Doctors Series: Dr. Ari Youderian


Recently, a few members of the Envision Sport team had the opportunity to attend a lecture presented by Mission Hospital. Dr. Ari Youderian, a shoulder and elbow specialist & surgeon from SCOS Orthopedics, spoke about shoulder injuries and strategies to combat shoulder pain.

While no shoulder injury is the same, there are some injuries that are seen more often than others. These include bursitis, frozen shoulder, arthritis, and perhaps the most common, rotator cuff injuries.

Defining the most common shoulder injuries

Bursitis - Within your shoulder joint are several fluid-filled sacs that are designed to reduce the friction in your shoulder. This sac is referred to as the bursa and can also be found in the hip joint. When the bursa is inflamed, the patient can suffer from pain in the shoulder, down the arm and into the elbow or wrist. This injury is referred to as bursitis.

Frozen shoulder - For patients who have a medical condition or procedure done that prevents them from moving their arm, it is common for them to suffer from frozen shoulder. Frozen shoulder is characterized by stiffness and/or pain in the shoulder joint. Patients lose range of motion of their shoulder and use of the arm becomes difficult.

Arthritis - There are several forms of arthritis that may affect the shoulder including: osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, rotator cuff tear arthropathy, and avascular necrosis. Perhaps the most common is osteoarthritis. In osteoarthritis, the outer covering of the bone, cartilage, is destroyed. As it wears away and becomes frayed or rough, the space between the bones of the shoulder decreases leading to the bones rubbing together and causing pain.

Rotator cuff injuries - The group of muscles and tendons that help to stabilize and move the shoulder joint are referred to as the rotator cuff. Contrary to what most people believe, the rotator is not one muscle, but a group of four muscles. Injuries to the rotator cuff are common in people who participate in activities that involve repetitive overhead movements like throwing a baseball. Injuries of the rotator cuff include bursitis, tendinitis, and tears.

Dr. Youderian spent some time discussing techniques for the prevention of rotator cuff disease. These strategies include: maintaining a healthy lifestyle and managing cholesterol. He placed an emphasis on smart workouts and keeping the ancillary muscles of the shoulder strong and healthy. To do this, it is important to not only work on the anterior part of the shoulder muscle, but to strengthen the lateral and posterior parts of the muscle, as well. The ancillary muscles of the shoulder include the middle and lower parts of the trapezius, the serratus, and of course, the rotator cuff muscles.

Here are some exercises to help strengthen the muscles of the shoulder:

Internal Rotation - Place a TheraBand in a door jam. Grab the TheraBand in the hand closest to the door and rotate your arm in towards your body keeping your arm bent at a 90 degree angle. Make sure that your elbow stays attached to your side. We tell our patients to think about holding a pocket book or $100 dollar bill in to your side.

External Rotation - Grab the TheraBand in the hand furthest from the door and rotate the arm away from your body keeping your arm bent at a 90 degree angle. Keep the same thing in mind as before; keep your elbow in and attached to your side. If needed, use a rolled towel between your arm and side.

Internal Rotation at 90 degrees - Raise your arm to shoulder height and form a 90 degree angle. Start with your arm parallel with your body then internally rotate the arm down while keeping the elbow level with your shoulders. Slowly return to the starting position and repeat.

External Rotation at 90 degrees - Raise your arm to shoulder height and form a 90 degree angle with your fist facing form. Start with your arm parallel with the group and rotate your arm up. Slowly return to the starting position and repeat.

Dr. Youderian also discussed the importance of maintaining flexibility, ensuring slow progression of exercises, adequate rest, and performing a proper warm-up prior to workouts and cool down-post workout. He stressed that your warm-up should consist of dynamic exercises and last for about 5 to 10 minutes and, for your post-workout, it is important to stay hydrated, stretch at home, and ice the muscles. You may need to take an anti-inflammatory medication such as Ibuprofen if you are sore or in a lot of pain.

If preventative strategies are unsuccessful, it is possible that surgery will be required. With today’s technology, surgeries performed on the shoulder are mostly done arthroscopically, meaning incisions are small and no large scars are left behind. Dr. Youderian explained a fairly new type of shoulder replacement, called a Reverse Shoulder Replacement. With a traditional shoulder replacement, a cup is fitted into the shoulder socket, and a ball is attached to the humerus (upper arm bone). In contrast, with a reverse shoulder replacement, the ball and cup are switched. The ball is attached to the shoulder socket, and the cup is attached to the humeral head. The reverse shoulder replacement relies on the deltoid muscle, rather than the rotator cuff muscles for movement, which leads to a more successful surgical outcome. The full recovery time for a reverse shoulder replacement is about 6-12 months, and for over 90% of patients, surgical results last longer than 15 years.

If you are having shoulder pain, don’t hesitate to contact one of our clinics to schedule an injury assessment. Our physical therapists can provide insight as to your injury, as well as make personalized recommendations for recovery. You can contact our Rancho Santa Margarita location at (949) 713-6445 or our Irvine location at (949) 262-9142.

We want to extend a special thank you to Mission Hospital and to Dr. Youderian for hosting the lecture and teaching us all something new about preventing shoulder injuries! If you would like to consult with Dr. Youderian regarding your shoulder injury or possible surgery, contact SCOS Orthopedics at (949) 586-3200.

#shoulderinjuries #orthopediclecture

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