Daniel Schwartz, MD, Orthopedic Surgeon, Shoulder Specialist, Seattle, WA

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Shoulder stretches can help relieve pain and stiffness in tight shoulders, which are a common problem among most adults. Stretching is a great way to improve flexibility and mobility and prevent injury.

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Shoulder cortisone injections have been used to treat inflammation since the late 1950’s. These shots are injected directly into the affected area, and are sometimes mixed with a local anesthetic to provide immediate relief for patients who are experiencing unbearable pain.

Because the medication is delivered directly to the site that is causing pain, a shoulder cortisone injection is much more effective than alternative methods, such as oral painkillers.

Additionally, cortisone is a hormone that is naturally produced by the body, so it is a form of medication that causes minimal side effects in most bodies.

How are shoulder cortisone injections administered?

As a general rule of thumb, a patient should receive a cortisone shot in the shoulder no more than 3-4 times a year, with a period of at least six weeks between each injection. This depends on the patient’s unique situation, however. Thus, it is best to speak with your orthopedic physician about the best course of action for your circumstances.

It’s important for patients to understand that cortisone injections are not a permanent solution. They are, however, a great way to reduce pain and restore mobility.

Are there any risks associated with receiving a cortisone shot for shoulder pain?

Overall, cortisone shots pose a minimal risk. Patients do expose themselves to the potential implications that come with any type of injection, such as skin discoloration at the injection site, as well as bleeding or infection.

These side effects are considerably rare, though, and rarely lead to serious health issues.

Additionally, patients with diabetes can experience increased blood sugar levels after receiving a cortisone injection in the shoulder. If you have diabetes, be sure to discuss your condition with your healthcare provider.

On a final note, prolonged use of cortisone injections has been linked to weakened bone density and cataracts, among other conditions. For these reasons, physicians always aim to keep injections to a minimum, while still providing relief.

If you have any questions or concerns about the potential side effects of injections for shoulder pain, Dr. Schwartz would be happy to speak with you and provide you will all the details you need to make an informed decision.

What should patients expect after receiving a steroid injection in the shoulder?

Most patients experience immediate pain relief after their cortisone shot has been administered. The soothing effect takes place almost instantly!

Some patients do develop some redness in the face and chest, along with a warm sensation.

It is normal to experience some pain after the anesthetic wears off. This is only temporary, however, as it takes approximately three days for the corticosteroids to fully take effect. During this time, patients can find additional relief by applying cold compresses to the shoulder.

In rare instances, a patient may experience fevers or chills, or notice liquid leaking from the injection site. If a patient experiences any of these symptoms, they should contact their healthcare professional immediately.

After a period of 48 hours, patients should be able to enjoy a full range of motion again, and be completely free of any stiffness or pain.

Do you still have questions regarding shoulder cortisone injections? Contact Dr. Schwartz today to learn more about the ways that an orthopedic surgeon can help you relieve pain and regain quality of life.

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Arthroscopic surgery is performed through small incisions around your shoulder. A camera is inserted inside your shoulder which magnifies your anatomy onto several HDTVs in the operating room. This allows Dr Schwartz to see in extremely fine detail the problems better than with a naked eye! Sterile water is pumped into your shoulder to create space to work. You may have anywhere between 3-6 small incisions the size of the tip of your pinkie around your shoulder depending on the complexity of surgery. There will be black nylon sutures placed on your skin that will be removed at your first postop appointment.

This surgery is most often done outpatient at the First Hill Surgery Center on Madison and Boren. This is a brand new facility and is state of the art. Sometimes this might have to be done at Swedish Orthopedic Institute for insurance or health concerns. Either way, you will be asked to arrive early. You will get a phone call normally 24-48 hours in advance letting you know the specific time. Please be punctual! The nursing staff will ask you many questions, not because we do not know the answers, but because we need to confirm everything about you for your safety. They will start an IV when finished with their “intake” and an anesthesiologist will come in to meet you. Usually somewhere around this time, Dr Schwartz will also come in to say a quick hello, mark the correct shoulder, and ask if there are any remaining questions. The anesthesiologist will continue on to perform a nerve block. This is vital to your postop pain control, and will function for 12-18 hours after the surgery. As it wears off, the necessity to start taking oral pain medications begin, so it is really your friend while it is working.

