When does shoulder pain become more than just a nuisance and require surgery?

It’s tough for a person to tell without visiting a physician, Dr. Tulio Figarola, an orthopedic surgeon, told Port City Kiwanis on Thursday.

“One of the first things I want to find out is if it’s really coming from the shoulder or a pinched nerve in the neck,” said Figarola, who joined the River Region Medical Center staff late last year.

Pain from a pinched nerve often radiates down the arm, but if a person has trouble reaching behind their back or above their head, it’s most likely a shoulder issue, he said.

Treatment begins with administering an anti-inflammatory drug three times a day for about three weeks, he said.

“A lot of people don’t think Tylenol is much, but if you take it three times a day, it can do a lot,” Figarola said.

If the pills don’t work, an anti-inflammatory shot is the next step. But if both those options fail, patients are sent to physical therapy.

“There are certain exercises that can avoid pain and strengthen the tendons,” he said.

If physical therapy doesn’t work or becomes too painful, patients need to undergo an MRI to find if there is a hole in the one of the tendons.

“We’re looking to see if the rotator cuff tendons are worn out or torn,” he said.

Tendons do not heal on their own and everyone experiences at lest some tendon deterioration during their lifetime, Figarola said. A substantial amount of people over 65, even those who experience no pain, have holes in their rotator cuff tendons, he said.

“It’s just everyday wear and tear. Eventually it just wears out,” he said.

Surgery is a fairly dramatic step and is avoidable as long as the pain doesn’t become unmanageable and the tendon doesn’t have a hole in it, Figarola said.

“There is no test known yet that will say a hole in the tendon will stay the same size into perpetuity or get bigger,” he said.