Treating Shoulder and Elbow Injuries

Featuring: David D. Savin, Patrick St. Pierre
Aging, overuse, wear and tear take a toll on your body, especially in your shoulders and elbows. Sports, carrying luggage and reaching into cabinets can upset your tendons.

Dr. Patrick St. Pierre and Dr. David Savin discuss common injuries in the shoulders and elbows, when to seek treatment, diagnosis and treatment.


David D. Savin, MD is a fellowship-trained orthopedic surgeon. He specializes in the diagnosis and treatment of shoulder and elbow disorders, as well as general orthopedics and fracture care. He has significant experience performing arthroscopic management of all shoulder injuries, as well as management of shoulder arthritis with both anatomic and reverse shoulder replacements. His surgical skill set also includes management of shoulder and elbow trauma and common elbow injuries. 

Learn more about David D. Savin, MD 

Committed to the care of athletes of all ages, Dr. Patrick St. Pierre is the team physician for College of the Desert, Palm Desert High School and Palm Springs Power Baseball. As Medical Director for the BNP Paribas Tennis Open, he cares for the world's best tennis players on a yearly basis. He has also served as team physician for Army Athletics (West Point), Tacoma Sabercats (AA Professional Hockey) West Coast Hockey League, Tacoma Rainiers (AAA Professional Baseball) Pacific Coast Baseball League and Marymount University. He is a nationally recognized shoulder expert and as such, is the only Coachella Valley member of the prestigious American Shoulder and Elbow Surgeons and one of only 200 nationwide.


Bill Klaproth (Host): Aging, wear and tear, and overuse can wreak havoc on your body, especially your shoulders and elbows. And since you are listening to this, you are probably experiencing pain right now and it's not fun, so, let's get you some help. Here to talk about treating shoulders and elbows is Dr. Patrick St. Pierre, Director Shoulder and Elbow Surgery and Dr. David Savin an orthopedic shoulder and elbow specialist, both with Eisenhower Desert Orthopedic Center. Dr. St. Pierre and Dr. Savin thank you both for your time. Dr. St. Pierre let's start with you. So, why are shoulders and elbows so susceptible to injury and pain?

Patrick St. Pierre, MD (Guest): Well, they are the action of the upper extremities that do all the things that we want to do. So, as you mentioned in the intro, these are very susceptible to overuse injuries and it can be things that we would all think about so sports like tennis and golf and softball or baseball, but also it can just be the routine everyday activities that we do by carrying luggage, reaching for things in the back seats of cars, lifting up grandkids and kids. So, there are all kinds of ways that we injury our shoulders.

Bill: Absolutely. Reaching up into the cabinet for those cans and Dr. Savin what are the most common problems you treat when it comes to shoulders and elbows?

David Savin, MD (Guest): Well the most common injury that we see tend to be related to the tendons around the shoulder as well as the tendons around the elbow. The rotator cuff that everybody is so familiar with is the workhorse of the shoulder that helps stabilize the shoulder and allow you to do all the actions by bringing your arm in space. It's also often the overworked tendon that can cause an injury in the shoulder. Same thing for the elbow. There is a common extensor and a common flexor tendon, both on the inside and outside of the elbow which is commonly known as tennis elbow or golfer's elbow and these are very prone to overuse injuries.

Bill: And Dr. St. Pierre for someone experiencing pain in their shoulders or their elbows, when is it time to see the doctor?

Dr. St. Pierre: That's a great question because we all get pain in our shoulders and elbows at times just from overdoing things and many times it gets better. I mean our bodies are amazing. And they heal themselves and with minor injuries; the resting, ice and compression and giving your body time is often the first step and it's really when those things persist and don't get better after a week or two that you really need to see a specialist and try to figure out what's going on. And that's true for most of the overuse type of activities that we do, but obviously, if there is trauma, if someone falls down some steps or you feel a big rip or a tear in your elbow or shoulder; then you should come in sooner.

Bill: And Dr. Savin how do you diagnose these injuries? What is the process and how do determine if this is something serious and someone needs further treatment?

Dr. Savin: So, I think the history and physical are the key components to diagnosing a shoulder and elbow injury. So, first I want to get the story, how did this happen, how long has this been going on, what is this affecting you in your daily life. Then going on to a physical exam; where does it hurt? There are key components to the exam that can help identify where the pain is coming from and occasionally a diagnostic and therapeutic injection can really help key in on diagnosis. When needed, advanced imaging including x-rays and MRIs can be helpful to confirm the diagnosis.

