Shoulder Pain
The shoulder is a complex joint which includes both the glenohumeral joint and the acromioclavicular joint. There are fifteen main muscles in the shoulder which combine with their associated tendons and the bony and cartilaginous tissues in the shoulder to allow a wide range of motion for the arm. These intricate interactions allow the shoulder to perform painless activities from scratching your back to throwing the perfect pitch. But, mobility has its tradeoffs and over time or with an injury these intricate interactions can become painful. Shoulder pain can occur only when the shoulder is moved, or may become constant and even limit a persons ability to sleep. It may lead to increasing problems with instability or impingement of soft tissue resulting in pain. Shoulder pain can disappear in a short time, or it may continue and require the attention of a fellowship trained orthopedic shoulder surgeon.
Potential Causes of Shoulder Pain
Shoulder problems can involve the soft tissues, muscles, ligaments, and tendons, or even the bones of the shoulder. Most shoulder problems fall into four major categories: tendinitis or tendon tears , bursitis, instability, arthritis and shoulder stiffness. Rare causes of shoulder pain include infection, nerve problems and tumors.
Tendinitis / Tendon Tears
Tendons are cordlike structure which connect muscle to bone or other tissue. The major tendons in the shoulder are the Rotator Cuff Tendons. The rotator cuff is the group of muscles and their tendons which provides most shoulder motion and stability. Tendinitis or tears can develop in the rotator cuff. Tendinitis can be a result of the wear and tear that takes place over a time, like the wearing process on the sole of a shoe which eventually splits from overuse. Occasionally tendinitis develops from an acute overuse problem such as excessive ball throwing or overhead activities such as painting a house or washing a car. The rotator cuff tendons may split and tear from acute injury or degenerative changes in the tendons due to advancing age. Rotator cuff injuries are among the most common of shoulder disorders and can lead to significant pain and limited use of the shoulder.
Bursitis
A bursa is a fluid-filled sac located around joints and tendons which act as a cushion and lessen the friction caused by movement. Sometimes, excessive use of the shoulder leads to inflammation and swelling of a bursa. This is called bursitis. Bursitis often occurs in at the same time as tendinitis in the rotator cuff leading to notable pain.
Instability
Instability is when the bones in a joint move out of their normal position. This can be mild abnormal movements called subluxations or the bones can completely come out of joint, which is called a dislocation. Recurring subluxation can cause pain and unsteadiness when you raise your arm or move it away from your body. When you use your arm for overhead activity, the shoulder may feel as if it is slipping out of place or an uncomfortable, unusual feeling may occur. Dislocations generally occur from forceful injuries and often require urgent care from an orthopedic surgeon.
Arthritis
Arthritis is when the smooth gliding surface in a joint wears out. This smooth gliding surface is called cartilage and when it wears out the bones in a joint rub against each other which is painful. Shoulder pain can result from arthritis. Shoulder arthritis causes swelling, pain and stiffness. Arthritis may be related to sports or work injuries.
Often people with arthritis will avoid shoulder movements in an attempt to lessen their pain. Over time the restricted motion and pain leads restricted use of the shoulder which can ofter limit a persons ability to perform their activities of daily living.
Stiffness
Sometimes the many tissues in the shoulder become inflamed and painful, which limits motion in the shoulder. The joint may stiffen. This condition is called a "frozen shoulder," or adhesive capsulitis.
When should I seek medical care?
Minor episodes of shoulder pain occur commonly and generally resolve rapidly. If you have an acute injury, with intense pain, you should seek medical care as soon as possible. If the pain is minor, it may be safe to wait a day or two to see if the symptoms resolve. If symptoms persist, a orthopedic surgeon may provide timely diagnosis and treatment
Determining the source of the shoulder problems is essential to recommending the right method of treatment. A well trained orthopedic surgeon can provide a comprehensive examination to find the causes of your shoulder pain. Your comprehensive examination will include a medical history and physical examination. X-rays, EMG or even an MRI may be needed to determine the best treatment for your shoulder problem.
Treatment of Shoulder Pain
Most shoulder problems respond well to altering activities, rest, medications and specific exercises. Occasionally physical therapy is needed to improve shoulder strength and flexibility. Shoulder injections may be needed to alleviate the pain involved in tendinits and bursitis. For patients who fail to improve shoulder surgery may be required. Most problems including rotator cuff tendinitis, subacromial bursitis, instability and shoulder stiffness can now be treated with minimally invasive techniques. Shoulder surgery generally involves shoulder arthroscopy which is performed using a small camera placed into the shoulder through a small stab incision. Specially designed instruments are placed through several other small stab incisions to remove degenerative tissues, bone spurs and repair tendons.
Dr. Grutter is Johns Hopkins fellowship trained shoulder surgeon and is well experienced in the evaluation and management of shoulder pain allowing him to get patients back to an active lifestyle as quickly as possible.
Further information about Shoulder Pain can be found at the following sites:
Please read this information about shoulder pain carefully. Write down any questions that you have about your diagnosis and its treatment and discuss them with your shoulder surgeon. Working together you and your shoulder surgeon will determine the best treatment for you.
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