Research Helps Patients Beat Unexplained Shoulder Pain

Man holding shoulder in pain

The patient had shoulder pain but tests couldn’t pinpoint the cause. Another couldn’t sleep because of the discomfort. A third couldn’t do even the most basic of everyday activities like shower, cook or drive a car. None of them knew what was causing the pain.

CHI Health Orthopedic Surgeon Matthew Dilisio, MD, set out to “explain the unexplained.”

And he did. With his research team, Dilisio discovered “new ways the shoulder tendon degenerates that are invisible to other testing modalities.” This opened the door to treatment options for patients who couldn’t be helped before. Even with previous MRIs and surgeries they hadn’t found relief.

By analyzing discarded symptomatic biceps tendons in the shoulder after surgery, Dilisio and his research team found a novel degenerative process that explained why a seemingly normal tendon can cause so much pain in patients.

“Now that we better understand these unique inflammatory pathways of the biceps tendon,” he said, “we are able to easily treat these problems with a minimally invasive 20-minute procedure.

The procedure is biceps tenodesis, in which the tendon is removed from the shoulder joint and re-attached farther down the humerus.

“The results of this surgery are excellent,” Dilisio said, “and many patients who previously had unexplained shoulder pain can now be helped with this procedure.” He’s seen patients get back to simple everyday activities, sleep through the night again and participate in favorite activities.

With his experience in biomechanics research, Dilisio was also able to study the fatty infiltration of the shoulder. After surgery, fat can sometimes invade the tendon area, preventing healing and blocking muscle tissue. “It’s as though you’ve just changed the tires on a car with no motor,” he said.

To get answers, he teamed up with Devendra Agrawal, PhD, in Creighton University’s Department of Clinical and Translational Science. He had previously studied the negative inflammatory effect of fat on cardiac tissue. The two of them, along with postdoctoral researcher Finosh Thankam, PhD, discovered a significant upregulation of certain proteins, known as TREMs, in shoulders that demonstrated arthritis. These molecules are a potential therapeutic target for novel medications that may help patients suffering from joint pain.

Their findings were recently published in Molecular and Cellular Biochemistry. Dilisio has published numerous articles over the past year.

The orthopedic surgeon also explored a possible link between shoulder tendon problems and vitamin D deficiencies. The work was a “springboard,” he said, to his work on the fatty infiltration of the shoulder.

Dilisio and his team just submitted a $2.5 million grant application to the National Institutes of Health. Everyone’s work “is going to put our orthopedic department on the map,” he said.

Matthew F. Dilisio, MD

Orthopedic Surgery,
Orthopedic Surgery Upper Extremity