Shoulder pain is an extremely common complaint for patients. There are many common causes for shoulder pain and it is important that you make an accurate diagnosis so the appropriate treatment can be recommended.
The shoulder is a ball-and-socket joint, called the glenohumeral joint. The rotator cuff is made up of 4 muscles; the infraspinatus, supraspinatus, subscapularis, and teres minor. Together these muscles contribute to the stability of the shoulder and rotates the humerus outward. The cuff adheres to the glenohumeral capsule and attaches to the humeral head.
The 4 tendons of these muscles converge to form the rotator cuff tendon. The supraspinatus is the most common muscle tendon that is torn in the rotator cuff.
Shoulder pain can be caused by soreness or a tear of a tendon of the rotator cuff, arthritis, a frozen shoulder or dislocation. These injuries can occur from activities such as playing sports, over use of your shoulder. Or you may not remember any specific injury to your shoulder and it gradually started hurting over time.
- Tendon inflammation or tear – When tendons of the rotator cuff separate from the bone. This can be caused by a specific injury, advanced age, or over use of the shoulder. There are several types and degrees of tears. Sometimes physical therapy or an injection can help relief the pain. Occasionally surgery is required.
- Arthritis – The most common type of arthritis in the shoulder is osteoarthritis. This typical begins around middle age and the pain slowly gets worse over time.
Injections can sometimes be helpful and although less common shoulder joint replacement can be recommended.
- Frozen Shoulder – This is common and leads to stiffness of the shoulder joint. Supervised physical therapy is an extremely important part of treatment.
- Dislocation – Usually occurs from an injury. The top of the arm bone can become disconnected from the scapula causing a dislocation.
Diagnosis and Treatment
If you sustained a specific injury it is best to seek medical attention as soon as possible. If you are unable to remember an injury it is usually safe to wait a couple days and then seek medical attention if the symptoms get worse.
There are many tests that your physician can perform in the office to check for physical abnormalities, weakness, and loss/decrease of range of motion.
There are several diagnostic tests that can be ordered as well.
- X-rays – Do not show soft tissue but can be used to rule out any boney abnormalities or fractures.
- MRI – Magnetic Resonance Imaging – A painless technique that allows the doctor to look at the soft tissues of the shoulder. They help identify not only if there is a tear but the location and size of the tear.
- Ultrasound – Ultrasound studies are also a means of identifying rotator cuff tears. Ultrasound transmits high-frequency sound pulses into your body using a probe. The waves travel between tissues and fluid and are then reflected back to the probe and relays it to the machine.
Ultrasound is painless and there is no radiation involved. Ultrasound is not always able to take the place of an MRI but it is faster, no exposure to radiation and less expensive than an MRI. They can also be used in the presence of metal, eg. Or for patients who are claustrophobic. Ultrasounds can be done at the time of the visit in the office.
The type of treatment completely depends on the diagnosis of your shoulder. Not all treatments are appropriate for all conditions.
- Rest – Sometimes rest is the best treatment for your shoulder. However, use caution because long term rest can lead to a frozen shoulder.
- Physical Therapy – The use of different modalities can be ordered to strengthen your shoulder muscles.
- Anti-inflammatory Medication – Nonsteroidal anti-inflammatory medication can be used for problems such as arthritis and tendonitis.
- Cortisone Injection – A mixture of numbing medication and cortisone can be used to help treat inflammation.
- Surgery – There are shoulder injuries that require surgery. If conservative treatment does not resolve the symptoms surgery is sometimes recommended. Most procedures are done arthroscopically on an outpatient basis. Recovery depends on the size and type of tear.