Shoulder Pain

The shoulder has a highly complicated and interesting anatomy. The shoulder region is an important piece of the human upper body and is regularly a site for muscle, ligament, and bone pains. Muscles from the shoulder travel in all directions and are connected to other muscles in the arm, neck, and back. These muscles allow the shoulder to perform a vast variety of motions but also allows for an increase risk of problems that can cause pain. The human shoulder comprises of the clavicle, humerus, glenoid, scapula, and several other soft tissue structures. There are several joints in the region such as the glenohumeral joint, the sternoclavicular joint, and the scapulothoracic joint. The glenohumeral joint is the region where most shoulder pain derives because it lacks a bony stability that would otherwise keep the shoulder from moving

At SFMMG we see patients with five of the most common shoulder pain issues and injuries. Since each shoulder injury is highly different from the other and requires different treatments we will differentiate between these shoulder scenarios.

Shoulder Arthritis

A common cause of shoulder pain in injured workers, the elderly and young athletes is osteoarthritis. This form of arthritis is basically due to an overuse of the shoulder joints and ligaments that occurs over time. Any form of arthritis is due to the wearing away of the protective cartilage that prevents bones from rubbing against one another. Rheumatoid arthritis can also affect the shoulder and is caused by the joints becoming inflamed and eventually wearing away the cartilage and bone.

Shoulder Arthritis Symptoms:

- Intense pain throughout the shoulder while performing physical activities
- A limited range of shoulder motion
- Shoulder stiffness
- Swelling in the joint regions
- A grinding sensations when movement is performed

It is important to note that most people who suffer from shoulder arthritis will report having good days and bad days with their shoulders. Some weeks the shoulder pain may disappear entirely and the next week it may return even worse than before. The pain usually worsens over time as the remaining protective cartilage begins to dissipate, as well.

Shoulder Arthritis Treatment

Medication--Patients may take anti-inflammatory pills as well as medications for pain. Most of these medications can be purchased over-the-counter while stronger doses may be prescribed by a doctor.

Physical Therapy--Muscles near the shoulder joint should be stretched and strengthened through physical therapy. This allows for the neighboring muscles of the shoulder to take on more of the load and release pressure from the shoulder.

Rehabilitation--The shoulder muscles, joints, and bones should be limited in their use. This is especially important for arthritis patients because the more strain and stretching that is placed on the shoulder the more worn down the cartilage becomes. Patients who receive shoulder replacements will need to work their shoulder slowly until they become used to the limited range of motion that comes with replacing the shoulder.

Injection--Cortisone injections can help relieve pain and ease the swelling that is associated with shoulder arthritis. These injections will not cure the arthritis but can help to relieve many of the symptoms that accompany the arthritis.

Surgery--Shoulder replacement surgery is a possibility for some patients with arthritis. The worn down cartilage is removed from the shoulder and replaced with an artificial ball-and-socket implant. This operation provides patients with pain relief and prevents further damaging the cartilage by replacing it entirely

Shoulder Tendinitis

Any form of inflammation or swelling of a tendon is commonly referred to as tendinitis. If shoulder pain is caused by tendinitis of the shoulder then the tendons around the rotator cuff have become swollen or sore. This can be caused by many factors but is usually the result of the tendons becoming pinched or squeezed by the surrounding parts of the shoulder. Other forms of shoulder tendinitis include calcific tendinitis and biceps tendinitis. These two forms are generally less common but also exhibit similar symptoms to rotator cuff tendinitis.

Shoulder Tendinitis Symptoms

Symptoms associated with tendinitis in the shoulder include:

- Discomfort of the shoulder when not in motion
- Upper shoulder and upper arm pains
- Trouble sleeping on the shoulder
- Pain that arises as arm is lifted

These symptoms and others will be noticed when shoulder tendinitis is present. However, shoulder tendinitis symptoms may arise slowly and over time. The sooner the symptoms are caught and the problem is recognized, the easier this disorder will be to diagnose and treat.

Shoulder Tendinitis Treatment

Medication--Anti-inflammatory pills along with pain relieving medications are prescribed for shoulder tendinitis. Ice is an excellent way to reduce swelling caused by tendinitis.

Physical Therapy--Behavior and posture modifications can help relieve tendinitis issues and symptoms. Poor posture is the primary cause of tendinitis and instructions can be given on how to correct posture that causes shoulder tendinitis. Therapeutic exercises can strengthen the tendons and joints that have become inflamed.

Rehabilitation--One of the most effective ways to treat shoulder tendinitis is to allow the muscles and ligaments to rest for a period of time. Heavy lifting and contact sports should be avoided in order to allow the tendons to heal and reduce to their normal size.

