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Shoulder Pain

The shoulder is actually made of up several joints between bones, muscles, tendons, and ligaments. Injury to any of the many structures of the shoulder can lead to shoulder pain. Because of the exquisite flexibility and range of motion of the shoulder, it is prone for injury. Shoulder pain can be very different in each individual who experiences it. The pain could be present all of the time, only with motion, be quite sharp, or be a dull ache. It may be temporary and disappear with time or may be chronic. No matter the type of pain, it deserves your attention and the attention of your doctor.

The following information includes brief descriptions of the kinds of injuries and consequences that may cause pain in the shoulder.

Shoulder pain is usually the result of injury to the soft tissues that support the joint, muscles ligaments and tendons, rather than the bones of the joint. The majority of problems can be classified into three categories:

1. Bursitis/Tendonitis
2. Injury/Instability
3. Arthritis

Bursitis is a usually a self-limiting inflammation of a structure that is part of the shoulder joint called the bursa. The bursa is a fluid filled sac located around the joint that lessens the friction associated with movement of the shoulder. Bursitis often occurs in association with rotator cuff tendonitis.

Tendonitis is an inflammation of an extension of muscle that connects to bone or other tissue (a tendon). Wear and tear of the tendons usually takes place over the period of years and can result in tendnitis (inflammation of the tendons). Generally, tendonitis is one of several types:

• Acute tendonitis following some overuse problem such as excessive ball throwing and other sports- or work-related activities.
• Chronic tendonitis resulting 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.

When the bones of the shoulder are sometimes forced out of their normal position the shoulder is said to be dislocated. Dislocations may be partial or incomplete, however no matter the type or direction of dislocation the shoulder will become instable and unsteady, and often times painful. 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.

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.

There are many way to approach shoulder pain. Typically, the initial approach is conservative, including altering activities and physical therapy to improve flexibility and strength of the shoulder. Nonsteriodal anti-inflammatory medications, like aspirin and ibuprofen, are sometimes given for pain relief. Injections of drugs into the joint may also be used. Often common sense and listening to your body can be the best medicine to relieve shoulder pain.

Ninety percent of patients with shoulder pain will respond to the conservative therapy described above, however, surgery may be required to resolve those that do not respond. In particular, certain types of shoulder problems, such as recurring dislocation and some rotator cuff tears may require surgery.

Time is one of the best cures, and it is safe therefore to wait a few days to see if time will alleviate minor shoulder symptoms. However, in the case of an acute injury, if the pain is intense, you should seek medical care as soon as possible. Orthopedists are specifically trained in the workings of the musculoskeletal system, including the diagnosis, treatment and prevention of problems involving muscles, bones, joints, ligaments and tendons.

The right method of treatment is very specific to the type and severity of the shoulder injury or problem. A comprehensive is necessary to determine the particular cause of shoulder pain.

It is important to provide your orthopedist with a complete and honest medical history. The medical history is the first step in determining when the pain started, its progression and overall general health. The medical history can also be helpful in determining the activities specially associated with the shoulder problem which gives the orthopedist insight as to the movements with relation to the structures of the shoulder.

The physical examination is the next piece of the comprehensive exam in which, if present, any physical abnormalities will be discovered including swelling, deformity or muscle weakness. Additionally, range of motion will be tested.
X-ray studies may be required so your orthopedist can look closely at the bones and joints in your shoulder. Other diagnostic techniques that may be used include:

• 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 orthopedist to better see the joint and its surrounding muscles and tendons.
• MRI (Magnetic Resonance Imaging) and ultrasound are other valuable diagnostic tools for orthopedists, because they provide images of the soft tissues without using radiation.
• Arthroscopy is a surgical procedure in which the orthopedist looks inside the joint with a lighted telescope. It is sometimes 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.