Once this is finished, and the room is ready, you will be greeted by a nurse that will escort you to the operating room. You may find the OR to be cold, bright, and a little uncomfortable. We will do our best to make you comfortable, and well positioned on the narrow but firm OR table. You will then drift off to sleep, and we will perform the required surgery. Dr Schwartz always will call your contact phone number and provide them with an update at the end of your surgery.

You will wake up in the “PACU” which is the recovery room. You will have a very large dressing on your shoulder which is really there to catch any water that may leak from your wounds over the next several hours. Your shoulder/arm will be swollen. This is normal, and will resolve over the next few days. You will also notice a bruise develop over the next few days along the front of your arm, extending into your biceps and maybe into your chest. This also is normal. You will be wearing a sling for a period of time as determined by your procedure.

Once you are awake enough, walking safely, reporting how you feel adequately with well controlled pain and tolerating POs (PO intake is oral intake, like drinking water, eating crackers, etc) you will be discharged home. The facility will reach out to your ride to come pick you up, and go over discharge instructions with them. Once at home, it is okay to walk around if you have the energy. Comfort foods like soup are best to use at least initially, as postop nausea is a common occurrence, and narcotics can also cause this as well.

Dr Schwartz will call you around 7 pm if you had outpatient surgery. This is a call to discuss your surgery with you, answer any questions, and advise you on pain control. He will not talk to you postoperatively at the surgery center by design. Drugs, anxiety, and meeting a lot of new masked faces sometimes adds to messages getting lost. In general, the most important message he provides is to stay on top of your pain. Nerve blocks wear off from your fingertips on up. As you start to feel your hand and move your hand, it is a safe bet that you should start taking your pain medication. Set an alarm in the evening 4-6 hours after going to sleep to check to see if you need to remedicate. The first 24-72 hours are always the most difficult, and if you fall behind the pain initially rather than having a rough 1-3 days, you may have a rough 3-5 days. So be cautious.

Icing your shoulder helps with pain control. A LOT! If you have a plan to ice with the ice machine that you can purchase from our clinic, we recommend removing the big bulky dressing the day after surgery, and placing band-aids over your incisions. This will better allow the ice to penetrate, and help you. If you are using ice packs, leave the dressing on until 2 days after surgery and then remove for icing. Either way, be sure to not leave ice on for too long and to give your skin breaks so you don’t hurt yourself.

Narcotics cause nausea, and they constipate. For constipation we recommend drinking plenty of fluids, a high fiber diet, walking/activity and an over-the-counter stool softener (such as Colace or Docusate) after surgery while you are taking the narcotic pain medication. If you are still experiencing constipation even after these preventative measures, you can try taking a laxative such as Miralax (polyethylene glycol) or a stronger laxative such as magnesium citrate. For nausea we give a prescription (Zofran is brand name, generic is odansetron).

You will likely receive some of these prescriptions on the day of your surgery. We do not routinely give prescriptions prior to surgery, but can upon request. Do not worry about picking them up the day of your surgery, the surgery center will fax them to your pharmacy, and with the nerve block you won’t have pain until late in the evening.

Post-operative Medications:

Diclofenac (may not be routinely prescribed)

Please take all of the Diclofenac prescribed. You will take this twice a day for three days. It is an anti-inflammatory and will help with the pain immediately after surgery. You may start this medication in the evening after your surgery.


Please take all of the antibiotic prescription, which is usually either Keflex (cephalexin) or clindamycin. You will be taking this for three days. It helps decrease your risk of a post-operative infection. You may start this medication in the evening after your surgery.

