Shoulder injuries are prevalent, especially in athletes who use repetitive motions in their sport such as think swimmers, tennis players, pitchers, and weightlifters. While common in athletes, injuries can occur during everyday activities too.
A countless number of people live with shoulder pain every day. If you are one of those people experiencing weakness or have trouble lifting above shoulder level, you should consult one of our surgeons.
WHEN TO SEE THE DOCTOR
Most shoulder injuries result from issues with the ligaments, tendons and muscles. Injuries can develop over time as the result of repetitive use or ignoring the warning signs of a problem. Occasionally, an injury will occur during or after an accident.
The Mayo Clinic recommends the following:
- Seeking immediate attention: If you are experiencing shoulder pain with difficulty breathing or feelings of tightness in your chest, you may be experiencing a heart attack. You require immediate medical attention. You should also seek immediate medical attention if your shoulder pain is caused by an injury. Please seek help right away if you are experiencing a joint that appears deformed, the inability to use the joint, intense pain, or sudden swelling.
- Scheduling an office visit: Make an appointment with your doctor when possible if you are experiencing swelling, redness, or tenderness and warmth around the joint. Do not wait to make an appointment if you feel any level of pain.
- Self-care: If you are experiencing minor shoulder pain, you can try pain relievers, resting and using ice to alleviate the uncomfortable. Avoid using your shoulder in ways that can potentially worsen your discomfort.
Orthopedic surgeons categorize shoulder injuries into many categories, primarily traumatic or overuse. The two most common shoulder problems seen by orthopedic surgeons are rotator cuff injuries and instability. The shoulder has more mobility than any other joint in the body, which leads to more injuries. Shoulder pain can usually be corrected with a simple non-operative treatment, such as anti inflammatory medications and physical therapy; cortisone injections can also help reduce pain and discomfort. If nonoperative management fails to improve pain and discomfort, surgery may be necessary.
POTENTIAL CAUSES OF SHOULDER PAIN
Shoulder tendinitis typically occurs from a repetitive motion. Occasionally, a more sudden, unexpected injury can cause the issue. It’s common in athletes, especially those who may inadvertently use the incorrect form, putting additional stress on the tissues and tendons in the shoulder.
Treatment for shoulder tendinitis focuses on regaining mobility and reducing the discomfort caused by pain and swelling. Rest and ice on the shoulder is a great start — it will help reduce the swelling. Physical therapy can help relieve the symptoms and help regain strength in the shoulder. Surgery is typically only needed if the tendon has been torn — either partially or wholly.
Bursitis
Shoulder bursitis occurs when the small fluid-filled sacs (bursae) that cushion and protect bones, tendons, and muscles become inflamed. The shoulder is one of the most common locations for bursitis, which often presents itself in joints that perform repetitive motions.
Bursitis can cause stiffness and swelling in addition to a general ache in the shoulder. It may be irritating when you apply pressure to the shoulder or move it. Generally, bursitis will subside with rest and extra care to protect the joint and limit use. If pain is persistent, you should see a doctor to develop a practical course of treatment. Your doctor may recommend medication to reduce inflammation, therapy to strengthen the muscles in the shoulder, injections to reduce more severe inflammation or surgery. Surgery is rarely needed in the treatment of bursitis.
Rotator Cuff Tear
Rotator cuff tears are common, especially in people who are middle-aged or perform repetitive overhead motions at their job or while playing a sport. Tears can occur over time as a result of wear and tear or from a sudden accident or injury.
Most people describe the pain from a rotator cuff tear to feel like a dull ache that worsens if you sleep on the affected shoulder. The tear can make it difficult to reach behind your back to do daily tasks like brushing your hair. It may also make your arm feel weak.
Rotator cuff tears are common in people:
- Over the age of 40
- Who work in the construction industry
- With family members who have had rotator cuff tears
- Athletes who play sports like baseball or tennis
If you suspect a rotator cuff tear or other serious shoulder injuries, it’s advised that you make an appointment to see an orthopedic doctor. There are many options for treatment, but they are generally more effective if the injury is diagnosed early.
At your appointment, your doctor will talk to you about your symptoms. Additional testing, such as an X-ray, ultrasound, or MRI, may be used to confirm the diagnosis and assess the severity of the tear.
Your doctor may recommend physical therapy to improve the strength in your shoulder. Injections are an option to help reduce the pain, although it’s important to remember that even though the pain may be gone, the underlying issue is not. Surgery can help repair the tendon and if necessary, replace the shoulder joint.
Frozen Shoulder
Frozen shoulder doesn’t occur suddenly — it gradually worsens, causing pain and stiffness in the shoulder joint.
There are three main stages:
- The Freezing Stage – You feel pain when you move the shoulder, and your range of motion becomes limited.
- The Frozen Stage – The joint is stiff and painful to use (pain can reduce during this stage).
- The Thawing Stage – Your shoulder slowly begins to return to normal.
The pain from frozen shoulder can worsen at night, especially if you sleep on the affected shoulder.
