Question: Hello Dr. Grief

At age 81, I have had soreness in my right shoulder about bi-annually since 2008. The soreness usually kicks up toward the end of a two-hour session of doubles tennis. I have played for about 40 years, am right handed as well as a Type 2 diabetic.

I have sought help at a local orthopedic clinic in 2008, 2010, 2013, and again early this month. The doctor's assistant called for an X-ray of my shoulder each visit as well as an MRI after the first shoulder problem in 2008. These diagnostic tests show that I have a small pea-size "calcium deposit" (I think that's the right lay term for it) located on the "acromion of the scapula". The clinic people tell me that that area has very tight spacing so that certain motions likely cause a muscle or a tendon to rub between the top the deposit and a bone causing a momentary sharp pain followed by a dull ache for a few of days. None of the diagnostic tests show any likely signs of damage to the rotator cuff.

In 2008, the "ortho" doctor gave me two cordisone shots in the shoulder about 6 months apart. In the mean time, I rested the shoulder for a month and eventually exercised the shoulder with some simulated tennis motions. After a few months, I returned to my regular tennis schedule and was fine for about two years -- then the same soreness returned in 2010, and I rested and eventually had a third cordisone shot. This again was followed by four weeks of twice/weekly physical therapy and then, as previously, a gradual return to tennis.

All was OK until the same shoulder problem again occured this last May 2014. The clinicain offered me several options: surgery (either orthopedic or open) to remove the growth; more PT; more rest; another cortisone shot, some combination of these, or quit tennis altogether (ugh!).

Surgery is not an option at this time. My wife is quite ill with rheumatoid artheritis and some other health issues making it so I must be available most of time to help with household chores. That to me makes the surgery with a long recovery time along with uncomfortable pain not a viable option. Besides, being in my 80s, does elective surgery really make any sense?

So I elected to try another round of PT for a month. The clinician recommended that I come back in two months to see where the matter stands. Perhaps at time they would recommend a fourth cortisone shot (after the third in 2010) and maybe more PT.

I seek medical advice on what to do here. Tennis and daily walking are the core parts of my weekly exercise program.

So should I:
A. get a second opinion on the matter from another local "ortho" doctor?
B. finish another round of PT,
1. without a cortisone shot?
2. or maybe include another cortisone shot eventually?
C. quit tennis altogether?

Unfortunately, the clinician kind of forced me to choose and so I answered number B1. However, not being deeply knowledgable of orthorpedic medicine, I'm just not sure this B1 is the way to go. Also, what are the general probabilities that any of the options layed out for me will solve my right shoulder problem -- such information was not discussed in my 20-minute office visit on XXXXXXX 3, 2014.

What medical advice could you please provide?

Thank you kindly,XXXX