Percocet (5mg oxycodone with 325mg acetaminophen/ Tylenol)

Instructions: Take one or two tablets every 4-6 hours as needed for pain

Side effects include nausea/vomiting and constipation

Please take this medication on a regular basis for the first few days after surgery. After the first few days you can try taking it less frequently as you feel comfortable, for example taking one tablet every 8 hours. When your pain has decreased you can wean down to an over-the-counter pain medication like Tylenol.

Zofran (ondansetron)

Instructions: take one tablet every 6-8 hours as needed for nausea

You only need to take this medication if you are experiencing nausea after surgery or with taking the narcotic pain medication.

Getting around after surgery will be a little challenging because you may be required to wear a sling for some time. It is not recommended to drive a vehicle while wearing a sling. If you should decide to drive there could be liability associated if you are cited or in a collision. You shouldn’t drive, operate heavy machinery or sign any documents if you are taking narcotic pain medication as they can impair your judgment and slow your reaction time. You may require some help getting to your first appointment with Dr. Schwartz 7-10 days out from surgery, and even your first physical therapy appointment depending on when that is scheduled.

Sling use is often a common concern for patients.

Shoulder Precautions:

It is very important to follow shoulder precautions to protect the healing tissue that was repaired during your surgery.

Do not put weight on the surgical arm

(Do not lean on it, lift objects with the hand or actively use the surgical arm).

No active internal rotation

(Do not pull objects toward your stomach).

No external rotation beyond 20 degrees

(Do not roll out your shoulder beyond the specified limited range).

No extension of your shoulder beyond neutral

(Do not bring your elbow behind your body).

In general you will feel more comfortable with your elbow supported, so if your sling is off while lying down, make sure pillows are propping up your elbow and your shoulder so that they don’t roll backwards.

How to Safely Use Your Shoulder Immobilizer

Taking the Shoulder Immobilizer Off:

  • Loosen the Velcro on the shoulder strap.
  • Use the unaffected hand to pull the shoulder strap over your head.
  • Unfasten the waist strap.
  • Unfasten the lower arm strap and undo the Velcro.
  • Straighten your elbow and keep your arm supported on your lap or a pillow beside you.

Putting the Shoulder Immobilizer On:

  • Use your nonsurgical arm to place the waist strap to go from the effected to the unaffected side.
  • Place the elbow back as far as possible in the sling. Keep arm bent at 90 degrees.
  • Fasten snaps and the lower arm strap.
  • Pull the shoulder strap over your head and adjust the strap.
  • Fasten the waist strap.

Activities that are safe do while in your sling:

You can allow your arm to hang by your side when you are at home and not around crowds.

You can use a keyboard and mouse to type.

Use silverware to feed yourself.

Remember to take your arm out of your sling often to straighten out your elbow, wiggle your fingers and wrists around. This will prevent your elbow, hands and wrists from becoming stiff and painful.

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Biological supplementation for the shoulder is certainly a hot topic. This expanding frontier of orthopedics is certainly intellectually interesting and promising for the future. Currently we do not have a lot of information regarding what promising new treatments (stem cells, platelet rich plasma or PRP) can do long term. There are also a lot of questions regarding efficacy which is why currently these therapies are usually cash pay.

Because they are cash pay, I really prefer that patients have done their due diligence and do not rely on a doctor promising anecdotal evidence with outlandish claims. This is also the reason that we could have had a clinic appointment and I would not even mention these choices to you; I desire to present medical evidence and provide state of the art surgical care. Some of the science, quoted below, can really muddy the waters so to speak, so I find it best to encourage patients to do their own research.

Bone Marrow Aspirate Concentrate or BMAC is a way to draw bone marrow out of a bone (it frankly just looks like really dense, viscous blood), and spin it down to isolate a concentrate of mesenchymal stem cells. These are stem cells within your own body that can differentiate into other tissue and help heal. After this concentrate is isolated, these are then injected at the surgical site of repair (where the tendon is repaired to the bone).

