Q: I had a car accident two years ago and have had severe right shoulder pain since then due to the whiplash injury I had. My MRI scan recently showed I have tendonitis and doctor gave me a steroid injection in the shoulder. Though that has helped a little, I would like to know if getting a key hole surgery is a better option? The doctor has suggested that I consider it if few steroid injections dont help get rid of the pain. What is the success rate of the surgery? Are there any other treatments I can take for reducing pain in my shoulder tendon muscles?

A:The shoulder has a unique arrangement of muscle and bone unlike any other location in the body. The rotator cuff (which is muscle) is sandwiched between two bones much like a sock lies between the heel and the edge of a shoe. In the same way that repeated walking eventually wears out the sock, the rotator cuff muscles fray with repeated rubbing on the bone thus wearing them out. As the muscle begins to fray, it responds to the injury by becoming inflamed and the pain pattern begins. With continued fraying, like a rope, it will eventually tear. The early phase of this process is called rotator cuff tendonitis or sometimes, bursitis. In the early phases, over-the-counter anti-inflammatory medications may provide benefit. However, to allow the inflammation to resolve, it is very important to cease any repetitive activity and it is equally important to keep the elbow below the shoulder level, till pain subsides, after which exercises to improve strength and function can be undertaken. Daily stretching while in a hot shower is also beneficial. If symptoms are more severe, prescription strength medication or a cortisone type injection may help, which can be repeated. If symptoms persist, surgery to remove some of the bone of the acromion can increase the space available for the inflamed tendon and may prevent further fraying or complete rupture. If an MRI shows a complete muscle injury, surgical repair may be required.