HCA Midwest Health - December 18, 2019

Whether reaching for the pickles on the top shelf, elbowing your way through the airport, throwing the perfect pitch, or even giving a quick hug, most upper body moves involve our shoulders. Keeping them strong is a must for staying active, mobile and injury-free, especially as we age.

Quick diagnosis and appropriate treatment are key to getting back in action when shoulder injuries or pain hit. Overland Park Regional Medical Center’s Shannon Carpenter, MD, one of the area’s few fellowship-trained elbow and shoulder specialists, shares a few common causes of shoulder pain and what to do about them.

3 common reasons for shoulder pain

Shoulders are a complex and powerful combination of bones, muscles, tendons and joints, all working together to allow our arms a remarkable range of motion – up, down, front, back, circular and sideways. Given that complexity, physicians see a variety of issues. Among the most common are:

Rotator cuff injuries

The rotator cuff is the group of muscles and tendons providing stability to the shoulder and allowing you to rotate and raise your arm. Physicians usually see rotator cuff injuries that fall within one of two categories: inflammation or tear.

Inflammation

When the tendons and muscles that help move your shoulder joint become inflamed and irritated, the result is rotator tendonitis. Also called “impingement syndrome,” tendonitis usually occurs in younger patients and is caused by overuse. That said, degeneration from arthritis can also lead to tendonitis. Another form of inflammation is bursitis when the small sac of fluid resting over the rotator cuff tendons (bursa) becomes inflamed, causing pain with overhead activities.

Symptoms of inflammation:

  • Minor, constant arm pain
  • Pain that moves from the front of your shoulder to the side of your arm
  • Pain that increases when you raise or lower your arm
  • Pain that worsens during the night
  • Weakness in your arm or shoulder
  • Tender or painful shoulder
  • Unable to hold the arm in certain positions

Rotator cuff tear

Rotator cuff tears occur when the tendons overstretch, and tear, either partially or completely, and becomes detached from the top of the humerus. Rotator cuff tears are caused by injury or the wearing down of a tendon over time, and are a common cause of shoulder problems in middle-aged or older patients, says Dr. Carpenter.

“As we age, our tendons start to degenerate and weaken, possibly due to a poor blood supply or factors such as bone spurs that can rub on the tendons,” she says. “This can lead to tears happening more easily as we get older.”

Symptoms of rotator cuff tear:

  • Limited range of shoulder motion
  • Painful to sleep on the impacted shoulder
  • Pain when reaching overhead
  • Pain generally worse at night
  • Pain or weakness in the shoulder when you lift or rotate
  • Difficulty reaching behind the back

Frozen Shoulder

Frozen shoulder happens when the lining of the joint becomes inflamed and stiffened causing you to lose range of motion. It can cause shoulder pain and stiffness that appear to come out of the blue. Although the cause is not totally known, people with hormonal imbalances such as thyroid conditions or diabetes, or a weakened immune system appear to be more prone to it.

Symptoms:

  • Pain causing you to limit your movement
  • Increasing stiffness, limited mobility (acute)
  • Difficulty reaching overhead
  • Pain when making moves such as putting your arms in a jacket

Arthritis

People often suffer from shoulder arthritis starting around age 50, as the cartilage in the joints starts to wear down either from regular use over time, or possibly from injury or trauma to the joint.

Symptoms:

  • Shoulder joint pain
  • Slow, insidious onset of pain and stiffness
  • Limited range of motion
  • Pain in morning and night, and being at rest as opposed to when you’re active

Looking over your shoulders

Diagnosing shoulder pain begins with a visit to a physician who will examine the injured shoulder and take a medical history specific to the pain or injury. Given all the muscles and joints and possible sprains, breaks or tears, and the fact that symptoms are similar in many conditions, Dr. Carpenter advises seeing a physician with shoulder experience.

“With every deeper level of specialization, you reduce your time to diagnosis,” she explains. “Shoulder specialists see shoulder injuries all the time and know the questions to ask about the type, frequency and severity of pain. That, along with a physical exam, allows us to quickly tell you what might be wrong, or if you need further testing such as MRI or X-ray.”

Additionally, she advises, see a physician sooner rather than later.

“I see many patients who only come when the pain is so severe they can’t sleep anymore,” she says. “That’s waiting too long. There are things we can do for faster relief and a better outcome.

“For example, the rotator cuff consists of four separate muscles, all interconnected like a sweater. A tear is like unraveling part of the sweater, which makes it easier for the whole thing to begin unraveling. With a tear, it’s easier to injure other muscles, so prompt treatment is best.”

Treating shoulder pain

Treatments for common shoulder problems, except in cases of severe tears, are very similar, with home exercises for strengthening, stretching, practicing better body mechanics, anti-inflammatory medicines (such as ibuprofen), and in cases of severe pain, possibly steroid injection.

“We always start with conservative treatments,” says Dr. Carpenter. “Even in cases of where you may eventually need surgery, we try and buy as much time as possible.”

When surgery is necessary, she adds, advances such as the smaller, stemless shoulder replacement and 3D technology which allows for patient-specific, customized implants, help get patients back to function and activity sooner, with less post-surgical discomfort.

“You don’t have to live with shoulder pain,” Dr. Carpenter says. “There are a lot of good surgical and non-surgical solutions and in the right hands, they can change your quality of life.”

Standing shoulder to shoulder with you

HCA Midwest Health offers a team of board-certified, fellowship-trained orthopedic surgeons and sports medicine specialists with experience in diagnosing and treating bone and joint issues of all types, including shoulder injuries. They offer the cutting-edge therapies, expertise and experience to restore mobility and get you back in action.

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