What is the cost of treating the repetitive strain injuries of the shoulder ("swimmer's shoulder")?

Severity Levels of Repetitive Strain Injury of the Shoulder ("Swimmer's Shoulder")

Repetitive strain injury of the shoulder, often referred to as "swimmer's shoulder," can vary in severity. Understanding these different levels can help patients and healthcare providers determine the most appropriate course of action for diagnosis and treatment.

Mild

• Symptoms: occasional pain, slight weakness
• Risk factors: occasional swimming or overhead activities
• Diagnosis: self-assessment or virtual doctor consultation
• Imaging/Labs: typically not necessary
• Treatments: rest, ice, over-the-counter pain relievers

Mild cases of swimmer's shoulder are often characterized by intermittent discomfort and minor weakness, typically occurring after engaging in swimming or other overhead activities. At this stage, many individuals can self-diagnose or seek a virtual consultation with a healthcare provider. Imaging or laboratory tests are usually not required, and treatment focuses on conservative measures such as rest, applying ice, and using over-the-counter pain medications.

Moderate

• Symptoms: frequent pain, noticeable weakness, limited range of motion
• Risk factors: regular swimming or overhead activities
• Diagnosis: in-person doctor consultation
• Imaging/Labs: X-ray, possible ultrasound
• Treatments: physical therapy, NSAIDs, possible corticosteroid injections

As the condition progresses to moderate severity, individuals may experience more frequent pain, obvious weakness, and a reduced range of motion in the affected shoulder. This level often results from regular participation in swimming or other activities involving overhead arm movements. An in-person doctor's visit is typically necessary for proper diagnosis. X-rays are commonly ordered, and in some cases, an ultrasound may be recommended. Treatment at this stage usually involves a combination of physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and potentially corticosteroid injections.

Severe

• Symptoms: constant pain, significant weakness, severely limited range of motion
• Risk factors: intense, prolonged swimming or overhead activities
• Diagnosis: in-person doctor consultation, possible referral to orthopedic specialist
• Imaging/Labs: MRI, possible EMG
• Treatments: intensive physical therapy, prescription pain medications, possible surgery

Summary Table: Severity Levels

Severe cases of swimmer's shoulder are characterized by persistent pain, marked weakness, and a significantly restricted range of motion. This level of severity is often associated with intense and prolonged participation in swimming or other overhead activities. Diagnosis requires an in-person consultation with a doctor, and referral to an orthopedic specialist may be necessary. More advanced imaging such as MRI is typically required, and in some cases, an electromyography (EMG) may be performed to assess nerve function. Treatment for severe cases is more intensive, potentially including a rigorous physical therapy regimen, prescription pain medications, and in some instances, surgical intervention may be considered.

Getting a Diagnosis

Getting an accurate diagnosis is the first step in treating repetitive strain injury of the shoulder ("swimmer's shoulder"). There are several options available, ranging from self-assessment to emergency room visits. Let's explore each option in detail, including costs and time estimates.

Self-assessment

Self-assessment is appropriate for mild cases and can be done immediately at no cost. However, it's important to note that this method may not be as accurate as professional medical evaluation.

• Cost: Free
• Time: Immediate

Virtual doctor consultation

Virtual consultations are becoming increasingly popular due to their convenience and accessibility. They are suitable for mild to moderate cases.

1. Teladoc:
   • General Medical Visits:
     • With insurance: $0 per visit (based on your benefits)
     • Without insurance: $89 per visit
   • Therapy Visits:
     • With insurance: $0-$99 per session
     • Without insurance: $99 per session
   • Psychiatry Visits:
     • With insurance: $0-$299 for the first visit and $0-$129 for subsequent visits
     • Without insurance: $299 for the first visit and $119 for subsequent visits
   • Time: Same-day to 2-3 days for appointment scheduling
2. MDLive:
   • Urgent Care: $82
   • Primary Care: $82
   • Dermatology: $95
   • Mental Health Therapy: $108 per session
   • Mental Health Psychiatry: $284 for an initial session, $108 for follow-up sessions
   • Time: Same-day to 2-3 days for appointment scheduling
3. OptimalMD:
   • Cost: Free with OptimalMD membership ($47/month for the entire family)
   • Time: Same-day to 2-3 days for appointment scheduling

In-person doctor consultation

In-person consultations are recommended for moderate to severe cases, allowing for a more thorough physical examination.

