Pediatric shoulder pain.  This is a category that can remain mysterious until an exam, careful history, and diagnostic ultrasound are done, all of which we do at ISM.  Typical problems include:

1. Growth plate injuries –  These can occur from repetitive overuse or trauma, such as a fall or hit of any kind.  These are hard to rule in or out at home and if you have some doubt about an injury that does not respond rapidly to rest, please come in for an evaluation.

2. Tendon and joint capsule laxity or overuse –  This category is complex with multiple overlapping factors.  We will need to listen intently to the story as we do the physical exam and possibly a diagnostic ultrasound.  Treatments can range from activity modification all the way to surgical options.

1. Rotator cuff tear or tendon degeneration –  We can see this stuff on diagnostic ultrasound, and you will see it too if it is there.  PT, activity modification, biologic therapies, nutrition, and discussion about what is being used for pain becomes part of this visit.  This can lead to a full-on rotator cuff tear if not treated early enough. This is one not to ignore. Be proactive and come see us. Red flags for this include weakness in the shoulder and pain when the arm and hand are held out away from the body in certain positions.

2. Arthritis of the main shoulder joint –  This is another one that can sneak up on you.  We can diagnose this with x-ray. Our preferred x-ray views are called Grashey, Axillary Lateral and “Y” views.  In arthritis, treatment possibilities include considering severity, patient age, and metabolic health. Treatments can range from non-surgical to surgical.  We will let you know what we think is best and as always you get to ask questions and exercise your autonomy in the final treatment plan.

1. Rotator cuff tear –  We can see this on ultrasound and put you on the right track, whether operative or non-operative.  If non-operative we have all the options available, most on site.

2. Fracture –  You will need x-rays if there has a fall and most fractures can be treated non-operatively.  If the fracture needs to be treated operatively, we will personally call a surgeon to arrange care.

Maybe it has been a while since a crash of some kind, and you did or did not get evaluated immediately after the crash.  This is an area where you do need special care such as ISM.

1. Post-traumatic arthritis – This can be treated with a combination and sequence of treatments that may include physical therapy, biologic treatments, or if we did not catch it in time we will let you know about other options including surgeries.

2. Post-traumatic progressive rotator cuff tears –  Our diagnostic ultrasound is immensely helpful in determining this.  We will let you know if this is the diagnosis, and whether the broad spectrum of non-operative care offered by ISM is appropriate vs. whether or not you need surgery.