Shoulder Pain

When I see a patient for the first time for shoulder pain I try and figure out the source within the first few minutes of listening to the patient.  The history will often give me an 80% chance of making the diagnosis. 

In the young patient shoulder pain usually occurs in two separate ways. First the patient may have fallen down landing on the shoulder or outstretched arm. This can produce an injury to the shoulder such as a separation or a fracture.  The fracture is more often in the clavicle. 

The other complaint in younger patients usually over age 18 is that they feel like their shoulder wants to dislocate or subluxate.  This may come from an injury or not.  It is important to identify if this occurs repeatedly since these patients do not do well with conservative treatment.  An MRI is necessary to be able to look at the joint and see the exact pathology. 

As patients get older, over  age 40, we then start to see rotator cuff tears. They often start small and are called partial thickness tears. Most of these patients can be managed with rest, therapy and an anti-inflammatory medication. If the tear is large or what we call full thickness then a more aggressive treatment plan may be in order. Not all full thickness tears need surgery and some may not be repairable.  We usually start the patient off with therapy and monitor their progress. If the pain is unbearable especially at night then surgical repair of the torn rotator cuff is usually necessary.  

Other injuries in the over 40 age group  is bursitis, tendonitis and impingement. Again, these patients usually do well with conservative treatment, which may also include a steroid injection as well as therapy.  I often tell my patients at the first office visit; your shoulder is like a book and today is chapter 1.  

Physical therapy can be an ongoing event which after a few formal teaching sessions can be done at home.  I encourage my patients to purchase braided stretch bands to do their home exercises. They have a handle which makes gripping the bands much easier and beneficial. 5 - 10 minutes a day, 3 - 4 times a week can often alleviate quite a bit of shoulder pain and improve function.

Lastly, patients over age  60 may have arthritis in the shoulder along with rotator  cuff tears.  These patients may require shoulder arthroplasty or replacement of the joint.  This is a major surgery  and requires an open procedure.  Patients can gain some improved motion as well as ehancement  of their lifestyle. 

As you can see there are many different shoulder problems that are seen in an orthopedic practice with many different treatment options. 

Author
Bruce I. Prager, M.D.

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