Shoulder pain – Causes, Symptoms and Diagnosis
Shoulder pain can be due to many reasons and that’s why you should see a medical doctor for an expert evaluation. Our pain management specialists are Ivy League trained and offer the best pain treatments in New York City for shoulder pain and non-operative care.
What are the common shoulder injuries and conditions treated at COMPLETE MEDICAL WELLNESS Medical Group?
The majority of shoulder pain issues typically involve the muscles and cartilage; however, ligaments and tendons are very frequently involved with work related injuries or aging.
These shoulder problems can develop from normal everyday activities, repetitive intensive routines, overuse, trauma, or more commonly from wear and tear or an injury from sports or accidents.
Here are the TOP 8 causes for shoulder pain:
- Shoulder arthritis
- Frozen shoulder/Adhesive capsulitis
- Rotator cuff conditions: tendonitis and bursitis
- Rotator cuff tear
- Shoulder dislocation
- Shoulder fracture
- Shoulder instability
- Impingement syndrome
Aging plays a major role in the condition of shoulder pain, which leads to osteoarthritis or otherwise known as degenerative joint disease. Complete Medical Wellnessspecialists use safe and non-operative procedures to treat shoulder pain, allowing you the freedom to return to your normal activities quickly and without pain.
Understanding your shoulder
The shoulder is a complex, most powerful joint built to allow movement in many different directions. Muscles and ligaments help keep the shoulder stable and secure in your shoulder socket. We use our shoulders to perform many of most basic motions, including pushing, pulling, lifting or driving a car. As a very flexible, multifunction joint, shoulder is highly sensitive to injury.
There are a variety of disorders in the shoulder that can impact not only normal daily activities, job function, but also exercise and sports performance.
Often people try a conservative approach such as rest, ice, modified activities, anti-inflammatory medications (NSAIDs), pain medications or physical therapy, are often the first treatment option prescribed by many physicians in patients affected by osteoarthritis.
More advanced options include Regenerative Medicine treatments offered at COMPLETE MEDICAL WELLNESS Center, which utilize the body’s natural healing ability to repair the damaged joints and muscles of the shoulder and allow our patients to regain mobility in their shoulders without invasive surgery and months of physical therapy.
The shoulder joint works like a ball-socket structure that allows the arm to move in many different directions. The joint comprises of 2 bones: Humeral head (which is the top portion of the bone of the upper arm) and fits into the glenoid fossa of the scapula (which is otherwise known as the shoulder blade).
This humeral head is kept securely in place by the joint capsule and labrum of the shoulder joint, which has thick bands of cartilage that cover where the humeral head fits. The rotator cuff muscles are the dynamic movers and stabilizers of the shoulder joint. They work to position the humeral head and scapula during shoulder movement.
The rotator cuff muscles are connected to the scapula and therefore any changes in the movement of the scapula with shoulder range of motion can cause several issues including, impingement of the rotator cuff muscles, causing problems with the movement of the shoulder itself.
The four rotator cuff has 4 muscles, which include:
- teres minor
Additional muscles that help stabilize and move the shoulder include the deltoid, teres major, coracobrachialis, pectoralis major and latissimus dorsi.
Rotator Cuff Tears
To understand shoulder pain it’s important to know the basic anatomy of your shoulder. The shoulder joint is stabilized by a group of 4 muscles and their attached tendons called the “rotator cuff”.
When damage to any of the four muscles that are attach to the bone via the ligaments occur, this is when patients often feel pain. This can be due to an acute injury, gradual aging or even chronic overuse. Unfortunately when this damage occurs it can lead to decreased range of motion and difficult to use the shoulder joint for certain activities, such as getting dressed, lifting, and exercising.
Rotator cuff tears are more common later in life, and the risk of injury can vary, but often increases with a person’s ages. Younger people, athletes, and likewise heavy laborers are often affected. It’s not uncommon for older adults to injure their rotator cuff when they fall on or from a strain the shoulder.
If left untreated or misdiagnosed, a rotator cuff tear can often cause decrease the ability to use the arm and result in severe pain. One first treatment option is to consider Physical Therapy. A therapists can help people with rotator cuff tears by addressing stiffness, pain and discomfort,improve their activities of daily living and restore movement to the shoulder and arm.
There are 2 major injuries that you may hear about. Patients often hear that their injury is either a “partial thickness” or “full thickness” rotator cuff tears. The difference depends on how severe the damage is.
- Partial-thicknesstears affect only a portion of a rotator cuff tendon/muscle, but do not extend completely all the way through.
- Full-thicknesstears extend from the bottom to the top of a rotator cuff tendon/muscle.
As any joint condition, these can either be “acute” or “chronic.”
