By Christopher K. Jones, MD
Shoulder pain is a prevailing ailment and accounts for more than 13 million doctor visits per year, according the American Academy of Orthopaedic Surgeons. Shoulder pain has many causes and is often helped with simple non-operative treatments, but at times requires surgery.
The shoulder joint is particularly vulnerable to injury because of its construction. Unlike the hip joint which has a bony “ball and socket” stabilizing it throughout its range of motion, the shoulder joint relies on “soft tissue” to hold it in place. The “soft tissue” includes the ligaments and tendons (rotator cuff) which surround the shoulder joint. This design allows the shoulder wonderful range of motion, but also makes it prone to injury.
Shoulder injuries regularly occur with traumatic events such as a fall, lifting heavy objects or a dislocation. However, most causes are less obvious and occur over time from repetitive motion, especially in the overhead position. In these circumstances, the exact start time of pain is difficult to determine.
The most common cause of shoulder pain involves injuries to the rotator cuff tendons. These thick cord-like tendons attach the muscles to the bone and provide movement for the shoulder joint. Four tendons surround the shoulder working together to balance shoulder joint movement. Injuries to these tendons vary from simple strains to complete tears. An injured tendon increases stress on the remaining tendons causing shoulder malfunction. Without treatment, the injury can progress and become more complicated. Treatment depends upon injury severity. With simple strains, pain will likely improve with conservative care—cortisone injection(s) and oral anti-inflammatory medications. Once pain is managed, exercising the rotator cuff retrains the muscles to work properly and restore normal shoulder function.
Torn rotator cuff tendons don’t heal without surgical repair. A torn tendon can retract or shrink over time to the point that it’s no longer repairable. Therefore, the timing of surgery is very important. State-of-the-art techniques are available that allow orthopaedic surgeons to repair rotator cuffs with minimally invasive techniques. An arthroscope is utilized to visualize the tear through a four millimeter incision and specially-designed instruments are used to reattach the tendon to the bone. Current techniques combined with rehabilitation have improved the healing potential and successful outcomes to greater than 90%.
Another common cause of shoulder pain is Adhesive Capsulitis or “Frozen Shoulder”. Frozen shoulder is characterized by severe pain and loss of motion in the shoulder joint. This disease affects approximately two percent of the population and usually affects patients over the age of 40. Its cause is usually unknown and occurs more frequently in patients with diabetes, hypothyroidism, hyperthyroidism, Parkinsonism or stroke. Frozen shoulder is usually self-limited, but can take up to several years to resolve. Treatments aim to relieve pain and restore range of motion. Steroid injections into the joint and oral anti-inflammatory medications relieve pain and stretching exercises restore range of motion. Sometimes patients don’t respond to conservative care and require surgical intervention. Current techniques involve minimally invasive arthroscopic release of the scar tissue that’s limiting the range of motion.
Arthritis is another common cause of shoulder pain. Although shoulder arthritis isn’t as commonplace as hip or knee arthritis, it can be severely debilitating. Pain and loss of motion are its most common manifestations. Arthritis of the acromioclavicular joint (between the collar bone and the shoulder blade) is the most common form of shoulder arthritis. It often responds to conservative care including anti-inflammatory medication, ice and physical therapy. Sometimes steroid injections are administered to provide pain relief. When conservative measures fail, an arthroscopic resection arthroplasty can be performed where a portion of the clavicle is removed to create space between the two bones. This space will fill with scar tissue and cease being a source of pain.
Shoulder joint arthritis also responds to conservative care in many patients, but when pain continues, a shoulder arthroplasty (joint replacement) can be performed. Shoulder arthroplasty, a very successful surgery, involves replacing the arthritic surfaces of the joint with an artificial joint composed of a metal ball and polyethelene (medical grade plastic) socket. Shoulder replacement is performed much less frequently than hip or knee joint replacements. Annually, approximately 23,000 patients undergo shoulder replacements compared to more than 700,000 patients undergoing hip and knee replacements. Shoulder replacement recipients can anticipate substantial pain relief and functional improvement.
There are many causes of shoulder pain and an orthopaedic surgeon is best qualified to diagnose and treat shoulder injuries. Ask your orthopaedic surgeon to evaluate your shoulder and determine the best treatment for you.
To learn more or to make an appointment call Colorado Springs Orthopaedic Group at 719-632-7669 or 719-574-8383.