Michael Khazzam, M.D. Answers Questions On: Shoulder Injuries

It depends on a person’s age. For younger patients, it’s often the result of sports or activity in general. For older people, it could be repetitive shoulder motion or it could be nothing more than the degeneration that comes with aging. At UT Southwestern, we see and help all ages – people with a very wide range of activity levels, from the weekend gardener to the professional athlete.

You want to choose someone who’s trained specifically in these kinds of techniques. There are sports medicine physicians who do only arthroscopic shoulder surgery, and there are generalists who’ve done maybe a handful of these types of procedures. But then there also are physicians like myself who have completed either a sports medicine or shoulder surgery fellowship and who have advanced experience with complex shoulder problems and do everything related to the shoulder.

Training and experience help achieve the best possible outcomes for patients. The more volume, the greater the number of shoulder surgeries successfully performed, the more likely the results will be positive for the patient. If there is a complication, or if a previous shoulder surgery has not repaired the problem, an experienced surgeon will be comfortable knowing how to handle it.

For rotator cuff repair techniques and healing methods, there’s always new, emerging science. All the current studies on how to optimize tendon-to-bone healing are a good example. We’re trying to figure out ways – even in what seems an irreparable cuff or a cuff that may not have good healing potential – to try not just to reverse it but to get that tendon to heal back down.

For the first-time shoulder dislocator who’s in the middle of the season in a contact sport, if we can keep that person playing and rehab him or her until the season ends, that’s something we try to do. We use bracing and proper physical therapy to get those muscles around the shoulder stronger.

As the age groups increase, there’s more we can do nonoperatively – it just depends on what the pathology is. For example, a swimmer with multidirectional instability is the type of patient we’re typically going to treat nonoperatively.

In recent studies looking at atraumatic (slow, degenerative), full-thickness rotator cuff tears, researchers have found that 80 percent did well without surgery. So, yes, there often are options, and knowing what those options are and being able to provide them are part of what it takes to ensure the most effective care available to patients.