An Overview of Shoulder Pain and Treatment
When discussing shoulder pain, it should be noted that there is a two out of three chance that a person will experience shoulder pain for some reason in his or her lifetime. This may be due to a traumatic injury or an overuse syndrome, or a person may simply have degenerative arthritis in the shoulder joint similar to what is seen in the knee or the hip joint.
What are the most common causes of shoulder pain?
The most common cause of shoulder pain by far is shoulder bursitis, which is also known as impingement syndrome. This is more common than all other causes of shoulder pain put together.
It involves the soft tissue that overlies the rotator cuff being pinched against the overlying bone called the acromion. As people lift their shoulders forward or outward, this soft tissue may become inflamed. This especially occurs in those who Increase their overhead activities dramatically in a short period of time. This may include a weekend warrior with sports such as golf, a middle-aged
individual who gardens for an entire weekend, or something of that nature. Over 90% of those who experience pain from impingement syndrome have a self-limiting course of the problem and will not need surgery.
Another common cause of shoulder pain in the general population is from degenerative arthritis. The shoulder is a joint that has an incredible range of motion, and has a ball and socket joint where the ball is called the humerus and the socket is known as the glenoid.
The articular cartilage is subject to arthritis just like the lower extremity joints, and the treatments are very similar. In addition, the glenohumeral joint of the shoulder is not the only cartilage surface that can cause shoulder pain from arthritis.
There is also a joint where the collarbone meets the acromion that is called the acromioclavicular joint. In layman’s terms, this is the AC joint and can experience arthritis and shoulder pain. If a person has a fall with a direct blow over this joint, that can lead to a separation with a ligament tear and this is called an AC separation or in layman’s terms, a shoulder separation.
Rotator Cuff Related Pain
When it comes to pain from soft tissue components of the shoulder, another very common reason for shoulder pain is due to a rotator cuffs tear or tendinitis. The rotator cuff is a combination of four muscles that come together to stabilize the glenohumeral joint and allow for an impressive range of motion in many directions. The rotator cuff Takes on significant responsibility for stabilizing the shoulder joint for this incredible range of motion. The four muscles that come together have a unified attendant that inserts on the upper part of the humorous. This tendon is rather large and may experience inflammation and tendinitis with overuse or normal wear and tear degeneration. If the degeneration continues, the person may have an actual rotator cuff tear which may end up needing a repair.
An additional area for inflammation that causes shoulder pain is the biceps tendon. The biceps tendon has two origins around the shoulder, one that asked you this through the shoulder joint and one that goes in front of it. Either of these tendons and experience inflammation, tearing and pain. Orthopedic and pain doctors who are about you in the patient for shoulder pain to take extra care to look for whether or not the biceps tendon are the pain generators.
One issue that is common with shoulder injuries from athletic activities is a cartilage tear inside the joint. This is known as a labral tear, and represents a pair of the cartilage soft tissue that surrounds the joint and helps to stabilize it. Typically a labral tear leads to a deep, aching pain that can cause the persons shoulder to feel unstable and also to have very significant pain with athletic overhead activities.
There are two different types of shoulder instability that physicians see. The first is when a person has a shoulder dislocation due to trauma, there can be soft tissue damage that makes it very likely the person will read dislocate in the future. This shoulder instability usually will end up requiring surgical intervention.
The second type of shoulder instability usually occurs in multiple directions and involves simply lacks soft tissues. This condition is often amenable to nonsurgical treatment with physical therapy and pain management.
How does the doctor figure out the cause of shoulder pain?
As you can see, there are a significant amount of reasons person can have shoulder pain. When it comes to figuring out where the pain is coming from, a comprehensive history and physical examination can help considerably with narrowing down the potential causes. Imaging studies which include plain x-rays and possibly an MRI maybe necessary to see if there is inflammation, the tendon tear in the extent of arthritis.
It should be noted that at times, shoulder pain is not coming from the shoulder at all. If an individual has a problem in the neck such as cervical spinal stenosis that is pinching on the nerve root for a few of them, it can cause referred pain into the shoulder and masquerade as a shoulder problem.
It may take an injection into the shoulder to see if that relieves pain. If numbing medicine doesn’t fact relief pain, then the shoulder can be deemed to be the source of the problem. For instance, if the doctor places numbing medicine into the area of the rotator cuff tendon in the bursa into the subacromial space, it can diagnose impingement syndrome. If that injection relieves the pain in the person is able to lift up his or her shoulder without discomfort, the diagnosis is confirmed. For some situations such as a labral tear, it may take an MRI with contrast being injected into the joint to confirm the problem.
What are the best treatments for shoulder pain?
Thankfully, most shoulder pain will not require an operation. Shoulder bursitis and rotator cuff tendinitis can often be treated with anti-inflammatory medications, Tylenol, possibly short-term narcotics and physical therapy. In addition, doctors can perform an injection of numbing and steroid medication to help with pain reduction. This may help the patient for months at a time.
For those individuals with inflammation of the biceps tendon, the same types of treatments are in order with soft tissue injection around the area of severe pain. These types of tendinitis are usually self-limiting as well.
For a patient who has had a shoulder dislocation or significant instability, it is important to attempt conservative pain management along with physical therapy prior to undergoing an operation. The same is true for degenerative arthritis. This is no different than management of hip or knee arthritis, where operation becomes a quality-of-life decision and all reasonable pain management treatments should be tried first. This may include steroid injections or hyaluronic acid injections such as Synvisc.
Most labral tears inside the shoulder joint do not respond well to conservative treatments. It is a cartilage region that does not have a great blood supply and often will not repair itself.
Are there any new treatments coming out for nonoperative shoulder pain?
The newest treatments that are in the beginning of clinical research involves regenerative medicine. These injections involve stem cell treatments consisting of either one’s own stem cells or from someone else’s tissue. One treatment is called PRP, which stands for platelet reactive plasma, it has been shown in limited studies to be helpful for soft tissue regeneration. There is also a stem cell rich substance that comes from the amniotic fluid of consenting donors, and this is called bio D amnio matrix.
Arizona pain also has a new study looking at a minimally invasive peripheral nerve stimulation device. One of the conditions it is being a value weighted for is supra-acromial nerve compression in the shoulder. It is an FDA clinical trial and is showing great promise in treating this condition.
Are there other conditions which cause pain in the shoulder that should be noted?
There are uncommon reasons for shoulder pain which include a tumor or infection. These are not discussed here as they are not typical pain management conditions that you treated. In addition, fracture management has not been discussed as those are typically seen by orthopedic surgeon.
If you or a loved one is experiencing shoulder pain and desire the best treatment possible, let Arizona pain specialists help you. The pain doctors are award-winning and board-certified, and offer comprehensive treatment for short pain. This includes options for medication management, interventional procedures such as subacromial and joint injections, stem cell therapies and physical rehabilitation.