Injection--A cortisone injection can help reduce inflammation of the tendons and quicken the healing process.

Surgery--In some severe cases of arthritis a physician may feel it is necessary to remove the tip of acromion, which rests on the shoulder blade, in order to free up space for inflamed tendons.

Shoulder Bursitis

The shoulder contains a liquid filled sac called the bursa. This sac lies between the tendon and skin or the tendon and the shoulder bone and functions as a method of reducing friction between the various pieces of the shoulder. If the bursa becomes inflamed or infected the shoulder can experience an intense pain. This can arise due to a sudden impact of the shoulder, an infection, or some other underlying condition.

Shoulder Bursitis Symptoms

Symptoms associated with shoulder bursitis include:

- Localized pain and swelling

- Shoulder tenderness

- A more intense pain when shoulder is put into motion

- Pain when arm is lifted above the head

- Difficulty sleeping at night

Shoulder Bursitis Treatment

Shoulder bursitis can often be a chronic disorder, which means that the symptoms may be recurrent. Some patients who experience shoulder bursitis will experience intense pain for a short period of time and then have the pain subside and return later.

Injection--Again, cortisone is one of the best anti-inflammatory injections that can be given to bursitis patients. Cortisone injections will reduce inflammation and speed up the healing process.

Medication--Anti-inflammatory pain killers such as ibuprofen and celebrex should be taken for several weeks until the swelling disappears. The shoulder should also receive ice treatments throughout the day in order to reduce swelling.

Physical Therapy--Proper strengthening and good posture can help patients to avoid bursitis. Patients can learn specific ways to move their shoulders that will prevent inflammation. A person who has been diagnosed with bursitis should not exercise their shoulder muscles or ligaments until the condition has been resolved.

Rehabilitation--Patients who are affected with bursitis should allow their shoulder muscles to rest until the condition is resolved. Heavy lifting and contact sports should be avoided and frequent ice packs should be applied to the region.

Surgery--Surgery is rarely needed or used to treat bursitis and is only performed when the situation is chronic or recurrent. In the case that surgery is required the surgeon will open up the bursa sac with a scalpel and allow it to drain in order to reduce inflammation. If the bursa has become overly infected then the sac may be removed entirely.

Impingement Syndrome of the Shoulder

Aging adults are the most common demographic who experience impingement syndrome of the shoulder, a condition that is related to bursitis and rotator cuff tendinitis. When the rotator cuff muscle becomes inflamed or swollen many other conditions may arise because the muscle is surrounded by bone. One of these conditions is that pressure increases and blood is not able to flow as easily in the capillaries. As blood flow decreases, the muscle tissue begins to become weaker and starts to wear away. The wearing away of of these tissues in the shoulder is known as impingement syndrome.

Impingement Syndrome of the Shoulder Symptoms

Impingement Syndrome Symptoms related to impingement syndrome of the shoulder include:

- Difficulty reaching up or backwards
- Pain in the shoulder
- Weakening of shoulder muscles
- Shoulder popping
- Difficulty sleeping on shoulder

If this condition continues for a long enough period the muscles in the rotator cuff may tear in two. This can cause more serious problems and requires much more extensive treatments.

Impingement Syndrome of the Shoulder Treatment

Physical Therapy--Simple stretching exercises can help to strengthen the muscles if they have not yet torn. These exercises should be very light and provide almost no resistance to the shoulder muscles. A combination of ice and heat is beneficial in order to cool down the inflammation and warm up the shoulder muscles.

Rehabilitation--Shoulder should be allowed to rest from heavy lifting, excessive motion, and contact sports until the issue is resolved.

Injection--Chorticosteroids and local anesthetics may be given to patients with severe pain and swelling due to impingement syndrome of the shoulder. These injections are rarely used and only sparingly as needed by patients with excessive pain.

Medication--Anti-inflammatory pain killers should be used in order to help patient deal with pain and reduce the swelling that accompanies shoulder impingement.

Surgery--Shoulder surgery may be recommended for patients who have chronic problems with impingement syndrome. The purpose of the surgery will be to remove bone spurs and small amounts of muscles in order to allow the inflamed tissues and tendons to have adequate room. This type of operation is known as an acromioplasty.

Torn Rotator Cuff

A torn rotator cuff is the result of a prolonged impingement syndrome or an intense blow or strain to the muscles within the shoulder region. A rotator cuff that becomes torn can be severe and very painful. A torn rotator cuff means that the muscles within the shoulder have torn or frayed, similar to how a rope frays.

