Shoulder pain is a common complaint among working individuals in the middle age range. Shoulder pain can occur with injury or without injury. Of the middle age group of patients, doctors see patients more often who report “no injury” than in patients who report injury.
The most common scenario for patients who present to the office with shoulder complaints is a 55 year old patient who states the shoulder started hurting and the pain has persisted despite time, rest and over the counter anti-inflammatories. These patients often complain of pain at night when they try to sleep and pain with certain movements of the shoulder, especially over the head motion. They often seek medical attention to find that they have an injury to the rotator cuff. What is the rotator cuff and why does it hurt without an injury?
The rotator cuff is a group of tendons that come together as a group to cause movement of the shoulder in different directions. The most common injury pattern is one that starts with bursitis and tendon irritation. This often results from a de-conditioned rotator cuff muscle that allows the rotator cuff to become weak. This results in a mechanical impingement of the tendon on the surrounding bone of the shoulder that causes the irritation. Sometimes we call this impingement. If the rotator cuff tendon is allowed to continue to rub the bone then it can ultimately cause a rotator cuff tear. This is how people develop rotator cuff tears without injury.
The treatment for rotator cuff tendonitis and bursitis is anti-inflammatory medication, possibly a shoulder injection with a steroid, and a physical therapy regimen of exercises to strengthen the rotator cuff. If this fails then often your surgeon will recommend a shoulder scope, which allows for removal of any bone impingement (bone spurs) and resection of inflamed bursa. This is always followed by physical therapy. This type of shoulder surgery generally responds quicker, and recovery is faster.
In the case when there is tearing of the rotator cuff, then surgery is almost always recommended to perform repair of the torn tendon. Physical therapy is a significant part of the recovery and always necessary. If you cannot undergo physical therapy after this type of surgery, then you should not have the surgery. This recovery is more involved and often takes a few months to fully recover.
Other patients who have non-traumatic shoulder complaints may have arthritis. Fortunately the shoulder is a non weight-bearing joint, and can tolerate more arthritis than weight bearing joints such as the knee or hip. Nonetheless, patients can still get arthritis in the shoulder that causes pain. A common location for this is the AC joint (collar bone joint). This often causes pain when the patient does movements across the midline of the body and sometimes with overhead activity. The pain is located in the front of the shoulder. Sometimes, injections can help but more often this requires a surgery performed through the scope, that allows the surgeon to clean out the joint through the scope, which alleviates the pain. These patients recover faster and require less intense physical therapy during recovery.
Lastly, some patients present with arthritis to the ball and socket joint (Glenohumeral joint). This is treated primarily with injections and ultimately with joint replacement surgery when symptoms get bad enough. It very common for patients to have a combination of these problems and often times your surgeon will address multiple problems with one surgery.
By Dr. Patrick Boyett, Orthopedic Surgeon