People most at risk for this condition have had a medical procedure or situation that limits movement in the arm; for example, somebody who has had a stroke or a broken arm. It’s also more common in people over the age of 40 and is seen more often in women than men.
Frozen shoulder usually gets better on its own within 12 to 18 months; however, physical therapy can be helpful to help maintain and recover mobility within the shoulder. Corticosteroid injections can help manage pain, although these injections are generally more useful in the early stages of frozen shoulder. Surgical options for frozen shoulder aren’t standard, but there are options should this be the course of treatment best for you.
Instability/Dislocation/Separation
When the humorous (upper arm bone) is forced out of the shoulder socket, shoulder instability occurs. Sometimes this is a result of overuse, while some cases are a result of sudden accident or injury. Unfortunately, once a shoulder has dislocated, it’s likely to happen again — when the shoulder repeatedly dislocates, the condition is referred to as chronic shoulder instability.
Shoulder dislocations can be partial or complete, meaning the ball comes either partially out of the socket or out of the socket. The condition can also be caused when patients have loose ligaments in their shoulder — whether the looseness is their anatomy or a result of repetitive overhead motion. Those who play volleyball, tennis, or swim sometimes have stretched shoulder ligaments. It’s also common in those who have an occupation that requires overhead work regularly.
Shoulder separation is a condition caused solely by loose ligaments — the bones remain in place, but the loose ligaments create a feeling of instability and weakness in the shoulder. As detailed above, some specific sports and occupations can increase the risk of problems with the ligaments in the shoulder.
Physical therapy and modifications to your activities can help minimize the symptoms. Physical therapy can also help strengthen the shoulder to improve stability. Anti-inflammatory medications and injections can also help to relieve the swelling and pain. Surgery is sometimes necessary to repair damaged ligaments, allowing them to hold the shoulder in place again. At MOA, we see consistently positive outcomes for shoulder surgeries.
Slap Tear
The ball joint of the humerus (upper arm) is held in place by the labrum — a rubber tissue attached to the shoulder socket to help keep the joint stable. A SLAP lesion (superior labrum, anterior to posterior) is a tear above the middle of the shoulder socket. Tears to the labrum can occur from a sudden injury or can wear and tear as we age.
Injuries that can cause a labrum tear include falling on the shoulder or arm, a direct hit to the shoulder, reaching overhead rapidly or a sudden pull. Some athletes, like weightlifters or throwing athletes, can see these types of injuries as a result of a repetitive motion that wears down the labrum.
A labrum tear causes pain, especially when reaching overhead. It may create a feeling of instability and loss of strength, along with a decrease in your range of motion. Some people experience a grinding sensation or popping and locking in the joint.
Physical therapy may help strengthen the muscles in the rotator cuff, while anti-inflammatory medications can help relieve the symptoms. Surgery may be necessary if there isn’t improvement with more conservative treatments. For a labrum tear, surgery is minimally invasive. While therapy is always needed after surgery to regain your range of motion and strength, there is minimal downtime.
TREATMENTS
Shoulder replacement surgery is not as conventional as hip or knee replacements. However, it is an effective way to treat severe pain, swelling, weakness, and loss of range of motion if these symptoms have not responded to more conservative treatments. People who have arthritis, rotator cuff tears, severe fractures and more may benefit from shoulder replacement surgery.
If you’re interested in the procedure, first, you’ll go through an extensive evaluation with your orthopedic surgeon. Here, you will discuss your medical history and have a full physical examination. Likely, you’ll also have imaging tests like an X-ray or MRI. As there are several different procedures for a shoulder replacement, you and your doctor must work together to ensure you understand your options.
For patients who had a previous shoulder replacement that failed, have an incredibly severe rotator cuff tear or debilitating arthritis, a reverse shoulder replacement may be an option. In a reverse shoulder replacement, the ball and socket are switched — a plastic socket is attached to the humerus, and a metal ball is attached to the shoulder bone. The reverse shoulder replacement means the patient can lift the arm with their deltoid muscle, not the torn rotator cuff.
At MOA, we have ample experience with shoulder replacement and can help you through the process. We understand that it is a huge decision and make sure you know all of the risks and benefits of the surgery before we proceed.
Download our new free guide, “Guide to Shoulder Pain” to learn about the conditions listed above, treatment and more.
Read our guide to shoulder pain.
MOUNTAINSTATE ORTHOPEDIC ASSOCIATES: HOW WE CAN HELP
Mountainstate Orthopedic Associates is one of the region’s leading orthopedic practices. We take pride in the education and experience that each of our doctors holds.
From your initial appointment to the conclusion of your treatment, we strive to keep you informed and active in the decision-making process. It’s always our policy to be conservative with our course of treatment, only recommending surgery if it is genuinely needed.
We also seek to be minimally invasive in our treatments, reducing the amount of time a patient is in the hospital. With many of our surgical procedures, patients are home the same day of surgery.
If you have shoulder pain, get in touch — we’ll schedule an appointment and create a plan to get you back to your normal activities.
Contact us to schedule an appointment.