Bone Marrow Aspirate Concentrate or BMAC (which contains stem cells)

1. Prospective Randomized Trial Of Biologic Augmentation With Mesenchymal Stem Cells In Patients Undergoing Arthroscopic Rotator Cuff Repair. B Cole et al. Orthop J Sports Med. 2019 Jul; 7(7 suppl5).

MSCs (stem cells) injected into the shoulder at the time of rotator cuff repair show improved tendon quality on post-operative MRI at 1-year post-op. This means that the repaired tendon tissue is thicker, which implies it is healthier.

2. Enhanced Tendon-to-Bone Healing of Chronic Rotator Cuff Tears by Bone Marrow Aspirate Concentrate in a Rabbit Model. Clin Orthop Surg. 2018 Mar; 10(1): 99–110.

This study demonstrated again thicker tendon quality in the rabbit model, with higher biomechanical strength.

Platelet Rich Plasma

1. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. Kim et al. J Orthop Surg Res. 2018 Jan 3;13(1):1.

Compared to a control group both BMAC and PRP injections helped increase shoulder scores (how you feel your shoulder feels in a written reproducible fashion), and trended to healed tendons compared to control. In general the authors concluded that BMAC-PRP improved pain and shoulder function in patients with partial tear of the rotator cuff tendon.

2. Use of Platelet-Rich Plasma for the Improvement of Pain and Function in Rotator Cuff Tears: A Systematic Review and Meta-analysis With Bias Assessment. Chen et al. Am J Sports Med. 2020 Jul;48(8):2028-2041.

Long-term retear rates were significantly decreased in patients with rotator cuff-related abnormalities who received PRP. Significant improvements in PRP-treated patients were noted for multiple functional outcomes, but none reached their respective minimal clinically important differences. Overall, our results suggest that PRP may positively affect clinical outcomes, but limited data, study heterogeneity, and poor methodological quality hinder firm conclusions.

This literature is just the tip of the iceberg so to speak, but in general I do believe evidence is trending in the direction that these adjuvant treatments are useful. Again if you are interested in pursuing this please call my office at for an appointment.

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The health of our bones plays a vital role in how we are able to function every day.

Since our bodies are exposed to a number of stress triggers, having good bone health is crucial to avoiding injuries and ensuring that our muscles, ligaments, and organs are protected.

But how can you ensure optimal bone health?

Let’s explore some of the most important foods for healthy bones and other useful bone tips.

Take Up Strength Training

Performing weight-bearing exercises is one of the most effective ways to increase your bone density and strength during their growth years, up to around 30 years old.

However, even older people can reap tremendous benefits from strength training – it helps improve bone density, strength, and even size, so if you’re looking for a training routine that will help maintain healthy bones, this is an excellent choice.

Consume Plenty of Calcium

Calcium is an integral mineral that helps to maintain the density, strength, and overall health of your bones. It is essential to include it in your diet.

For most adults, around 1,000 milligrams is the recommended daily dosage, so if you aren’t sure if you’re getting that with your diet, you should consider taking a supplement.

Some of the high-calcium foods you could take include leafy greens, legumes, and dried fruit.

Take Vitamin D

Vitamin D is another crucial vitamin for bone health, but unfortunately, a significant percentage of people around the world suffer from its deficiency, which can result in lower bone density.

As you may know, vitamin D is produced by the body through sun exposure, but during the less-sunny seasons, that is not enough.

You should make sure to take foods that are rich in vitamin D such as fatty fish or cheese. You can even take supplements during the colder and darker months.

Include Omega-3 Fats in Your Diet

Omega-3 fats are known as one of the most important nutrients for a wide range of reasons, and bone health and strength are one of them as well.

These types of fats promote healthy bone development, as well as the formation of new bones, and they can even help prevent osteoporosis.

Take Magnesium and Zinc

We already covered a few minerals, fats, and vitamins, but the list doesn’t end there – there are quite a few different nutrients that are vital for your bone health.

Namely, magnesium and zinc are two minerals that have been scientifically proven to increase bone density, promote the formation of bone-building cells, and help protect the bones from deterioration.

