Pain in the shoulder is a common orthopedic complaint that I see in my practice. Patients will notice that their range of motion is restricted, painful and they are unable to sleep on the affected shoulder.
There are many different pathologies that can occur in the shoulder, but many are related to the rotator cuff. In previous blogs I have discussed there are four muscles that make up the rotator cuff. Pain is usually in the front, but patients often complain of pain radiating down the side of the shoulder. On examination the patient may have a painful range of motion along with weakness in certain tests that we perform.
If we are concerned about a torn rotator cuff we will often order an MRI. The MRI is usually very accurate in determining if a tear is partial or complete. I consider partial tears of those under 50% of the thickness of the rotator cuff. Those more then 50% will often become full thickness tears. For those patients with partial tears physical therapy and oral non-steroidal anti-inflammatory is the most appropriate treatment. I sometimes will try a steroid injection, but the problem is that if the patient does not improve then you may have to wait up to 6 months before doing surgery.
Physical therapy for a shoulder invovles patient education. If a patient is motivated on their own they can go for a few sessions and do most of the rehab on their own. I encourage my patients to go online and buy braided stretch bands. They are easy to use and can be used everywhere, even when traveling.
Most patients will improve their range of motion and strength with a partial rotator cuff tear with conservative treatment. It requires patience and active participation. For those who follow this advice they will usually be rewarded with a pain free shoulder that is able to perform most activities.
Those patients who do not improve after 6 months of conservative treatment may need to consider surgery as their next option.