Shoulder pain can affect anyone in any stage of life. If your shoulder hurts, you will quickly find out how important it is for the use of your arm.
Some of the simplest shoulder problems begin with imbalance and weakness of the muscles around the shoulder, which will often lead to a gradual onset of worsening pain with certain movements. Once this imbalance is identified, specific strengthening and stretching exercises can treat and relieve this pain.
Think of the shoulder as a large ball sitting in a small cup, much like a golf ball sitting in a tee. The ball is held in the cup by strong ligaments that connect the ball to the cup. When these ligaments are loose or are disrupted after injury, further problems with shoulder stability can occur and often lead to inflammation, pain or even dislocations. Sometimes these structures can heal by themselves, but other cases require reattachment or surgical repair.
A severe fall or contact injury can result in a bone breaking around the shoulder, which leads to bleeding, bruising, swelling, stiffness, or pain at rest or with use. The initial treatment should consist of icing, rest and evaluation with an X-ray. When pain and swelling start to decrease, supervised range of motion in the shoulder can help prevent long-term stiffness.
When inflammation is contained to a localized area called the bursa, icing may be enough to relieve the pain. If that does not work, a cortisone injection can bring relief. How you respond to a cortisone injection can be helpful in confirming the cause of the problem and deciding on future treatment. Once the pain is decreased, a stretching and exercise program can strengthen the shoulder and help prevent recurrence.
Sometimes magnetic resonance imaging (MRI) is needed, which reveals soft tissues around the shoulder including muscles, tendons, ligaments, cartilage, and joint fluid much better than an X-ray. This will be helpful in deciding if any of the important structures are torn or damaged and may need surgical repair.
Many shoulder conditions can be treated surgically by arthroscopic techniques. An arthroscope allows your surgeon to look inside your shoulder through a small incision to see structures that may be torn and need repair or to see bone spurs that need removal.
Recent advances in materials and techniques have made surgical reconstruction of torn tendons and ligaments of the shoulder much more successful and less painful. Recovery after surgery usually involves supervised physical therapy.
Dr. Robert W. Nolan, an orthopaedic surgeon with Baptist Health Medical Group Orthopaedics & Sports Medicine, practices at Baptist Health Richmond.