This post was written based on the appearance of Dr. Michael Rosen, PPG – Orthopedics, on the television program PBS HealthLine.
Shoulder pain can develop from an injury, repetitive movements, rotator cuff problems or arthritis. This post digs into the common causes and the treatment options available to patients.
Is shoulder pain typically caused by an injury or overuse?
It really depends on the patient's age. Sports-related injuries are more common in younger athletes, but overuse can happen too. As people age, overuse becomes more common, and arthritis can also contribute.
How can someone tell whether their shoulder pain is from an injury or overuse?
Injury-related pain is often more sudden and noticeable. Often, there's a sudden change in function or pain level. Someone who was fine before an incident may unexpectedly not be able to lift their arm in the air or experience debilitating pain. Those types of injuries are a little more obvious.
Overuse injuries, however, sometimes creep up on people over several months before they actually seek treatment. By then, many people have tried common approaches to reduce discomfort on their own, such as modifying their activities. But if the pain has persisted for some time, it may be worth having it evaluated.
What are the first steps in treating shoulder pain?
Generally, shoulder pain treatment starts with a conservative approach for essentially everyone. However, if it's an overuse injury that has lasted a long time despite home remedies, we may consider other options.
Often, before seeking medical attention, patients have already started treating their injury on their own. They've modified their activities to limit performing the motion that's bothering them. They may also try over-the-counter anti-inflammatory medicines, along with some home exercises or stretches to find relief. If those approaches don't provide relief, we can explore other nonsurgical options next, depending on the nature of the injury.
How is shoulder pain diagnosed?
An X-ray is generally the first step in evaluating shoulder pain, and we can usually do it right in the office. This imaging can tell us a lot about the shoulder.
In a younger patient, the X-ray may show open growth plates, which tells us that they're still growing. In someone who's skeletally mature, such as a high school or college-age athlete, the images typically show normal anatomy without bone spurs or other signs of arthritis.
An X-ray may also show signs of injury, such as a sprain where a bone is slightly out of position, or changes in the bone that suggest the ball of the shoulder previously came out of the socket and returned to its normal position.
However, imaging is just part of the diagnostic process. The patient's perspective is just as important. One of the main things we do when someone comes into the office is ask what happened and listen. If we really listen to patients closely, they'll point us in the right direction. They'll tell us what's been going on, which lets us focus on a thorough physical exam.
The X-ray and physical exam give us useful information we can correlate with what the patient tells us. Together, these findings help us determine the best treatment approach.
What nonsurgical treatments are available for shoulder pain?
A lot of times, we start by modifying the activities that hurt the most. That's usually the most obvious thing, and patients often start doing that on their own. Some over-the-counter anti-inflammatory medicines can also be helpful.
Physical therapy is another very helpful option. The shoulder is a really complex joint. There are a lot of muscles attached to it, and it moves through a wide range of motion. An abnormality or dysfunction in any of those muscles can lead to pain, overuse and sometimes injury. Physical therapy can help everything move more smoothly, improving shoulder function.
Injections are another available option. We commonly use cortisone, a potent anti-inflammatory steroid. When administered into the subacromial space, the area just above the rotator cuff, it can reduce inflammation and improve pain. That may allow someone to participate in physical therapy more frequently than they otherwise could while experiencing significant pain.
How long does it take to recover from shoulder pain?
Recovery varies for everyone and depends on what the patient is having treated. If it's an overuse issue, sometimes just modifying activities is all that's needed. If irritation has caused more damage or a partial rotator cuff tear, the tendon can remain attached and heal, though it may take longer.
This is one instance when a patient may need additional imaging. An MRI lets us view the rotator cuff and examine those tendons closely. We can determine whether it's just irritation, a partial tear or actually a full tear in which the tendon is no longer attached to the bone. Sometimes that can be diagnosed during a physical exam, but those tears don't necessarily heal on their own.
Imaging may show rotator cuff irritation, but it can be completely asymptomatic and painless. That's why we treat the patient, not the MRI. It's important to perform a thorough exam and see how the patient feels. Even if an MRI shows a small tear, we can often manage it conservatively.
When should someone consider shoulder surgery?
Pain and dysfunction affect everyone differently. In sports medicine, we're especially interested in helping people do the activities they enjoy. If shoulder pain gets in the way of what someone wants to do, we evaluate it, perform a physical exam and order imaging to find the source of the issue.
From there, we can determine whether we can offer guidance to speed up recovery. Not everything we do is highly invasive. We offer many minimally invasive shoulder procedures. Shoulder arthroscopy is one of my specialties. It's a minimally invasive approach that uses small incisions, typically less than a centimeter. We use a camera and long, thin instruments to repair rotator cuff tendons, address biceps tendon problems and perform other procedures without a large incision. These less invasive approaches can still benefit patients, especially if they've already tried other treatments.
Find care
Having surgery is a big commitment. However, if you’re experiencing pain in your joint, having it replaced could help you enjoy life again. Talk with your healthcare provider about your options for joint replacement.
To schedule orthopedic care in Allen County, call Ortho NorthEast at 260-484-8551 or click to request an appointment. To find orthopedic care outside of Allen County, click to view PPG - Orthopedics locations.