Acute rotator cuff tears: usually occur unexpectedly, and can often be due to traumas; including, lifting injuries, falls, or athletic sports.
Typical signs of acute shoulder pain / injuries:
- Sudden tearing sensation which will then have severe pain radiating from the upper shoulder area down the arm toward the elbow and decrease range of motion
- Bleeding and muscle spasm, these issues usually resolves in few days
- Inability to move the arm (raise it away from the side of the body) due to significant pain and loss of muscle power.
Chronic rotator cuff tears: usually found in people with strenuous occupations or people who play a lot of sports, it is often seen in those who’s arms are working above shoulder level or requiring excessive overhead activity such as painters, construction workers, baseball pitchers or tennis players. Likewise, these chronic injuries may be a result of a previous acute injury that has caused a structural problem within the shoulder and affected the rotator cuff anatomy and function.
Typical signs of chronic shoulder pain / injuries:
- Pain or discomfort is usually worse at night
- As the pain worsens, you may develop gradual weakness and decreased shoulder motion
- Difficulty to move the arm (move it out to the side).
Symptoms of Rotator Cuff tears
The classic symptom of rotator cuff tears is pain in the shoulder and around the shoulder joint and painful movement of the shoulder. This pain is often described as a dull ache that originates deep in the shoulder. Weakness in the arm and difficulty reaching behind your back or overhead may occur at the same time. Often the pain will interfere with sleeping, especially when lying on the injured shoulder.
The most common symptoms of rotator cuff tears:
- Shoulder weakness
- Clicking during shoulder elevation
- Pain over the top of the shoulder or down the outside of the arm
- Decrease shoulder motion
- Weakness lifting your hand above shoulder height or reaching behind your back
- Inability to lift the arm to reach up, or reach behind the back
- Inability to perform common daily activities due to pain and limited motion
- Disturbed sleep: pain in the shoulder, particularly on the side of the injured arm may make your sleep difficult
Rotator Cuff Treatments:
Top 5 treatment rotator cuff treatments options:
- Physical therapy and strengthening exercises
- Simple rest and reduction of any overhead activity
- Anti-inflammatory medication
- Corticosteroid injection
- Regenerative medicine injections: Platelet Rich Plasma or Adult Stem Cell
Anti-inflammatory medication: In the early phases, conservative care (e.g., resting the impacted part, using hot/cold packs) along with medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) may provide benefit. Anti-inflammatory medication work by blocking the production of certain body chemicals that cause inflammation and are typically prescribed to help reduce pain, swelling and inflammation. Many patients with rotator cuff tears can function quite well once the pain and inflammation are controlled with physical therapy combined with medication.
Cortisone Injections: If conservative care treatments are not effective, a steroid (cortisone) may be used in the shoulder bursa region above the tendon. This treatment will not only relieve discomfort, it may break the cycle of bursal irritation and swelling, while allowing the patient to manage strengthening exercises. A total of three cortisone injections per shoulder every 6 months The injections should be followed by regular stretching and exercises for better results.
Platelet Rich Plasma (PRP) Therapy: PRP therapy involves injecting platelets and growth factors from the patient’s own blood to heal a damaged tendon or cartilage. Platelets help to initiate repair process and attract the critical assistance of stem cells from patient body. This natural healing process jumpstarts an intensifies the body’s efforts by delivering a higher concentration of platelets directly into the damaged portion of the tendon or cartilage.
Shoulder impingement syndrome
Impingement in a shoulder can develop over time as a result of a small injury, or due to repetitive motions that lead to inflammation in the shoulder bursa. The bursa is a cushion between the rotator cuff and the acromion bone. This occurs when the tendons of the rotator cuff gets pinched in the narrow space beneath the acromion. Subsequently, this causes the tendons and bursa to become inflamed and swollen.
This can cause weakness in the muscles of the shoulder complex and rotator cuff, and then allow the shoulder to ride up in the socket causing a dynamic narrowing of the space leading to further impingement and significant shoulder pain. This pinching is worse when the arm is raised away from the side of the body.
With the onset of arthritis, the acromion can develop bone spurs that can even further narrow this space. In older patients, impingement caused by bone spurs is much more common; Likewise, patients who participate in sports or work activities that require overhead arm positions.
There are 3 types and gradings of shoulder impingement:
- Grade I: marked by inflammation of the bursa and tendons
- Grade II: progressive thickening and scarring of the bursa
- Grade III: occurs when rotator cuff degeneration and tears are evident
Shoulder Impingement Symptoms
The symptoms have some very common signs and symptoms. If you have any of these symptoms, and medical expert from Complete Medical Wellnesscan quickly diagnose your problem.
