Shoulder pain is one of the most common injuries that is seen in an orthopedic practice. The shoulder is a ball and socket joint that is controlled by the rotator cuff muslces. Shoulder pain occurs from injuries to the rotator cuff and from surrounding structures.
Anatomy of the Shoulder
The shoulder is composed of the humerus, scapula (shoulder blade) and the clavicle (collarbone). It is held in place with a number of muscles of which the rotator cuff is the most important. Between the rotator cuff and the roof of the scapula is a bursa. This is a sac-like structure that provides lubrication to the shoulder. It allows the shoulder to move freely.
Sources of Shoulder Pain
There are three main reasons that someone gets shoulder pain.
1. Tendinitis: The rotator cuff can becomes inflammed especially if it is partially torn or damaged.
2. Bursitis: The bursa can also become inflammed and it will cause shoulder pain as well as restrictions of movement.
3. Impingement: As you raise your arm to the side the space between the humerus and the scapula can become narrowed resulting on pressure on the bursa and rotator cuff.
Symptoms of Shoulder Pain
Rotator cuff , burisitis and impingement syndrome cause pain especially at night. Patients have pain raising their arms to the side and behind their back. It is painful to lay on the affected shoulder. Often there is a loss of strength with certain movements of the shoulder.
Imaging Tests for Shoulder Pain
Xrays are usually done and they will show narrowing of the shoulder joint as well as any spurs which can impinge on the rotator cuff. However, an MRI will show the tendons and other soft tissue structures that may be causing the shoulder pain.
Most shoulder pain can be treated with a combination of ice, non-steroidal anti-inflammatory medication and physical therapy. Steroid injections are often useful and provide quick and sometimes lasting relief. The injection is not painful and is done in the office.
When a course of conservative treatment has not produced relief then surgery may be recommended. If there is not enough space between the roof of the shoulder and the humerus then a procedure to “decompress” the joint is done with an arthroscope. During arthroscopy the surgeon is able to determine if there is any other pathology that may need to be repaired. Physical therapy is then started after surgery.
Most patients with shoulder pain respond well to treatment and can go on to return to activities. Recovery from impingement, bursitis and rotator cuff tendinitis may take weeks to months to recover. However, if a patient follows instructions and puts in the rehabilitation time they should have a good outcome.