Torn Rotator Cuff Symptoms

Symptoms related to a torn rotator cuff include:

- Intense pain in the shoulder region at all times
- Pain becomes increasingly more severe during motion
- Weak muscles in the arms
- Popping or clicking noises when shoulder is moved.

If pain is less severe or only felt when the arm is in motion and not when the arm is at rest then the tear might not be too devastating. Sometimes a person will only slightly tear the rotator cuff and will only feel pain when they stretch or reach for objects.

Torn Rotator Cuff Treatment

Rehabilitation--Recuperation from a severe rotator cuff problem can take many months. Most patients are required to rest their shoulders and perform little lifting activities. Muscles are slowly stretched over the course of a few months until they regain their original strength. Small rotating activities are also encouraged if the patient feels they are possible without causing further damage.

Injection--Cortisone injections can be used to ease the swelling caused by a torn rotator cuff. This will allow the patients arm to heal quicker and become less inflamed.

Medication--Pain relieving medicine is the most common for patients dealing with rotator cuff problems. If over-the-counter drugs do not relieve the pain then a physician may prescribe you with medications that offer a higher dosage.

Physical Therapy.Therapy is often the initial treatment for rotator cuff tears. The goal of the physical therapy is to help muscles in the shoulder region improve their abilities to function. This will allow many muscles to take on lifting activities and spread the force across all of them rather than only on the muscles that have become torn. This will ease the pressure that is generally applied on the rotator cuff.

Surgery--Rotator cuff surgeries are somewhat invasive and require a general anesthetic in order to put the patient to sleep. The operation typically takes one to two hours and allows the surgeon to reattach the damaged tendons to the upper arm. The surgeon may also remove small portions of bone spurs and moves around ligaments that may be pressing on the tendon.

Frozen Shoulder

A frozen shoulder is also known as Adhesive Capsulitis and is a condition that affects the region where the shoulder and arm join. The precise cause of frozen shoulder is not known but it tends to be accompanied by other shoulder problems such as a torn rotator cuff. The condition affects the shoulder joint and makes it difficult or impossible to achieve shoulder motion.

Frozen Shoulder Symptoms

Symptoms related to a frozen shoulder include:

- Pain in the shoulder
- Stiffness or an inability to rotate the shoulder
- Inability to raise arm above the head

The condition of a frozen shoulder is broken down into three stages: the freezing stage, the frozen stage, and the thawing stage. During the first stage the patient primarily feel pain and no stiffness. The frozen stage is accompanied by less pain but greater stiffness. The thawing stage is gradual and allows for the patient to slowly regain arm motions.

Frozen Shoulder Treatment

Physical Therapy--Therapy is the first and most beneficial treatment for frozen shoulder. Physical therapy can be painful for patients but is the quickest and most effective way for them to regain motion of the shoulder. If the condition is caught early on, it is possible to reduce this pain and treat the condition with smaller amounts of physical therapy. Therapy may include ultrasound, ice, and heat in order to stretch the muscles within the shoulder.

Surgery--Frozen shoulder patients will rarely require surgical operations. In extremely rare cases it may be necessary to perform surgery in order to remove any scar tissues that may have formed on the shoulder joint. The operation is done arthroscopically through a small incision. Deformed or infected ligaments may also be removed during the operation.

Rehabilitation--A frozen shoulder needs to be in motion in order to be treated. Though many patients report having intense pain as they rehabilitate their muscles, it is necessary to exert some strength. Small lifting and stretching exercises accompanied with cold ice and warm water can loosen up the muscles and ligaments within the shoulder and speed up the recovery process.

Injection--Cortisone injections are common for frozen shoulder patients in order to reduce the inflammation in the shoulder joint. The injections are also beneficial in order to reduce pain and allow the patient to perform an increased amount of physical therapy and rehabilitation exercises.

Medication--Pain relieving medicines should be used in order to help the patient deal with painful symptoms related to frozen shoulder. Many anti-inflammatory medications have not been proven to help in the recovery process from frozen shoulder.

San Francisco Shoulder Pain Multi-Disciplinary Approach

The San Francisco Multi-Specialty Medical Group (SFMMG) provides Full Spectrum care for your Shoulder. Our physicians and staff members represent a number of specialties including:

• Orthopedic Medicine
• Physiatry
• Chiropractic
• Podiatry
• Physical Therapy
• Acupuncture

Being able to offer appropriate, comprehensive and timely diagnosis and treatment in one location. Please call to schedule an appointment with our physicians at one of our locations.