Used to Treat Shoulder Pain?

Injections, Shoulder, Shoulder Pain

when are injections used to treat shoulder pain 62767f972a339

When Are Injections Used To Treat Shoulder Pain?

The answer to this question depends on the cause of your shoulder pain as well as the type of injection being considered.

There are two main types of injections used in and around the shoulder, these include steroid medications, which are the most common and PRP or “platelet rich plasma”.

Steroid is a type of medication that is used very frequently in medicine. Some forms of steroid are taken by mouth, some are used through an IV, and others are made to be injected into different locations, including into and around the shoulder joint. Steroids are actually naturally occurring, meaning that we normally have steroid in our body, but the type that is used for injections are slightly different and are made in a laboratory. Steroids work through the inflammation pathway, blocking several molecules that lead to inflammation, redness and pain. Therefore, they are very helpful for treating painful orthopedic conditions.

Dr. Johnny T. Nelson uses steroids for two main reasons in and around the shoulder.

The first reason is if the patient is in severe pain, sometimes this pain is so severe that the patient is not able to start or participate in physical therapy which may be the best treatment for that pain. Also, patients can have pain that is so severe that they cannot sleep, and they cannot work and provide for themselves. If that is the case, the decision is sometimes made to perform a steroid injection.

However in some patients, such as patients with large rotator cuff tears that may require surgery, Dr. Nelson sometimes avoids steroids because there is evidence that steroids impedes and prevents the healing that is necessary after shoulder surgery and rotator cuff repair surgery(1).

The second reason Dr. Nelson uses steroids is to identify the actual cause of your pain. Because there are so many structures in and around the shoulder that can cause pain, sometimes even with imaging, physical examination performed by your orthopedic surgeon, the actual cause of your pain may be unclear. A steroid injection around a structure may help to define or eliminate whether that structure is the cause of the pain. For example, Dr. Nelson often performs injections around the biceps tendon sheath under ultrasound, if the patient’s pain improves, it is very likely the biceps tendon is a cause of the pain.

Okay, what about platelet rich plasma?

Platelet rich plasma is a new technology that shows a lot of promise. Certain patients with certain problems around the shoulder can be candidates for platelet rich plasma therapy. These include patients with bad bursitis, inflammation, partial tearing of the rotator cuff, and even arthritis. Although the evidence for effectiveness of platelet rich plasma is limited because the technology is so new, it is a good nonsurgical treatment method to try in some situations.

Although platelet rich plasma is not usually covered by insurance, it is a simple process. It requires taking some of your own blood, spinning it down in a machine, and taking the portion of the blood that contains many special growth factors and other molecules and injecting it around the area that is painful and inflamed. This platelet rich plasma injection triggers an inflammatory response that after several weeks will quiet down, leaving the inflamed and painful area more quiet, healed, and less painful.

If you are having shoulder pain, call 919-872-5296 to schedule a visit with shoulder specialist Dr. Johnny Nelson. Before you see your primary care doctor, physical therapist, chiropractor, or other provider, it is important that you have a thorough history and physical examination by an orthopedic surgeon to establish the correct diagnosis!

References:
Puzzitiello RN, Patel BH, Nwachukwu BU, Allen AA, Forsythe B, Salzler MJ. Arthroscopy. 2020 May; 36(5):1468-1475. Epub 2019 Dec 17.

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Will Injections Fix my Shoulder, Elbow, or Hand Problem?

Hand Surgeon, Injections, Shoulder Pain, Tendonitis

Will injections fix my shoulder, elbow, or hand problem?

Steroid injections are commonly used in the treatment of shoulder, elbow and hand problems. As a result, there is some confusion about what these injections actually do for different conditions.

As a general rule, orthopedic surgeons such as Dr. Nelson use steroid injections for 3 main reasons:

1) To completely cure a condition, now and forever

2) To help relieve inflammation and pain that is unbearable for the patient, even if temporary

3) To help clarify exactly what condition the patient has and what structure is bothering them

What conditions can be completely cured with steroid injections?

Although we can never know and predict with 100% certainty that the steroid injection will cure a certain patient’s condition, we know that some conditions can be cured with a steroid injection. Problems that have high rates of cure with injection include tendinitis around the hand and wrist, including trigger finger. Problems with lower rates of cure include tennis and golfer’s elbow and shoulder biceps tendinitis, for example. Of course, the steroid injections are often administered along with recommendations for a period of rest, possibly bracing and icing, or physical therapy, which also may help the condition resolve.

Okay, so what conditions cannot be cured with steroid injections?

One of the most common reasons to perform injections around joints is arthritis, or wear and tear of the joint surface. It is important to understand that the steroid injection does not fix or reverse the arthritis. Arthritis is always there, and in fact tends to progress with time, no matter what you do. The main reason to perform injections for problems like wrist, hand, or shoulder arthritis is to “kick the can down the road,” temporarily reducing pain so that the patient can remain active, participate in physical therapy, and avoid resorting to surgical intervention.

Nerve problems also usually cannot be cured with steroid injections. For example, carpal tunnel syndrome is very common, and injections are often used to help reduce patient’s symptoms, especially if the carpal tunnel syndrome is due to a new or recent activity and the patient is not able to undergo a carpal tunnel release. But usually the carpal tunnel symptoms will usually return after a time.

So how can injections help clarify the cause of pain?

Sometimes even the best orthopedic surgeon has difficulty knowing with 100% certainty what structure is the cause of pain, or what the correct diagnosis is. Sometimes a good option is to perform an injection to clarify if a certain structure is the cause of pain. If an injection of steroid around the structure make the pain go away, even for a short time, this tells the patient and surgeon the injected structure is likely the cause. We also know that patients who have relief of their carpal tunnel symptoms, even temporarily, after injections are very likely to respond favorably to a carpal tunnel release with permanent relief of their symptoms.

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