Maintain a Steady and Healthy Weight

Weight has a significant effect on the healthy bone structure of our bodies.

People who are underweight commonly suffer from issues related to lower bone density and strength, and have a higher risk of developing osteoporosis, healthy diet or not.

And while overweight people generally have stronger bones, the stress caused by the additional weight can increase the risk of fractures and long-term damage.

Finally, weight fluctuations have been shown to be especially detrimental, causing significant bone loss over a person’s lifetime.

Eat a Well-Balanced Diet

Although getting the proper nutrients is undoubtedly essential, you must also make sure that the diet itself is sufficient in terms of caloric intake.

If you don’t get enough calories as part of your daily diet, your body will have a hard time maintaining optimal bone density, as there simply won’t be enough nutrients.

Increase Protein Consumption

If you want healthy bones, you must consume enough protein, as it is a building block that helps make up our bones.

And for most people, getting enough daily protein can be a challenge, so you should make a conscious effort to increase protein intake.

To prevent loss of calcium due to blood acidity, make sure to supplement your protein intake with plenty of vegetables and legumes.

Diversify Your Vegetable Intake

Most people understand the importance of taking vegetables to get enough of plant-based foods for bone health, but it’s also vital to diversify your vegetable intake and take as many different vegetables as possible.

Vegetables such as broccoli or cabbage contain high amounts of antioxidants that have bone protective qualities, so they can help stimulate bone regeneration and strengthening.

Limit Alcohol

Alcohol impacts all parts of our health, and the health of bones is no exception.

Heavy drinking can lead to a decrease in bone strength, density, and overall health, so you should make sure to stick to the daily recommendations of no more than 2-3 drinks per day.

Quick Tips for Bone Health

Along with the major suggestions above, here are a few more tips you can run with to help maintain bone health and prevent osteoporosis:

  • Don’t smoke – Smoking, similar to drinking is a known factor that can cause a loss of bone mineral density.
  • Get tested – Many people don’t know that there are tests for bone density. This is a great option to ask your doctor about if you are concerned.
  • Take medication – Depending on your specific situation, there are medications that can help with bone health. This is another options that is best to consult with your doctor.
  • Vitamin K – Like Vitamin D, Vitamin K supports the health of your bones.
  • Consider collagen supplements – This hasn’t been as widely tested as some of the other tips, but there is early evidence that collagen may help your bones.


Maintaining optimal bone health is essential when trying to prevent shoulder injuries, and all of the tips in this article can go a long way in ensuring that your bones remain healthy throughout your life. Bones are one of those aspects of our bodies that are easy to forget about, but the fact that you are taking the time to seek out information means that you are well on the way to a healthy routine.

If you would like to learn more about how to keep your bones healthy or would like to discuss your shoulder or elbow problem with an orthopedic surgeon in Seattle, please call or fill out our contact form. We look forward to helping you achieve and maintain total wellness!

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Bursitis and tendonitis are common and relatively similar conditions, both of which concern the inflammation of the soft tissue that’s involved in movement.

These types of conditions are very common in shoulders, elbows, wrists, knees, and ankles. They are conditions that are critical to identify and treat early. If left untreated, they can lead to larger issues down the line.

Even though many people confuse tendonitis vs bursitis and even use the terms interchangeably, they are, in fact, quite different. So what is the difference between bursitis and tendonitis, exactly?

Let’s explore the differences as well as the similarities for these two conditions and their respective treatment options.

Similarities Between Tendonitis and Bursitis

There’s a reason why the concept of tendonitis vs bursitis causes confusion – these two conditions are indeed quite similar and often present themselves with almost identical symptoms.

Just like bursitis, tendonitis causes inflammation in certain parts of the body such as the shoulders, the elbows, or the wrists. At first glance, you may not be able to tell them apart.

In fact, sometimes both conditions can affect one another and even occur simultaneously. This is why medical professionals will often refer to bursitis or tendonitis as the same condition and call it, for instance, rotator cuff tendonitis or shoulder bursitis interchangeably.