1. Primary Care Physician (average costs):
   • Without insurance: $150 to $300 (average $171)
   • With insurance: Varies based on copay and coinsurance
   • Time: 1-7 days for appointment, 30-60 minutes for consultation
2. Orthopedic Specialist (average costs):
   • Without insurance: $250 to $400 or more
   • With insurance: Varies based on copay, deductible, and coverage
   • Time: 7-14 days for appointment, 30-60 minutes for consultation
3. OptimalMD:
   • Cost: Free with OptimalMD membership ($47/month for the entire family)
   • Time: 1-7 days for appointment, 30-60 minutes for consultation

Emergency room visit

Emergency room visits are typically reserved for severe cases with acute pain or sudden loss of function.

1. Hospital Emergency Room (average costs):
   • Insured Patients: Average $1,082 (range $623 to $3,087)
   • Uninsured Patients: Average $1,220 to $2,200
   • Time: 2-6 hours total visit time
2. Urgent Care Center (average costs):
   • Without insurance: $100 to $300 (average $258)
   • With insurance: $150 to $300 before deductible, $60 to $170 after deductible
   • Time: 1-3 hours total visit time

Summary Table: Assessment Options

This table provides a quick overview of the various diagnosis options, their appropriate use cases, associated costs, and efficiency. Keep in mind that actual costs may vary depending on location, specific medical needs, and insurance plans.

Imaging and Laboratory Tests

When diagnosing and assessing the severity of repetitive strain injury of the shoulder ("swimmer's shoulder"), various imaging and laboratory tests may be necessary. The choice of test depends on the suspected severity of the condition and the healthcare provider's assessment. Let's explore the different options, their costs, and time estimates.

X-ray

X-rays are often the first imaging test ordered for shoulder pain. They can help rule out bone abnormalities or fractures.

• Procedure time: 15-30 minutes
• Results availability: Often same day

Pricing options:

• Hospital Radiology Department: $470 to $1,250 (cash price)
• Insurance: Typically covered with copay, usually $20-$50
• Urgent Care Center: $85-$175 (cash price)
• OptimalMD: Free with OptimalMD membership

Ultrasound

Ultrasound can help visualize soft tissues, including tendons and ligaments, making it useful for diagnosing rotator cuff injuries associated with swimmer's shoulder.

• Procedure time: 30-60 minutes
• Results availability: Often same day

Pricing options:

• Hospital Radiology Department: $445-$650 (cash price)
• Insurance: Typically covered with copay, usually $30-$50
• Independent Imaging Center: $200-$400 (cash price)
• OptimalMD: Heavily discounted with OptimalMD membership

MRI

MRI provides detailed images of soft tissues and is particularly useful for assessing severe cases of swimmer's shoulder or when surgery is being considered.

• Procedure time: 30-60 minutes
• Results availability: Typically 1-3 days

Pricing options:

• Hospital Radiology Department: $1,000 to $3,227 (cash price)
• Insurance: Typically covered with copay/coinsurance, usually $100-$250
• Independent Imaging Center: $400-$800 (cash price)
• OptimalMD: Heavily discounted with OptimalMD membership

EMG (Electromyography)

EMG is used to assess nerve and muscle function, which can be helpful in diagnosing severe cases of swimmer's shoulder where nerve involvement is suspected.

• Procedure time: 30-60 minutes
• Results availability: Often same day or within 1-2 days

Pricing options:

• Hospital Neurology Department: $150-$500 (cash price)
• Insurance: Typically covered with copay/coinsurance, usually $50-$100
• Independent Neurologist: $100-$300 (cash price)
• OptimalMD: Heavily discounted with OptimalMD membership

Summary Table: Diagnostics

Note: All listed services are either free or heavily discounted with OptimalMD membership ($47/month for the entire family).

When choosing an imaging or laboratory test, consider the severity of your condition, your doctor's recommendations, and your budget. Remember that while cost is an important factor, the accuracy and timeliness of the diagnosis are crucial for proper treatment of swimmer's shoulder. Always consult with your healthcare provider to determine the most appropriate tests for your specific situation.

Prescription Medications

In treating repetitive strain injury of the shoulder ("swimmer's shoulder"), prescription medications play a crucial role in managing pain and inflammation. The choice of medication often depends on the severity of the condition and the patient's individual needs. Here are some common prescription medications used for this condition:

NSAIDs (e.g., Celebrex, generic celecoxib)

NSAIDs are often the first line of prescription medication for moderate to severe cases of swimmer's shoulder. They help reduce inflammation and alleviate pain.