Bill: And Dr. St. Pierre let's move to treatment then. When it comes to treatment, can you talk about noninvasive methods, surgery and shoulder replacement?

Dr. St. Pierre: Yes, so as David mentioned, sometimes we will do diagnostic injections or therapeutic injections to try to calm down bursitis. It's very common in the shoulder for people to get what's called rotator cuff syndrome or impingement syndrome in the shoulder where it's just bursitis and there's maybe some injury to the tendon but it's not torn completely and doesn't need surgery. So, the combination of taking care of the pain with an injection or sometimes over-the-counter anti-inflammatory medications along with the proper physical therapy to strengthen the shoulder and get it back into a functioning mode is the first step. And the great thing about Eisenhower Medical Center is that we have multiple physical therapy components within our system that do a great job at doing that.

When we fail at nonoperative treatment; that's when we start looking towards doing surgical intervention and there's really two main ways that we do that. With soft tissue injuries such as rotator cuff tears or sometimes labral tears when people dislocate their shoulders we often do an arthroscopy and then treat that or repair those tendons at that time. And then it's when it gets onto bigger things like arthritis and massive rotator cuff tears that we move onto should replacement, such as a total shoulder or what's called a reverse total shoulder arthroplasty which takes care of the arthritis and the rotator cuff tear.

Bill: And Dr. St. Pierre, let me stick with you for a minute. How common are shoulder replacement surgeries now? It seems like I'm hearing more and more about it and it seems like they are becoming more commonplace.

Dr. St. Pierre: Well they are because we have developed a better way of doing it. So, just like hips and knees; we have started off with shoulder replacements that were anatomic. They looked exactly like the shoulders that God gave us. And that works great as long as there is an intact rotator cuff that heals after the surgery and the rotator cuff can make the shoulder function. However, as we get older, and get into our 70s, 80s and 90s; the rotator cuff is 70, 80 and 90 years old and oftentimes when you go through a surgery like this; it doesn't function as well as we would have hoped and that's where the reverse shoulder comes in and by reversing the ball and the socket we get a shoulder that can function now even though the rotator cuff isn't there or it's not functioning as well as it was before. So, that's really been in the United States now for 14 years and over the past decade it's really changed the way that we can take care of patients with these really bad problems.

Bill: And Dr. Savin with improving treatment options like Dr. St. Pierre was just talking about, what is the long-term outlook for someone experiencing shoulder or elbow pain?

Dr. Savin: So, it really depends on the source of the pathology. So, if it's a tendon related injury that is minor; there is a good prognosis that this can be treated without surgery. But if there's a large tendon tear especially like a rotator cuff tear, if the pain persists and then we recommend surgery; the outcomes are fairly good, and people can expect an excellent recovery. People have to understand that this is a long recovery because tendons take a long time to heal. It usually takes at least three months for the tendon to be strong enough that we could strengthen the tendon. But overall, the outcomes are fantastic for shoulder and elbow.

Bill: And speaking from experience, I can attest to that. I have had both of my shoulders worked on. Physical therapy on both. I could even throw a baseball it was so bad and physical therapy has to this point knock on my desk here, cured them both. So, you are absolutely right about that. And Dr. St. Pierre are there ways we could move or stretch or reach to help keep our shoulders and elbows healthy as we age?

Dr. St. Pierre: Well your story was a perfect segue into this because it's really the rehab and the therapy that protects our shoulders. So, the rotator cuff that we have been talking about through this whole segment is really the key to the shoulder because those muscles keep that ball centered in the socket and when people get in trouble, it's usually because there is overuse or an imbalance between those muscles and so we have videos on our website, the Eisenhower website that show different ways to stretch and to strengthen those muscles around the shoulder and then the other thing that often gets forgotten is the back. So, our shoulder blades are really the basis and the stability for the shoulder and so we have to strengthen our back and the muscles around the shoulder blades to keep them better. So, when we get to take care of professional athletes and college athletes, they are spending a lot of time strengthening those shoulder muscles so that they don't get in trouble and what they are doing doesn't cause further damage.

Bill: Such great information and you are so right about that. I was upset I couldn't throw with my kids and I went and I had the physical therapy on the shoulder. It's amazing what you just said, is so true about the stretching, but you have to keep up with it and you have to keep at it, but it does work. So, absolutely correct. Well Dr. St. Pierre and Dr. Savin thank you so much for your time. This has been very informative. To learn more about Eisenhower Desert Orthopedic Center visit, that's This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.