Shoulder Pain

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm, from scratching your back to throwing the perfect pitch. Mobility has its price, however. It may lead to increasing problems with instability or impingement of soft tissue resulting in pain. You may feel pain only when the shoulder is moved, or in some cases all of the time. The pain may be temporary and disappear in a short time, or it may continue and require medical diagnosis and treatment.

What causes shoulder pain?

Most shoulder problems involve the soft tissues, muscles, ligaments and tendons, rather than bones. And most of these problems fall into three major categories:

Tendinitis/bursitis
Injury/instability
Arthritis

Other much more rare causes of shoulder pain are tumors, infection and nerve-related problems.

1. Tendinitis A tendon is a cord which connects muscle to bone or other tissue. In most patients, tendinitis is a result of the wearing process or “overuse” that takes place over a period of years, much like the wearing process on the sole of a shoe which eventually splits from overuse. Generally, tendinitis is one of several types:

acute tendinitis due tooveruse ; such as excessive ball throwing and other sports- or work-related activities.
chronic tendinitis results from degenerative disease or repetitive wear and tear due to age.
the splitting and tearing of tendons which may result from acute injury or degenerative changes in the tendons due to advancing age. Rotator cuff injuries are among the most common of these disorders. The rotator cuff is the arrangement of muscles and their tendons which provides shoulder motion and stability.

2. Bursitis is the excessive use of the shoulder which leads to swelling and inflammation of the bursa. Bursas are fluid-filled sacs located around the joints which lessen the friction caused by movement of the shoulder. Bursitis often occurs in association with rotator cuff tendinitis. Sometimes the many tissues in the shoulder become inflamed and painful, limiting the use of the shoulder. The joint may stiffen as a result, a condition called a "frozen shoulder." Fortunately, with appropriate care, this condition will resolve itself.

3. Injury/Instability Sometimes the bones in one of the shoulder joints move (or, in an injury, are forced) out of their normal position. This condition, instability, can result in dislocation of one of the joints in the shoulder. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. When you lift your arm over your head, the shoulder may feel as if it is slipping out of place or an uncomfortable, unusual feeling that some people refer to as having a "dead" arm.

4. Arthritis Shoulder pain can also result from arthritis. There are many types of arthritis, but generally it involves wear and tear changes with inflammation of the joint, causing swelling, pain and stiffness. Arthritis may be related to sports or work injuries.

Often people will avoid shoulder movements in an attempt to lessen the pain arising from these conditions. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.

Treatment

Treatment generally involves altering activities and includes the following:

Rest
Physical Therapy to help you improve shoulder strength and flexibility.
Medication may be prescribed to reduce inflammation and reduce pain. For example, Ibuprofen, Naproxen, Celebrex
Injections of corticosteroids may also be used to reduce inflammation
Surgery may be required to resolve shoulder problems; however, 90 percent of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise and medication. Certain types of shoulder problems, such as recurring dislocation and some rotator cuff tears may require surgery.

When should you seek medical care for your shoulder pain?

Many patients ignore temporary minimal shoulder symptoms with few bad effects. In the case of an acute injury, if the pain is intense, you should seek medical care as soon as possible. If the pain is less severe, it may be safe to wait a few days to see if time will alleviate the problem. If symptoms persist, call your orthopedic surgeon to get the proper diagnosis and treatment.

Diagnosis of shoulder pain

Determining the source of the problem in the shoulder is essential to recommending the right method of treatment. Therefore, a comprehensive examination will be required to find the causes of your shoulder pain.

Your doctor will gather the following information:

A complete medical history to see if this is the first injury to the shoulder or if this is a repetitive injury
How did the pain start and when
Did you have this pain previously and if so, how was it treated
What activities aggravate your shoulder pain?
Do you take medications to relieve your pain? If so, which ones?

During your physical examination, your doctor will be looking for:

Physical abnormalities
Swelling
Deformity
Muscle weakness
Numbness
Tingling
Areas of tenderness
How is your range of motion
How far and in which direction can you move your arm.

Diagnostic techniques:

X-ray studies may be required so your orthopaedist can look closely at the bones and joints in your shoulder.
CT scan (computerized tomography), which provides a more detailed view of the shoulder area
Electrical studies such as the EMG (electromyogram), which can indicate nerve damage
Arthrogram : an X-ray study in which dye is injected into the shoulder to allow the orthopaedist to better see the joint and its surrounding muscles and tendons.
MRI (Magnetic Resonance Imaging) to diagnose Rotator Cuff Tears
Ultrasound are other valuable diagnostic tools for orthopaedists, because they provide images of the soft tissues without using radiation.
Arthroscopy is a surgical procedure in which the orthopedic surgeon looks inside the joint with a lighted telescope. It is used to diagnose causes of shoulder pain. Arthroscopy may indicate soft tissue injuries that are not apparent in the physical examination, X-rays and other tests.

If you are currently experience shoulder pain, Contact Us to get a thorough orthopedic evaluation of your symptoms.

Dr. Emmanuel - Providing services in orthopedic surgery to the area of Culver City, Los Angeles and Beveraly Hills, California (CA).