1. Celebrex (brand name):
   • Cash price: $600.21 for 30 capsules (200 mg)
   • With insurance: Copay varies, typically $30-$50 for a 30-day supply
   • With discount card: As low as $8.81 for 30 capsules of generic Celebrex
   • Free with OptimalMD membership
2. Celecoxib (generic):
   • Cash price: $18 for 14 capsules (200 mg)
   • With insurance: Copay varies, typically $5-$20 for a 30-day supply
   • With discount card: As low as $8.81 for 30 capsules
   • Free with OptimalMD membership

Time: Effects typically felt within 1-2 hours, taken daily or as prescribed

Muscle relaxants (e.g., Flexeril, generic cyclobenzaprine)

Muscle relaxants can be helpful in cases where muscle spasms contribute to shoulder pain and limited range of motion.

1. Flexeril (brand name):
   • Cash price: $135 for 30 tablets (7.5 mg)
   • With insurance: Copay varies, typically $10-$30 for a 30-day supply
   • With discount card: As low as $45 for 30 tablets
   • Free with OptimalMD membership
2. Cyclobenzaprine (generic):
   • Cash price: $20 for 30 tablets (10 mg)
   • With insurance: Copay varies, typically $5-$15 for a 30-day supply
   • With discount card: As low as $3 for 30 tablets
   • Free with OptimalMD membership

Time: Effects typically felt within 30-60 minutes, taken as needed or prescribed

Corticosteroids (e.g., prednisone)

Corticosteroids are powerful anti-inflammatory medications that may be prescribed for short-term use in more severe cases of swimmer's shoulder.

1. Prednisone:
   • Cash price: $13 for 10 tablets (20 mg)
   • With insurance: Copay varies, typically $5-$15 for a short course
   • With discount card: As low as $4.63 for 10 tablets
   • Free with OptimalMD membership

Time: Effects may be felt within a few days, typically prescribed for short courses (5-7 days)

Summary Table: Prescription Medications

Note: All medications listed are free with OptimalMD membership ($47/month for the entire family).

Over-the-Counter Treatments

Over-the-counter (OTC) treatments are often the first line of defense for managing mild to moderate cases of repetitive strain injury of the shoulder, commonly known as "swimmer's shoulder." These treatments are readily available without a prescription and can provide quick relief for many patients. Let's explore the various OTC options, their costs, and efficiency.

NSAIDs (e.g., Advil, generic ibuprofen)

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation associated with swimmer's shoulder. Ibuprofen is a popular choice, available under brand names like Advil or as generic versions.

Based on the cost information, we can see that the price of ibuprofen varies depending on the dosage, quantity, and brand:

• Generic Ibuprofen (800mg, 30 tablets):
  • Average retail price: $13.39
  • With discount card: As low as $2.37
  • Without insurance: Up to $33.32
• Brand-name Advil (200mg, 100 caplets):
  • CVS Pharmacy price: $11.99
• Generic Ibuprofen (200mg, 1000 tablets):
  • CVS Pharmacy price: $23.83

Efficiency: Effects are typically felt within 20-30 minutes, and the medication can be taken as needed, making it a quick and flexible option for pain relief.

Topical pain relievers (e.g., Bengay, generic menthol/methyl salicylate cream)

Topical pain relievers can provide localized relief for swimmer's shoulder. Popular options include Bengay and generic menthol/methyl salicylate creams.

Cost breakdown for topical pain relievers:

• Generic menthol cream (2 oz):
  • Price: As low as $3.09
• Brand-name options:
  • Biofreeze (3 oz): $10.00
  • Icy Hot PRO (2 oz): $17.99

Prices for topical pain relievers generally range from $3.09 to $17.99, depending on the brand and size. Insurance typically doesn't cover over-the-counter topical pain relievers, but some flexible spending accounts (FSAs) or health savings accounts (HSAs) may allow their purchase.

Efficiency: Effects are typically felt within 15-30 minutes of application, providing quick, localized relief. These can be applied as needed, making them a convenient option for many patients.

Cold/hot packs

Cold and hot packs are essential tools for managing swimmer's shoulder pain and inflammation. They're reusable and can be applied immediately for relief.

Cost breakdown for cold/hot packs:

• Reusable cold/hot packs (individual):
  • Price range: $0.75 - $23.99
  • Economy options: $0.75 - $1.84
  • Premium options (e.g., Walgreens Extra Large): $23.99
• Bulk purchases (for clinics or frequent use):
  • 24-pack: $16.50 (approximately $0.69 per pack)
  • 50-100 pack: $84.99 - $119.00 (approximately $0.85 - $1.70 per pack)

Insurance typically doesn't cover over-the-counter cold/hot packs, but some FSAs or HSAs may allow their purchase.

Efficiency: Cold/hot packs offer immediate application and can be used for 15-20 minutes at a time. They're highly efficient for quick, at-home pain relief and can be reused multiple times, making them a cost-effective option in the long run.

