What is Best if Your Shoulder Hurts

By: Robert Friedman, MD   October 6, 2016
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What is Best if Your Shoulder Hurts?

Many people suffer from shoulder problems and are reluctant to seek care, fearing that they will be told that they need surgery to fix the issue. In addition, most everyone has heard horror stories of painful, miserable experiences treating a shoulder which further substantiates their fear. The real truth is that most shoulder problems are fixable without surgery, if it comes to surgery state of the art arthroscopic, outpatient procedures are not that terrible, and most importantly, delaying treatment may cause something that was fixable with simple measures to requiring more invasive procedures.

  • Most shoulder issues are fixable without surgery
  • Surgery is not nearly as traumatic as previously
  • Delaying treatment may make matters worse

There are many causes of shoulder pain and finding the correct diagnosis is paramount to developing a treatment plan that will result in resolution of the symptoms. Potential reasons include rotator cuff injury or inflammation, arthritis, Acromioclavicular joint problems, instability or tears of the labrum, frozen shoulder, or even a pinched nerve in the neck. Certain features can help distinguish between these potential causes and discussing these features with your physician will help him or her arrive at the correct origin. A good physical examination and xray analysis is usually sufficient to diagnose the problem.

Rotator cuff problems generally manifests as pain in the arm on the outer aspect which frequently radiates to the elbow. The rotator cuff is a dense network of fibers or cables responsible for moving the arm in space. The movement is complex, because you can place your arm right, left, up, or down at varying degrees or angles. In addition, placing any object in your hand creates a large lever force and greatly accentuates the amount of stress seen by the cables. As a result, the fibers are very prone to injury, inflammation or tearing.  Pain in more intense with any overhead activity. Many people also have pain when sleeping. If detected early, in the inflammatory stage, rotator cuff injuries can be treated with some combination of exercises, oral medication, and/or a cortisone shot. Initiating these measures and monitoring the effects four weeks later is usually a good start in treatment.

If these measures are unsuccessful, other tests such as an MRI may be necessary. The cuff may have a full tear in it, and surgery may be necessary to repair it. The recovery is characterized by a period of rest followed by progressive rehabilitation. You can drive and perform simple tasks, such as bending the elbow to eat, write, or type. You are restricted from any overhead or reaching activities for the first month.  It may take 4-6 months to recover fully. With proper guidance during this period, you can achieve a very successful result. 

Another problem that can cause shoulder pain occurs when calcium within the fibers of the rotator cuff form spontaneously. Most of the time we do not know why it forms, but it may be related to repetitive traumatic stresses. Symptoms for this problem are very similar to rotator cuff tears, but seem to be much more intense. An xray is diagnostic. Treatment can take two avenues: shots to alleviate pain or removal to cure the problem.

Frozen shoulder is characterized by deeply seated, constant and intense pain with loss of motion. An inflammatory process spreads to the lining of the joint, causing the capsule to shrink from the size of a grapefruit to an orange. The ball simply does not have space to move, and patients with this condition complain of inability to use the arm overhead or reach behind their back. Diabetics are more prone to developing this issue. A shot in the joint (different than the rotator cuff shot) combined with vigorous physical therapy can usually resolve the issue, although it may be quite slow to respond. In some cases, surgery is needed to release the capsule. In this situation, the arm is mobilized right away and there is no period of rest.

Arthritis of the shoulder is very common, especially as people age. Arthritis causes pain, limitation of motion, and marked grinding or squeakiness with motion. A shot in the joint and exercises can be very helpful, but in severe cases it may require a replacement.

Labral tears are often more difficult to diagnose because of vague symptoms. Painful clicking, feeling that the ball is slipping out of the joint or locking may be present. Overhead athletes are prone to this issue. It’s generally due to an event with trauma to the shoulder and the sensation that something ripped. Complete tears usually happen if a complete dislocation occurred and the shoulder had to be reduced in the emergency room under sedation. In this situation, the diagnosis is clear. Minor damages can be improved with a good exercise regimen, but more significant instability or tearing might require surgery.

The acromioclavicular joint is where the collar bone meets the shoulder bone and is different than the ball and socket joint. It can also be a frequent cause of shoulder pain. People who lift weights can develop cysts or arthritis in this joint. The pain occurs on the top of shoulder and into the base of the neck. A cortisone shot can alleviate this pain. For persistent pain, the end of the collar bone can be trimmed back to healthy bone, which usually cures the problem.

There are other problems, outside of the shoulder joint, which can manifest as pain in the same region. The most common cause is a pinched nerve in the neck. The symptoms are similar with pain in the shoulder. Usually it is located in the shoulder blade, is present all the time, whether you are moving the arm or not, and can be quite intense. There may or may not be associated neck pain, or numbness and tingling into the hand. Treatment with anti-inflammatory medicine and physical therapy to the neck usually resolves this issue.

All of these shoulder issues may require surgery if simple measures fail. The surgery is much different than it used to be. It is now arthroscopic, performed through three or four small holes with the aid of a camera. It is outpatient and the pain and discomfort associated with the procedure is minimal. Anesthesia personnel are more skilled in performing blocks now, which helps to reduce the postoperative pain immensely.

It is important to realize that ignoring shoulder pain could cause the problem to escalate. If detected and treated early, most problems can be resolved with simple measures. 

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