By Stephanie Curtis, PA-C, LIVING WELL Magazine
Shoulder pain is one of the most common orthopedic complaints in the aging adult and is most often caused from a condition known as impingement syndrome. Three bones comprise the shoulder joint including the upper arm (humerus), shoulder blade (acromion), and collarbone (clavicle). The rotator cuff is made up of four tendons which function to keep the shoulder in the socket and raise the arm. Impingement of the rotator cuff can be the result of bone spurs beneath the acromion, variations in the shape of the acromion or chronic injury of the rotator cuff tendon, resulting in tendinitis of the tendon itself or inflammation of the overlying bursa. The typical symptoms of impingement include pain with overhead use of the arm, weakness of the shoulder muscles, difficulty reaching behind the back or pain lowering the arm from an elevated position. Night pain is frequently associated with the condition as well and commonly results in sleep disruption.
Upon presentation to your orthopedic surgeon he or she will likely perform specialized X-rays, which may demonstrate arthritis and/or bone spurs, and a detailed physical examination of the shoulder. Once the diagnosis has been established, treatment initially consists of oral anti-inflammatory medications, such as ibuprofen or naproxen if not contraindicated in the patient. Home exercises and stretches should be performed daily to prevent further debilitation or a referral to a physical therapist can be made. Frequent overhead activity and heavy lifting should be avoided. If a six to eight week trial of anti-inflammatories are ineffective then a steroid (cortisone) injection into the shoulder may be utilized to directly reduce inflammation within the rotator cuff tendon and bursa. MRI scanning may be ordered if symptoms or significant weakness persists to ensure there are no tears to the rotator cuff tendon. If all available conservative treatment fails the surgeon may then recommend a shoulder arthroscopy to remove bone spurs and bursitis, thus decompressing the shoulder and reducing impingement and pain. Rotator cuff tears can also be addressed and repaired during an arthroscopic evaluation of the shoulder. The majority of patients, however, are successfully treated with medications, exercises, and lifestyle modifications.
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