Lucendia Adams, MD and Raheleh Rahimi Darabad, MD

Indiana University Department of Physical Medicine and Rehabilitation; Indiana University Department of Advanced Pain Therapies 

 

INTRODUCTION

 

• Millions suffer from chronic shoulder pain with rotator cuff pathology being the number one culprit

• Studies have shown no appreciable long-term difference in conservative vs surgical treatment for chronic shoulder pain

• Conservative treatment is less costly and leads to less complications, so should be advocated for as initial treatment approach 

• What options are there for patients who have failed multiple conservative treatments and are deemed non-surgical candidates? 

 

Case: 

 

• 82 yo female with known HTN and CHF with 2 years of left shoulder pain secondary to MRI confirmed rotator cuff pathology, GH joint arthritis, and AC joint arthritis

• EMG confirmed Left C7 radiculopathy

• Failed conservative treatment: 

• Physical Therapy 

• Oral analgesics and anti-inflammatories

• Topical anti-inflammatories

• Neuropathic agents: gabapentin and Lyrica 

• Muscle Relaxants: Tizanidine and Baclofen

• CESI at C7-T1

• Multiple surgical consultations – all deeming not surgical candidate given age and comorbidities