Summary Table: OTCs

Here's a summary table of the over-the-counter treatments discussed:

Remember that prices may vary depending on location, brand, and specific retailer. It's always a good idea to compare prices at different pharmacies and consider generic options when available to optimize cost-effectiveness.

Procedures

Procedures for treating repetitive strain injury of the shoulder ("swimmer's shoulder") can vary depending on the severity of the condition. Here, we'll explore the most common procedures, their costs, and time considerations.

Physical Therapy

Physical therapy is often the first line of treatment for moderate to severe cases of swimmer's shoulder. Let's look at the costs and providers:

Based on the information from our providers and national averages, here's a breakdown of physical therapy costs:

• National average: $75 - $150 per session
• PhysioWorks (New York, NY): $75 - $120 per session
• HealthSpring Physical Therapy (Los Angeles, CA): $75 - $120 per session

Insurance coverage for physical therapy varies widely. Many insurance plans cover physical therapy, but patients may be responsible for copays ranging from $20 to $55 per session. Some plans may require a deductible to be met first.

Time considerations:

• Individual sessions typically last 30-60 minutes
• Treatment plans usually involve 2-3 sessions per week
• Total duration often ranges from 4-8 weeks, depending on the severity of the condition

Corticosteroid Injections

For cases where pain is severe or persistent, corticosteroid injections may be recommended. Let's examine the costs:

Based on the available information and national averages:

• National average: $25 - $300 per injection
• MedStar Health (Washington, D.C.): $25 - $300 per injection
• Mayo Clinic (Rochester, MN): Prices vary, contact for specific estimates

With insurance, out-of-pocket costs typically range from $20 to $100 per injection, depending on your plan and whether you've met your deductible.

Time considerations:

• The procedure itself takes about 15-30 minutes
• Relief may be felt within a few days and can last for several weeks to months
• Patients are usually limited to 3-4 injections per year to minimize side effects

Surgery (for severe cases)

In severe cases where conservative treatments have failed, surgery may be necessary. The most common surgical procedure for swimmer's shoulder is arthroscopic surgery. Let's look at the costs:

Based on the information from our providers and national averages:

• National average: $6,000 - $22,000
• Hospital for Special Surgery (New York, NY): $6,000 - $22,000
• Cleveland Clinic (Cleveland, OH): $4,400 - $11,900, with an average of $7,093

Insurance coverage for surgery can significantly reduce out-of-pocket costs. With insurance, patients may be responsible for:

• Deductible (if not already met)
• Coinsurance (typically 10-30% of the allowed amount)
• Copayments for follow-up visits

Time considerations:

• The surgical procedure itself typically takes 1-3 hours
• Patients usually stay in the hospital for 1-2 days
• Full recovery and return to normal activities can take several months, with physical therapy often required during the recovery period

Summary Table: Procedures

Remember, these are general estimates, and actual costs may vary depending on location, specific provider, and individual insurance plans. Always consult with your healthcare provider and insurance company for the most accurate information regarding your specific situation.

Optimizing for Cost

When optimizing for cost in treating repetitive strain injury of the shoulder ("swimmer's shoulder"), consider the following strategies for each severity level:

Mild Cases:

• Start with self-assessment and home care using the RICE method (Rest, Ice, Compression, Elevation)
• Use over-the-counter NSAIDs like generic ibuprofen for pain relief
• If symptoms persist, opt for a virtual doctor consultation instead of an in-person visit
• Avoid unnecessary imaging tests unless recommended by a healthcare professional

Moderate Cases:

• Begin with a virtual doctor consultation to determine if an in-person visit is necessary
• If prescribed, choose generic versions of NSAIDs or muscle relaxants
• Consider at-home physical therapy exercises guided by online resources or telehealth sessions
• If imaging is required, opt for X-rays or ultrasound before more expensive MRI scans

Severe Cases:

• Schedule an in-person consultation with a general practitioner before seeing a specialist
• Request generic medications when possible
• Explore outpatient physical therapy options, which are often less expensive than hospital-based services
• If surgery is recommended, compare costs between different healthcare providers and facilities

General Cost-Saving Tips:

• Check if your insurance offers telemedicine services at reduced rates
• Look for discount programs or coupons for prescription medications
• Consider using flexible spending accounts (FSAs) or health savings accounts (HSAs) to pay for medical expenses with pre-tax dollars
• Inquire about payment plans or financial assistance programs offered by healthcare providers

By focusing on cost-effective options and utilizing available resources, patients can minimize expenses while still receiving appropriate care for their repetitive strain injury of the shoulder ("swimmer's shoulder"). Remember that while cost is an important factor, it should not compromise the quality of care or delay necessary treatment.