The top 6 symptoms are:
- Pain and/or restriction when your arm is overhead or at shoulder level
- Shoulder muscles weakness
- Pain when reaching behind your back or head
- Weakness or pain when lifting objects
- Pain when lying on the affected shoulder
- Persistent and/or chronic shoulder pain
Related to shoulder impingement is rotator cuff tendinitis, which tends to get worse over time. Initial symptoms may be relieved with some rest, but the symptoms can later on become constant. If the symptoms go past the elbow usually indicate another problem.
Symptoms of rotator cuff tendinitis include:
- swelling in the front of your shoulder and/or side of your arm
- pain that is triggered by raising or lowering your arm
- clicking or sensation sound when raising your arm
- Shoulder stiffness
- pain that causes you to wake from sleep at night
- pain when reaching behind your back or getting dressed
- a loss of strength and mobility in the affected arm
Non surgical shoulder treatment
Cortisone injections for various shoulder problems are typically used in order to reduce inflammation causing pain and swelling. One of the most common uses is for a condition called subacromial impingement. A combination of steroid medication and local anesthetic can provide long lasting pain relief and decrease inflammation caused by shoulder arthritis, rotator cuff tears and shoulder injuries. A patient can receive a series of 2 – 3 cortisone injections over a period of every 6 months. .
There are 4 locations where steroids can be injected:
- Intra-articular injections
- Subacromial injections
- Acromio clavicular joint injections
- Biceps tendon injections
Hyaluronic Acid Injection are designed to help lubricate the joint and reduce the pain and inflammation of the joint. This procedure is performed in a similar fashion to cortisone, but instead use a natural lubricant to help make the shoulder glide easier and reduce pain and inflammation. These injections likewise help replace the joint’s natural fluid called synovial fluid and help to restore the lubrication lost from degenerative joint disease.
Platelet Rich Plasma Injection
Platelet Rich Plasma (PRP) is an injection of your own (autologous) platelets and bioactive proteins called growth factors extracted from your blood. The blood draw and injection are safe and done at the same office visit, an outpatient clinical procedure. PRP has shown great promise in stimulating repair of body tissues including tendons, ligaments and cartilage. Research studies shows that PRP is superior to other injections in the treatment of osteoarthritis and healing of chronic tendinitis.
Who are the best candidates?
Upon a consultation with one of our pain management specialist, they will request for the patient to get an MRI if they don’t already have one. The MRI will help the doctors see what type of degenerative changes that are going on in the affected area; such as arthritis. This will further help the Doctors target the exact location where the pain is occurring.
Describe the procedure:
The injection itself takes less than 5 minutes. Like any injection you will feel only a slight pinch followed by a burning sensation that is temporary and will wear off within seconds.
Does it hurt?
Tiny pinch with a brief burning sensation from the local anesthetic that will dissipate quickly.
What are the expected results? 50-75% improvement each time, most patients require 2-4 treatments for full results.
Does insurance cover the treatment?
Yes, if approved by insurance company.
What is the recovery like?
After the injection there is no down time. Doctors will often recommend patients to do Physical Therapy or home exercises to help keep the muscles and joints active.
Any side effects?
From the local anesthetic patients may experience temporary numbness for a few hours after the treatment. Once the numbing wears off there is a chance of getting increased joint pain. The aching may last up to 24 hours sometimes longer depending on the patient but the discomfort will eventually subside.
Specialized shoulder injections
Scapular Nerve Block:
What’s the treatment?
A Scapular Nerve Block is an injection of local anesthetic near the suprascapular nerve which is where your shoulder blades are located. This procedure can also be helpful in diagnosing treatment for patients who have on going shoulder pain, arthritis and degenerative joint changes along with rotator cuff disease.
Who are the best candidates?
Patients who are having onset of subtle pain, postoperative pain, and patients with mild shoulder injuries. Also patients who have tried steroid injections and find that they aren’t experiencing any long term relief are great candidates because with this procedure it will block off the output signals in the nerves that way the patient won’t experience any more pain. It’s sort of like rebooting a computer, your nerves are starting off fresh.
Describe the procedure:
The procedure is done under ultrasound guidance to make sure the doctor is in the exact targeted location of the affected area. The doctor will then numb you with a local anesthetic so you will experience no pain just possible mild discomfort. The patient will then be injected with steroids into the suprascapular area.
Does it hurt?
The patient will feel a tiny pinch with a brief burning sensation from the local anesthetic that will dissipate quickly.
What are the expected results?
Results vary from patient to patient. Patients can experience anywhere for 1 year to 3-6 months of pain relief. More than one procedure may be needed, that is also subjective per patient.
Does insurance cover the treatment?
Yes, depending on the insurance coverage.
What is the recovery like?
Patients are expected and encouraged to resume all their normal daily activities.
Any side effects?
Temporary bruising and soreness that last for roughly 24-48 hours.