The underlying issue that’s causing bursitis and tendonitis may also often be the same, which further connects the two related, yet separate issues in the eyes of many people.

For instance, just like tendonitis, bursitis can be caused by an acute injury or a strenuous repetitive motion, such as running.

However, in the next section, we’ll explore the fact that there are significant differences between the two conditions. These differences can affect everything from diagnosis to treatment.

How They Differ

When exploring the differences between bursitis and tendonitis, it’s essential to first get to the bottom of exactly what each of the terms means.

Tendinitis is a condition that causes inflammation of the tendons, which are the tissues that connect muscles to bones. Tendons help ensure smooth movements between muscles and bones and maintain stability in the shoulder, the knees, the elbows, and other parts of the body.

Tendons can greatly vary in size, depending on their role and the part of the body in which they are in, but the primary function is always the same.

When inflammation occurs, it can cause sharp and stabbing pain and is often the result of muscle atrophy, asymmetry, swelling, joint effusions, or other reasons.

Meanwhile, bursitis is a condition that affects the bursa, which is a fluid-filled sac that prevents friction between bones, muscles, and tendons in various parts of the body.

The biggest bursa sacks are located in the shoulders, elbows, and knees, and can get inflamed for a range of reasons, including repetitive motion or injury, which is similar to the causes for tendinitis as well.

The biggest difference is the fact that bursitis can be caused by other things as well, such as an infection, arthritis, or even gout.

What’s more, bursae aren’t present in all of the same areas where there is a tendon. They only form in places where bones participate in movements, such as shoulders or hips.

Treatment Options

When it comes to treating bursitis or tendinitis, the focus will usually be on trying to identify the root cause of the problem and addressing it while also managing the symptoms.

At first, your doctor is likely to recommend that you refrain from the activities that caused the problem in the first place, which can often be enough to alleviate the symptoms.

Sometimes, even a simple posture or position change during the activity can make a huge difference and help prevent the problem in the future. Adding a more effective warm-up routine could also be helpful, especially for high-intensity sports such as basketball, football, or tennis.

During rest periods, it may be advisable to use ice packs on the affected areas to reduce inflammation and help both the tendon and the bursa to return to normal.

Sometimes, NSAIDs (non-steroidal anti-inflammatory drugs) may be prescribed to help manage the symptoms and reduce inflammation. If the symptoms persist, a cortisone shot may be required, although it isn’t a viable long-term solution.

Finally, with the help of physical therapy, it is possible to strengthen the surrounding muscle areas and reduce the strain on the tendons and ligaments, helping prevent swelling in the future.

Quick Facts

Here are a few quick facts about these two conditions:

Bursitis Facts

  • There are over 150 bursae located throughout the body of a human.
  • The most important bursae are located in the knees, hips, elbows, and shoulders.
  • The fluid inside of a bursa sac is called synovial fluid.
  • Overweight individuals are at a higher risk for bursitis.

Tendonitis Facts

  • If left untreated, tendonitis can lead to a rupture of the tendon. This is a serious medical problem with treatment options including surgery or casting.
  • Frozen shoulder is considered a form of tendonitis.
  • Tennis elbow and golfer’s elbow are also forms of tendonitis.
  • Tendons are not restricted to attaching muscles to bone. They attach to other parts of the body as well, including the eyeball.
  • The structure of tendons consists of organized collagen fibers.


Whether you have tendonitis or bursitis, it’s very important to determine the cause and find the most effective treatment option. Otherwise, the conditions can not only cause discomfort but can also result in more severe issues. There are critical health problems that should be addressed as soon as possible. Even if you only have a suspicion that something is wrong, it is best to consult a doctor.

If you want help addressing your tendonitis or bursitis issues in a shoulder or elbow, contact ShoulderMD today by calling . You can also use our online contact form. Dr. Shwartz is a Seattle orthopedic surgeon with the expertise needed to alleviate your chronic symptoms. We look forward to helping you find the best way to move forward with your particular condition!

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