Optimizing for Efficiency

When time is of the essence, optimizing the treatment plan for repetitive strain injury of the shoulder ("swimmer's shoulder") for efficiency becomes crucial. Here are the most time-efficient strategies for each severity level:

Mild Cases:

1. Self-assessment followed by a virtual doctor consultation
2. Over-the-counter NSAIDs for immediate pain relief
3. At-home exercises and rest, as recommended by the virtual doctor

This approach allows for quick intervention without the need for time-consuming in-person visits or imaging tests.

Moderate Cases:

1. In-person doctor consultation with same-day X-ray
2. Immediate start of physical therapy (ideally within 1-2 days of diagnosis)
3. Prescription NSAIDs or muscle relaxants for faster pain relief
4. Corticosteroid injection if rapid improvement is needed

This strategy combines swift diagnosis with immediate treatment initiation, potentially shortening recovery time.

Severe Cases:

1. Emergency room visit for immediate assessment and pain management
2. MRI scheduled within 1-2 days of initial assessment
3. Referral to orthopedic specialist with expedited appointment (within 3-5 days)
4. Aggressive physical therapy regimen (3-4 times per week)
5. Consideration of early surgical intervention if conservative treatments fail to show improvement within 2-3 weeks

This approach prioritizes rapid intervention and specialist care to address severe symptoms and prevent further deterioration.

By focusing on efficiency, patients can potentially reduce recovery time and minimize the impact of swimmer's shoulder on their daily activities. However, it's important to note that the most efficient approach may not always be the most cost-effective or medically optimal for every individual. Always consult with a healthcare professional to determine the best course of action for your specific situation.

Balancing Cost and Efficiency

When balancing cost and efficiency for treating repetitive strain injury of the shoulder ("swimmer's shoulder"), consider the following strategies for each severity level:

Mild Cases

• Start with self-assessment and over-the-counter treatments
• If symptoms persist, opt for a virtual consultation to save time and money
• Utilize at-home exercises and stretches recommended by reputable online sources
• Consider a single in-person physical therapy session to learn proper techniques

Moderate Cases

• Begin with an in-person doctor consultation for accurate diagnosis
• Choose generic NSAIDs over brand-name options when possible
• Opt for X-rays instead of more expensive imaging unless deemed necessary
• Attend physical therapy sessions, but supplement with at-home exercises
• Consider telehealth follow-up appointments to reduce costs and save time

Severe Cases

• Prioritize a comprehensive in-person evaluation with a specialist
• Invest in necessary imaging (MRI) for a thorough diagnosis
• Balance the cost of intensive physical therapy with potential long-term benefits
• If surgery is recommended, compare costs and recovery times of different procedures
• Utilize a mix of in-person and virtual follow-up appointments during recovery

By carefully considering these balanced approaches, patients can optimize their treatment plan for both cost and efficiency, ensuring they receive appropriate care without unnecessary expenses or delays. Always consult with healthcare professionals to determine the best course of action for individual cases.

Conclusion

In this comprehensive guide, we've explored the various aspects of diagnosing and treating repetitive strain injury of the shoulder, commonly known as "swimmer's shoulder." We've covered the different severity levels, diagnostic methods, imaging and laboratory tests, prescription medications, over-the-counter treatments, and potential procedures involved in managing this condition.

Key takeaways from this article include:

1. The importance of accurately assessing the severity of swimmer's shoulder to determine the appropriate level of care.
2. The range of diagnostic options available, from self-assessment to specialized imaging tests.
3. The variety of treatment options, including rest, medications, physical therapy, and in severe cases, surgery.
4. Strategies for optimizing care based on cost, efficiency, or a balance of both.

Understanding the costs and time estimates associated with each step of the treatment process empowers patients to make informed decisions about their care. It's crucial to remember that while cost and efficiency are important factors, the primary goal should always be effective treatment and recovery.

Every case of swimmer's shoulder is unique, and treatment plans should be tailored to individual needs and circumstances. While this guide provides a comprehensive overview, it's essential to consult with healthcare professionals for personalized advice and treatment recommendations.

By being informed about the various options and their associated costs and timeframes, patients can work more effectively with their healthcare providers to develop a treatment plan that addresses their specific needs while considering practical factors such as cost and time efficiency.

Remember, early intervention and proper care can significantly improve outcomes and prevent long-term complications associated with repetitive strain injury of the shoulder. Don't hesitate to seek professional medical advice if you're experiencing symptoms of swimmer's shoulder.