My shoulder hurts!

Joel L. Boyd, M.D./MSR News Online

Some common shoulder diagnoses and treatments

Shoulder pain is a common complaint by patients seen in my office. The shoulder joint can sustain an injury from carrying a lot of weight, repetitive use, throwing or a fall. What follows are some common shoulder diagnoses and treatments. If you have developed shoulder pain and tried conservative management but pain and disability continue, do not hesitate to contact your primary care or orthopedic physician.

Tendinitis

Tendinitis is when the tendons around the shoulder become irritated or inflamed. This could be due to injury, overuse, or even your anatomy. You can have pain with activity, certain positions, and sometimes even at rest. Overhead activities such as throwing a ball, reaching into a cupboard, or sleeping with an outstretched arm can exacerbate these symptoms.

For tendinitis, initial treatment can include rest, anti-inflammatory medications, steroid injections, and activity modification. If your pain persists beyond four to six weeks or you notice any type of weakness, you should see a medical professional.

Impingement

Impingement is related to tendinitis. It is sometimes also caused by your anatomy. The shoulder joint is a ball and cup joint made up of the top of your humerus bone and portions of the clavicle (collarbone) and scapula (shoulder blade).

When certain parts of the clavicle or scapula are too low, they effectively lower the height of your shoulder joint. When the roof is too low, this causes underlying tendons to become pinched by the low-lying bone during motion.

Symptoms can also include pain with activity, positional pain, and rest pain. This can also be treated with rest, anti-inflammatory medication, and activity modification.

Again, if your pain persists beyond four to six weeks, you should see a medical professional. If this impingement leads to tendinitis and pain that does not resolve with therapy, anti-inflammatory medications, or injections, surgery may be required. Surgery can include shaving part of the bone away using arthroscopy, which is a technique surgeons utilize involving small cameras and tools inserted through small poke-hole incisions around your shoulder.

Rotator cuff tears

The shoulder joint is stabilized by four muscles. Together these make up the rotator cuff. The tendons of each of these muscles are attached to the top of the arm bone and help in stabilizing and moving the shoulder.

Due to trauma, prolonged tendinitis, or degeneration, these tendons can tear. This is what is known as a rotator cuff tear. Sometimes one tendon can tear, or multiple tendons can tear. If acute trauma leads to a rotator cuff tear, then surgical intervention is commonly required.

However, if the rotator cuff tear is chronic, there may be a role for non-operative treatment. Non-operative treatment includes rest, anti-inflammatory medication, steroid injections, and targeted physical therapy.

If there is significant weakness or pain, surgical repair or reconstruction of your rotator cuff may be required. Less commonly, shoulder replacements can be required if your rotator cuff has been dysfunctional for a long period of time.

AC joint

The acromioclavicular joint is where the end of your clavicle and scapula meet in the front of your shoulder. Often times, this area can sustain traumatic separations and fractures.

In chronic settings, this joint can often get arthritis. Arthritis is the degeneration of the cartilage or surface of a joint. In the acromioclavicular joint, pain can be experienced with reaching across your body or with touching the front and top parts of your shoulder.

Non-operative treatment includes rest, anti-inflammatory medication, steroid injections, and physical therapy. If the pain persists, surgery can involve shaving down part of the joint as well.

For traumatic injuries, you should see a medical professional for evaluation if there is persistent pain or any visible deformity in the front or top of your shoulder. These injuries can sometimes require repair or reconstruction.

Biceps tendinopathy

Your biceps has two attachments. One is inside your shoulder joint. This is called the long head of the biceps and can be injured by trauma or overuse.

Symptoms can include pain with rotating your forearm, like turning a doorknob. There can also be pain in the front aspect of your upper arm. These can be treated with rest, anti-inflammatory medications, and therapy.

Sometimes these tendons can even spontaneously tear leading to patients having a biceps looking like that of Popeye the Sailor. You should see a medical professional if the pain persists despite rest. Surgical treatment can include cutting the diseased portion of the tendon and possibly reattaching it to the humerus bone.

Joel L. Boyd, M.D. earned his medical degree from the Temple University School of Medicine. He is a member of numerous professional organizations and is currently an associate professor in the Department of Orthopaedic Surgery at the University of Minnesota. His clinical interests include sports medicine, specializing in arthroscopy, ACL injuries, multiple ligament injuries, reconstructions, and revision ACL reconstructions. Dr. Boyd has been the team physician for the Minnesota Wild for the past 17 years and previous team physician for the NFL (9 years) and WNBA (15 years). His primary practice is at TRIA Orthopaedic Center in Bloomington, MN.

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