Better remedies bring relief to elbows and shoulders

New surgical materials and techniques are making surgery a viable option for more patients, while medications are helping others avoid it altogether.

Theodore Blaine, MD, examines a patient to determine the best treatment option.

(September 2012) Shoulder or elbow pain can interfere with your ability to type, get dressed, carry bags of groceries, exercise and sleep comfortably through the night. But doctors at Yale Orthopaedics & Rehabilitation offer several treatment choices, both surgical and non-surgical, to provide relief.

Orthopaedic surgeon Theodore Blaine, MD, who joined Yale Medical Group last fall as chief of Shoulder and Elbow Surgery, says patients are surprised to learn how shoulder surgery alone has grown and changed.

"In the beginning, the first replacement surgeries for fractures did OK, but not incredibly well," says Dr. Blaine, who works closely with Drs. Karen Sutton, Seth Dodds and Michael Medvecky. "But now the trend is toward minimally invasive techniques, including better bone-conserving techniques, smaller prostheses and a clearer understanding of how operations should be done. This gives us more treatment choices and expands the number of patients we can help."

Improved materials, techniques

A former competitive swimmer and lacrosse player who knows firsthand how frustratingly painful and inconvenient shoulder and elbow injuries can be, Dr. Blaine has pioneered several new techniques.

He says the materials and devices used in shoulder replacements are engineered to last longer than ever before, and work with the patient's normal bone. One shoulder replacement is fabricated of metal with the same consistency as bone, bringing greater longevity and less likelihood of complications over time. Another attaches to the humerus, or armbone, with a short stem or no stem at all, so it is less likely to loosen over time and require replacement.

Minimally invasive surgical techniques have evolved as well. In addition to quicker recovery—patients spend a day in the hospital instead of a week—this evolution makes shoulder replacement a viable option for more people. "We used to do this only for patients in their 60s, 70s and 80s; now we do it for people in their 40s and 50s, and sometimes younger," Dr. Blaine says. "Shoulder replacement surgery is more than 90 percent effective in patients with arthritis. People walk in with pain that they describe as an 8 or 9 on a 0-10 pain scale; after the surgery they rate their pain as 0 or less than 1. That's a pretty significant improvement."

Best option may be nonsurgical

Dr. Blaine and Karen Sutton, MD, review X-rays with a patient. The goal is to treat injuries non-surgically whenever possible.

Surgery may bring the most dramatic results, but it is not necessarily the first or best option for shoulder or elbow pain. "Our goal is to be able to treat shoulder and elbow injuries non-surgically whenever possible," says Dr. Blaine.

In addition to such conservative treatments as rest, ice, physical therapy and medication, he and his colleagues provide patients with access to new drugs, including targeted therapies that may not be available elsewhere.

On the research front, Dr. Blaine is studying the causes of shoulder instability in athletes, and injectable medications for shoulder arthritis and tendinitis. He developed and patented an injectable drug that targets "stromal derived factor 1," a potent inflammatory molecule that occurs after tendon injury. Unlike common nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen, this medication may cause far fewer side effects. It should be available in clinical trials in a few years.

Injuries can happen anywhere

Each year, as many as 10 million Americans visit their doctors for treatment of shoulder and elbow injuries. The majority of these injuries occur in people playing sports, but they can also happen at work or in daily life. "We also see a lot of patients who work with machinery in their jobs, like press operators, as well as artists working on large overhead paintings and, of course, painters in general," says Dr. Sutton, who is also an athlete herself.

Many shoulder and elbow patients tend to be older, partly because as people age discomfort that was barely noticeable can evolve into intolerable pain—old injuries turn into arthritis and bursitis, two of the most common causes of shoulder pain, Dr. Sutton says.

Four months after having her shoulder replaced by Dr. Blaine, 47-year-old Karen Clark of Westport was playing tennis, cycling and kayaking with no discomfort at all. She says her athletic lifestyle and age were factors Dr. Blaine considered in selecting the best prosthesis for her. "My pain level is zero," says Clark, who suffered for years from pain in a shoulder she injured long ago. She now plays sports without discomfort and looks forward to doing so for many more years. "My new joint is designed so that the bone will grow into it, so hopefully I won't need another one in my lifetime," she says.

Story by Nicole Wise
Photos by Robert Lisak