One of my main responsibilities as an orthopedic surgeon is to listen carefully when patients tell me about their pain. Sports medicine is largely defined by pain – shoulder pain, knee pain , elbow pain and more. People whose everyday activities have been curtailed by crippling pain are often desperate for solutions; understanding precisely where and how the pain arises is the first step toward a solid diagnosis. Once we have the diagnosis in hand, step two is to explore some reasonable ways we can draw down the pain and increase movement and mobility. I remain bullish about the many nonsurgical techniques that can help patients diminish the anguish of knee and shoulder pain. This article covers a few tips you should know. Money quote:

A recent publication in the Journal of Arthritis & Rheumatology reported that one out of every two people will suffer from arthritic knee pain at some point in their lives, but the good news was that they also determined some very specific exercises that target a particular muscle group were the most significant factor in a reducing knee pain .

If you’ve been looking for low-impact and highly effective ways to reduce knee pain on your own, I strongly recommend you clip and save these exercises. Extensions and lifts may seem simple, but their effects can be long-lasting indeed. Want to learn more about the best ways to relieve knee pain ? Please contact my San Diego orthopedic knee surgery offices today.


Calcific tendinits is an extraordinarily painful shoulder condition that deposits calcium crystals into the rotator cuff tendons.  This leads to subacromial bursitis.  A recent study was performed to determine whether shoulder pain from calcific tendinits could be relieved without surgery, through a technique known as shock wave therapy.

Tufts Medical Center researchers reviewed 28 clinical trials evaluating the efficacy of the therapy, which can be performed in a doctor’s office, and found that it was effective for a specific form of the condition where calcifications were present on an imaging scan of the tendons. The researchers also found that high-energy shock therapy worked better than the low-energy method, according to the results published Monday in the Annals of Internal Medicine.

This is a preliminary finding, but one which could eventually change the lives of many patients who suffer with the abiding agony of rotator cuff pain caused by calcific tendinits. Although the FDA has yet to approve shock wave therapy for this purpose, further trials are already in the works.  Currently shock wave therapy is used to treat achilles tendinitis and plantar fasciitis.

In the meantime, contact your San Diego orthopedic surgeon to learn more about the best options available today.


A provocative article in last week’s New York Times discusses the quiet epidemic of older people living with serious pain who fail to report it to their doctors. Whether it’s due to stoicism, resignation, or something else, the net effect can be devastating:

[S]tudies have found that elderly patients are less likely than younger adults to report pain to their doctors. Instead, many suffer in silence at considerable cost to the quality of their lives. . . .

Untreated or inadequately treated pain is disabling and can hasten the death of an older adult by interfering with the ability to exercise, eat properly or maintain social contacts. Persistent pain can lead to immobility, depression, sleep problems, loss of appetite and isolation, all of which may increase the need for expensive medical care.

The article addresses cases of shoulder pain, hip pain and knee pain. Each could have been addressed earlier with proper orthopedic care, especially in cases where arthritic pain has led to a vicious cycle of immobility and declining health.

Agonizing pain is not a natural byproduct of aging, and no one should accept its arrival as a sort of grim “new normal.” If you have chronic knee, shoulder, elbow or hip pain and desire expert orthopedic care in San Diego, please contact my offices.


Stem cell therapies are hardly new. In fact, they are perennially on the cusp of finding their way into mainstream orthopedic medicine. The problem has long been a lack of reproducible findings – and a prohibitive cost.

At least one half of that equation may finally be getting addressed. Doctors are seeing more consistent results with certain stem cell therapies for orthopedic issues such as knee pain and shoulder pain. The process has remained largely unchanged since the technology was invented/discovered:

Doctors use a needle to extract bone marrow from the crest of the hip bone. It’s then sent to a lab, where it is spun down to get at the layer of stem cells — cells that have the potential to become any type of cell.

The stem cells are then combined with the patient’s platelets, a type of blood cell involved in healing. Then, it’s given back to the patient. The idea is to have the stem cells turn into new tissue and improve pain and function. . . .

Typically, this is done for various inflammatory tendon problems, though it can be used  for hips, knees, shoulders, ankles, and spine. Patients usually notice improvement by three months, with full benefit in one year.

It is a promising approach, although the body of literature on stem cell therapies versus traditional knee surgeries remains in its infancy. The best bet if you’re experiencing chronic knee pain: Visit a San Diego Orthopedic Surgery Center and get a full workup.  You will be counseled on the risks and rewards of the various treatment options available to you, based on your unique situation.  We provide PRP (platelet rich plasma) injections among the other various conservative treatment measures. In addition, we are able to provide the complete array of surgical procedures. This broad and comprehensive approach to treating your pain and dysfunction puts us in a unique position of being able to provide you an honest appraisal of your options. Our goal is to make you better!


Hot on the heels of my last post about knee pain, I’d like to return to the very same space to discuss some ways you can manage shoulder pain, improve mobility, and avoid shoulder surgery altogether.

The key is strength, especially the kind of supple, dynamic strength that arises from stretching rather than brute-force workouts with kettle bells, dumb bells, or bar bells. In a recent New York Times column, people with rotator cuff injuries were offered the same basic advice, including stretching with bands and supporting your body through the full range of motion. And then came this especially useful tip:

Don’t wait to start the program, by the way, until your shoulders ache. “These exercises are excellent for preventing shoulder injuries,” Mr. Ellenbecker said, “in addition to rehabilitating injured shoulders.”

This exercises focus on strengthening the rotator cuff muscles and the muscles of the upper back.  Again, this is the holy grail of shoulder longevity and health.

Whether you’re heading for shoulder surgery or recovering from an orthopedic surgical procedure, basic stretches are the easiest way to keep your body moving comfortably, fluidly and without pain. To learn more, please contact the San Diego shoulder surgery experts here today.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow