Shoulder pain? Personalized medicine is best approach for treating our patients

Our shoulders give us an incredible range of motion, something most of us take for granted until one day when we can't reach that coffee cup or swing a golf club without pain.

"The very anatomical structure that gives us that range of motion and allows us to put our hand anywhere in space also makes us susceptible to shoulder instability and injuries," says Dr. Josef K. Eichinger, an MUSC Health board-certified orthopedic surgeon who specializes in shoulder and elbow surgery. "It's like a golf ball on a tee, compared with the hip, which is more stable and like a grapefruit in a bowl. In comparison to a shoulder, it takes a tremendous amount of force to dislocate a hip. It doesn't take nearly as much to knock a golf ball off a tee or dislocate a shoulder."

While someone might immediately think of surgery to relieve pain and restore range of motion, Dr. Eichinger says numerous treatment options are available, ranging from physical therapy and injections to shoulder surgery.

"A correct diagnosis is key, and sometimes that can be difficult," he says. "Whether it's a fracture, a rotator cuff tear or arthritis, in general, we try to be conservative.

"We love doing surgery, but the vast majority of patients we see don't require it. We try to avoid surgery to see if we can get patients better with physical therapy, injections or discussing how they might modify their activities so their shoulder bothers them less."

Dr. Eichinger says shoulder procedures can be classified into roughly two categories: open surgery or arthroscopic surgery. Most soft tissue procedures such as a rotator cuff repair or labrum repair are done using arthroscopy. Surgery that involves the bones of the shoulder, such as a shoulder replacement, is frequently an open surgery.

As a result, saying exactly what is the right procedure for "you" is not as clear-cut as many people think.

"A multitude of procedures are available for different conditions," he says. "A patient has several choices, and until we have evaluated that patient, arrived at a diagnosis and discussed lifestyle, goals and all the options available to achieve those goals, we can't say what is the best approach."

Regardless of the surgery he performs, Dr. Eichinger says shared decision-making, the practice of involving his patients in their treatment instead of telling them what to do and limiting their ability to choose is essential to optimal treatment and care.

"We are practicing personalized medicine," he says. "We want to empower our patients to make decisions based on their preferences. Once we have a correct diagnosis, we discuss treatment options, risks, how they fit into the patient's goals, and what the odds are they'll be happy with their treatment. The best patients are the most informed patients. When they have a voice and can choose, they feel confident in their decision."

Eichinger takes care of patients of all ages with all kinds of shoulder conditions. He says having that broad perspective and the ability to offer a full complement of treatment options is an advantage for him and his patients.

He singles out rotator cuff tears, which occur in various degrees of severity, as an example. Rotator cuff tears are a normal part of aging, and many people don't even know they have one because the tear is asymptomatic. Other tears can cause severe pain and be accompanied by underlying conditions.

"We must factor in age, activity level, prior procedures and whether the pain is chronic," he says. "Then we must synthesize the information and lay it out for our patients and help them make the best decision. It is the essence of medicine and orthopedic surgery."

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The Musculoskeletal Institute at MUSC Health is recognized as one of the nation's high-performing specialties in U.S. News & World Report, and MUSC Health was named by U.S. News & World Report for the seventh year in a row as the No. 1 hospital in South Carolina. To make an appointment with Dr. Eichinger, call 843-876-0111.