Insights into Shoulder Injuries with Dr. Austin Yeargan III, MD

Founder of The Carolina Joint and Arthritis Clinic (CJAC) in Wilmington, N.C., Dr. Austin Yeargan III, MD is an orthopedic surgeon with a Sports Medicine Fellowship and Shoulder, Elbow and Knee sub-specialization. His experience is in regenerative molecular immunobiologic medicine and sports medicine with a focus on non-operative management of arthritis and other musculoskeletal manifestations of orthopedic disease including cartilage, tendon, ligament and bone. Dr. Yeargan has been successfully using Bone Marrow Concentrated Mesenchymal Stem Cell technology since 2006 and was the first orthopedic surgeon in the country to use Cellular and Molecular technology for tears involving the rotator cuff in 2009. To learn more, visit: https://carolinajointarthritis.com.

Q. Bone spurs in the shoulder joint that pinch the tendons of the rotator cuff, causing pain and weakness, seem to be a common problem amongst tennis players who serve and swing a lot during matches. What should a player do if he or she has a bone spur of the shoulder and is wondering whether a traditional subacromial decompression to remove the spur is recommended?  

First, I’d like to address a common misperception about bone spurs. Yes, bone spurs of the shoulder are common amongst tennis players, however, the “bone spur” in the shoulder usually does not cause problems – rather, it just signals what the problem is. 

You see, if the rotator cuff is sloppy, or dysfunctional, the normal force couple that constrains the head into the cup is lost.  This causes the vector of translation to change and the head of the shoulder to strike the undersurface of the front edge of the acromion and acromial ligament where it becomes strained with range of motion.  

When the head of the shoulder keeps hitting this ligament, bone starts to form within it, and it bends over making a “hook” shape, giving the misperception that there is a “toothy” structure sticking into the shoulder.  The same phenomenon occurs in the foot where plantar fasciitis is concerned.  The pulling of the plantar bands on the bone cause the bone “spur” to form.  It’s not a spur that causes the problem, it is a marker that disease may be present.  

So, the real issue that needs to be addressed is the compromised condition of the rotator cuff, itself, and traditional shoulder surgery usually is not the answer.  To complicate matters, scapular function also plays a role in shoulder biomechanics, and exercises to strengthen the muscles that anchor the scapula to the thorax should be prescribed in this setting.  

Rotator cuff problems come in all shapes and sizes from a fully intact but dysfunctional cuff to a partial thickness tear to a full thickness tear of varying size that may benefit from rotator cuff surgery. Physical therapy is the mainstay of treatment in any of these disorders and focuses on shoulder range of motion, followed by strengthening exercises to keep the shoulder joint centered during mid-range of motion.  

Partial thickness rotator cuff tears often cause the most symptoms and treatment recommendations vary from physical therapy and home exercises, to surgery to complete the tear and repair it back to the bone.  Conservative treatment options should always be exhausted prior to moving up the ladder of treatment modalities.  

Regenerative molecular immunobiologic techniques that eliminate pain and encourage tendon healing have been developed by our clinic, and we have been using them successfully since 2009.  These techniques are minimally invasive and can be performed in an office procedure room setting.  Among the benefits are short times to recovery and a fast return to desired recreational and vocational pursuits.  These procedures do not “burn any bridges” and have proven safe and effective for many types of partial thickness tears that do not respond to simple, conservative treatments.  

Partial thickness rotator cuff tears are seen often in the setting of a ‘hooked’ acromion and should be specifically sought either with ultrasound imaging or MRI when conservative treatment fails.  Shoulders that remain painful during or after play deserve a clinical work up including history and physical examination followed by appropriate imaging studies to determine the nature of the pathology.