Shoulder pain

Georgios Panagopoulos MD | Orthopaedic Surgeon

Shoulder pain is a common orthopaedic complaint that affects millions of people worldwide. Most of us don't think about are shoulders much until we suddenly experience pain on them, which can make the simplest everyday task seem monumental.

The shoulder is a complex joint with a wide range of motion, making it susceptible to various injuries and conditions. Causes of shoulder pain are numerous. A delayed or wrong diagnosis may lead to unnecessary pain. A functioning shoulder is crucial for performing efficiently many activities of our daily living.

What are the symptoms?

Shoulder pain characteristics may vary based on the underlying pathology. Pain may not present in isolation, but may be associated with other symptοms, that may help in the diagnostic process. Symptoms related to shoulder problems may include the following:

• Dull or sharp pain around the shoulder
• Reduced range of motion & stiffness
• Inability to raise arm or carry objects
• Shoulder & arm weakness
• Swelling & tenderness around the shoulder
• Pain that gets worse with movement, or at night
• Clicking or cracking sounds while moving the shoulder (crepitus)

What are the causes of shoulder pain?

There are many causes of shoulder pain, including the following:

• Rotator cuff pathology: cuff tears, due to acute injury, or degenerative related to ageing.
• Frozen shoulder: also called adhesive capsulitis, manifested with pain & stiffness.
• Shoulder Arthritis: Osteoarthritis, rheumatoid arthritis, post-traumatic arthritis - leads to irreversible cartilage damage, pain and reduced motion.
• Dislocated Shoulder – shoulder instability: the humeral head loses its usual relationship with the glenoid - torn labrum (Bankart lesion).
• BursitisInflammation of the bursae, small fluid filled cavities that cushion the tendons.
• Tendonitis: Inflammation of the cuff tendons
• Impingement Syndrome: cuff scuffing against the overlying acromion, leading to burial sided tears, pain upon abduction & painful arc of motion.
• Fractures: Broken bones around the shoulder ( proximal humerus fractures, glenoid fractures, clavicle fractures, ACJ separation, etc).
• Calcific tendonitisα: Calcific deposits in the cuff tendons, with inflammation & night pain.

Shoulder pain - Diagnosis

An accurate diagnosis is very important for appropriate treatment. A correct diagnostic process may include the following:

• Full history & clinical exam
• Xrays
• MSK Ultrasound: to visualise soft tissues, such as tendons
• MRI scan

Shoulder pain - Treatment

Treatment choice depends on the underlying pathology and disease severity. Options may include:

Non-surgical treatment

In most cases, conservative treatment may provide long-term relief. Options include:

• Rest & activity modification
• Ice therapy
• Physiotherapy & home exercise program
• NSAIDS
• Cortisone injection

Surgical treatment

In severe cases, or if conservative treatment fails, there might be a need for surgical treatment. In many cases, surgery can be performed arthroscopically. In other cases, open surgery might be needed, ie shoulder arthroplasty or fracture fixation.

Conclusions

If you have shoulder pain, it's important that you consult with an experienced shoulder surgeon. Dr Panagopoulos will guide you to the appropriate treatment for your condition and will help to restore your quality of life.

FAQs - Frequently Asked Questions