Shoulder Pain

Description

The shoulder is a complex ball and socket joint with multiple supporting muscles and tendons. It is susceptible to age related wear and tear and traumatic injury. Shoulder pain can be secondary to multiple causes such as muscle sprains or strains, rotator cuff injuries, subacromial bursitis, and fractures.

Causes

  • Sprain and strains
  • Rotator cuff abnormalities including impingement, tendinitis and injuries
  • Bursitis
  • Fractures
  • AC joint separation
  • Glenoid labrum/cartilage tears
  • Dislocations
  • Frozen shoulder/adhesive capsulitis
  • Arthritis including osteoarthritis and rheumatoid arthritis
  • Polymyalgia rheumatica
  • Referred pain from another part of the body

Symptoms

Symptoms of shoulder pain depend on the nature and severity of the underlying problem. They can range from mild discomfort to unbearable pain. Common signs and symptoms include inflammation, tension, warmth, red discoloration, swelling, stiffness and decreased range of motion due to pain.

Diagnosis

Establishing a diagnosis involves a history and physical exam. The physician will ask you about your activities and if you had any recent injuries. They will ask about your professional and recreational activities and family history.

The physical exam may include an assessment for tenderness around the shoulder and moving the shoulder to assess stiffness and pain. The doctor will also look for any deformities or discolorations.

X-rays are useful for identifying any bony abnormalities such as a fracture or osteoarthritis. X-rays can also be used to observe minor changes in the joints such as joint space narrowing due to cartilage erosion.

Ultrasound exams can highlight swelling and soft tissue injuries and abnormalities with tendons and muscles.

An MRI can provide more detailed images of soft tissues such as cartilage and muscles, identifying tears, ruptures, and abnormal growths such as tumors.

A nerve conduction study detects interruptions in electrical impulses in nerves that may be compressed or irritated, causing shoulder pain.

Management

Treating shoulder pain depends on the underlying cause and its severity. Most mild cases of shoulder pain can be effectively managed with rest, ice and heat packs and over the counter pain medications such as nonsteroidal anti-inflammatories like ibuprofen. Physical therapy can aid significantly as can chiropractic care. Techniques such as myofascial release have proven effective for syndromes like frozen shoulder. An interventional pain management physician or other appropriately trained physician can treat myofascial shoulder pain with trigger point injections. Aside from over-the-counter pain medications, a physician can prescribe muscle relaxants for shoulder conditions that involve tense muscles or spasms. Commonly prescribed muscle relaxants include baclofen, cyclobenzaprine and tizanidine. Surgery is used for conditions such as rotator cuff tendon ruptures or tears that are not likely to heal on their own. Newer techniques such as arthroscopic surgery involve using thin cylindrical tubes to insert cameras and surgical instruments. This type of surgery allows for smaller incisions and faster healing. For severe fractures and advanced arthritis, either partial or complete shoulder replacement surgery may be required. In shoulder replacement surgery, prosthesis are used to replace the shoulder joint and the bone that rests in the joint.