Shoulder that pain, Sir!

Shoulder that pain, Sir!

A common problem patients come looking for orthopedic help is shoulder pain. The main reason is that shoulder pain can be particularly troublesome at night. Disrupt a few nights’ sleep and your livelihood is shattered.

The shoulder is a big enough joint that is largely responsible to orient the hand in space to perform the myriad of function the upper limb is responsible for; be it basic personal hygiene to highly skilled functions such as painting or playing an instrument.

Anatomy of joint:

The great design of this ball and socket joint enables the shoulder to have a wide range of movement to enable reaching far behind the back to stretching out to reach far off. This large range of movement comes at a price, however. The stability of the shoulder comes from its enveloping muscles, namely the rotator cuff; which is a cuff of tendons (refer to blog: taxing misnomers) that surround the very mobile ball of this joint keeping it in check. Anything happens to these restraints and the result is instability and/or pain.

There are a few main issues with this setup and this plays a vital role in understanding, diagnosing and treating the cause of the pain

Instability

This typically affects the younger patient and is usually an early or late result of a structural injury to the anatomy of the joint. As a result, the restraints are lax and the shoulder is allowed to escape the shallow ‘socket’ resulting in abnormal movement and pain. Treatment relies on elucidating the injured structure and fixing it. Needless to say, rehabilitation (read: Re-training) of the entire shoulder girdle is of utmost importance.

Cuff pathology

This refers to tendinopathy (inflammation around the tendon), inflammation of the space just on top of the shoulder to frank tears in the tendons making up the rotator cuff. Depending on the exact cause, treatment may include physiotherapy to retrain the shoulder girdle, injections and might include surgery if the previous options do not help.

Fractures

In case of injury to the shoulder, fractures may result which will impair shoulder function. Treatment may include splinting, or surgery to restore physical dynamics if indicated. Due to the period of immobility in allowing bones to heal, function is lost in most situations and physiotherapy to restore good movement is imperative.

Arthritis

Like any other joint, this one is not immune from wear, be it inflammatory or otherwise. The hallmark of arthritis is stiffness and pain due to the loss of the articular cartilage lining the end of the joint surfaces.

To make matters worse, neck pain arising from spinal conditions can also radiate down into the shoulder and upper arm and is one of the conundrums in diagnosing neck and shoulder pathology. The clinician will use a set of skills and tests to make out what the diagnosis is and then institute treatment accordingly. This can range from physical therapy, cortisone injections or surgery in resistant cases. As is often the case in medicine things are never entirely black or white and sometimes multiple conditions may co-exist muddling the picture further.

Success in treatment relies entirely on the correct workup and timely treatment; often a hefty dose of patience is needed as most cases of the oft-encountered shoulder impingements may take a while to settle despite optimal treatment.

If you want to read more about this topic I urge you to click this link for a more detailed text on shoulder pathology written in plain English from a reliable source; all thanks to the American Association of Orthopaedic Surgeons (AAOS).

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