Shoulder pain is a common ailment experienced by many people, although the incidence of shoulder pain tends to increase with age. This pain may be caused by a number of different shoulder conditions, and may be acute or chronic, and caused by injury or overuse. Damage or injury may occur within the muscles, ligaments, tendons and bones. Common shoulder conditions may include:
Rotator Cuff Tear
Depending on the condition, individuals may experience stiffness, pain, loss of strength, limited range of motion and other debilitating symptoms.
Shoulder problems may be diagnosed after a review of symptoms and a physical examination of the shoulder. Additional tests may include X-rays, CT scans or MRI scans to rule out any other conditions that may be causing symptoms. A doctor may also test the individual’s range of motion and arm strength by asking the patient to perform different actions with the arm and shoulder.
Treatment for shoulder pain depends on the location and cause of the pain. Many shoulder conditions can be effectively treated through nonsurgical methods such as rest, applying ice or heat, stretching, physical therapy and anti-inflammatory medication. Some patients with severe shoulder conditions may require surgery, but most of these procedures can be performed through arthroscopy. Surgery is often successful in repairing shoulder problems and restoring function and strength to the joint.
Bursitis is a painful inflammation of a bursa, one of the small sacs at the joints that cushion the tendons, muscles and bones. Bursae normally enable fluid movement, but when overtaxed they can inflame and fill with fluid. Once a bursa becomes irritated, gritty and rough, it can create painful friction in the joint. Bursitis usually results either from repetitive stress or sudden injury and presents with swelling, redness and deep, aching pain. The joints most commonly affected by bursitis are the shoulder, elbow, hip and knee.
Usually bursitis responds to simple remedies, although the inflammation may take a week or many weeks to subside. Patients should see their physicians to rule out more serious injuries. They are typically advised to rest the injured region, avoid activities that intensify discomfort, ice the area, and take over-the-counter anti-inflammatory medications. Sometimes stronger oral medications are prescribed to reduce inflammation and sometimes corticosteroid injections are administered. Physical therapy is often recommended to increase range of motion as healing takes place. Only in rare cases is surgery necessary to treat bursitis.
The rotator cuff is the thick band of muscles and associated tendons that cover the top of the upper arm and hold in it place, providing support and stability to the shoulder joint. The rotator cuff also allows for a full range of motion while keeping the ball of the arm bone in the shoulder socket. These tendons can become partially or completely torn as a result of a rotator cuff tear or injury. A rotator cuff tear often occurs as a result of overuse of the muscles over a long period of time. This condition is more common in individuals over the age of 40, as well as in athletes or those who practice repetitive lifting or arm movement in their occupation. A rotator cuff injury may also occur as a result of a traumatic injury.
Treatment for a rotator cuff injury varies and may include conservative treatments such as the use of a sling, rest, ice and physical therapy. Treatment for pain and discomfort may also include anti-inflammatory medication or steroid injections. While these nonsurgical methods cannot completely heal a tear, they can often restore function to the shoulder without the need for a surgical procedure. Rotator cuff tears that cause persistent pain or do not respond to conservative treatment may require surgery. Surgery may be performed through arthroscopy or a traditional open procedure, depending on the severity of the tear.
The labrum is a protective cuff of cartilage found in ball and socket joints like the shoulder and hip. It provides stability, cushioning and a full range of motion for the shallow shoulder joint. A labral tear can occur as a result of injury or overuse, causing pain and “catching” of the joint while it is in motion.
Treatment for a labral tear depends on the type and severity of the tear. Many labral tears can be effectively treated without surgery by managing pain symptoms and undergoing physical therapy. Surgery may be required for more severe cases, and involves an arthroscopic procedure that can restore full movement and strength to the joint.
A shoulder is deemed unstable when it frequently dislocates or slips partially out of the joint, known as subluxation. This condition commonly occurs after an injury or from a naturally loose joint capsule that does not hold the ball of the joint in its socket. Patients with instability may experience pain when lifting the arm and a constant feeling that the shoulder is slipping out of place.
Patients with shoulder instability are often treated with physical therapy and rehabilitation to strengthen the shoulder and help it stay in place. Surgery may be required if conservative methods are unsuccessful. The type of surgical procedure performed depends on the cause of the instability, but may involve tightening the shoulder capsule or repairing damaged or torn ligaments.
Impingement is a common shoulder condition that causes pain as a result of pressure on the rotator cuff from the acromion, or roof of the shoulder. There frequently is a bone spur that is rubbing on the rotator cuff, causing a pinching feeling as the arm is lifted overhead.
The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. When impingement occurs and the arm is lifted, a bone or ligament can rub against the rotator cuff, producing pain and limiting movement. Shoulder impingement typically worsens over time.
Initially, individuals with a shoulder impingement may feel mild pain in the shoulder, which often radiates from the front of the shoulder to the side of the arm. The pain may worsen upon lifting the arm, reaching for something or throwing, and there may be some swelling and tenderness at the front of the shoulder as well. As impingement progresses, pain and stiffness worsen until the patient may not be able to lift or lower the affected arm. Eventually, if left untreated, the condition may severely limit arm motion to the point that the arm becomes difficult to move at all.
Initial treatment of shoulder impingement includes conservative measures such as resting the arm, non-steroidal anti-inflammatory medications, corticosteroid injections and a regimen of physical therapy. However, if these techniques do not provide adequate pain relief, surgery will most likely be recommended.
The Subacromial Decompression Procedure (Acromioplasty)
Severe cases of impingement may require surgery to remove the pressure and create more space for the rotator cuff. The most common procedure for treating impingement is subacromial decompression. This surgery involves the removal of some of the affected tissue and part of the bursa, which is the small sac that has become inflamed due to the impingement. In some cases, the front edge of the shoulder blade must be removed as well. Either general or local anesthetic will be administered prior to the start of the procedure.
A subacromial decompression (Acromioplasty) can be performed through an all arthroscopic technique. Three tiny incisions are made in the shoulder area. The arthroscope and specialized surgical tools are inserted into the incisions and the surgeon uses a video monitor to view the damaged area and excise the bone spurs and bursitis, as needed. Once sufficient space has been created to allow for free movement of the tendons of the rotator cuff, the surgeon will withdraw the instruments and suture the incisions closed.
Recovery from Subacromial Decompression
The length of recovery from a subacromial decompression procedure will usually be 1-2 months. However, the sling will be discontinued after a few days to reduce the risk of postoperative stiffness. Once the sling is no longer necessary, a rehabilitation program will begin that focuses on increasing strength and range of motion of the affected shoulder. Improvements to the shoulder in comfort and function are typically apparent within a few months after the subacromial decompression procedure, but full recovery may take as long as a year.