Shoulder pain

Dr Sumit Mahajan
Shoulder joint is made up upper arm bone (humerus), collar bone (clavicle) and shoulder blade (scapula). The head of humerus fits into a rounded socket in shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps humeral head centered in shoulder socket. These tissues are called rotator cuff.
Most of the shoulder problem falls into 4 categories
* Tendon inflammation (tendinitis & bursitis) or tendon tears of rotator cuff.
* Recurrent shoulder dislocation.
* Arthritis
* Fracture , Infection and nerve related problems
Bursitis: Bursae are the small fluid filled sacs that are located in the shoulder joint between bone and soft tissue. Sometimes, because of overuse of shoulder, there is inflammation and swelling between rotator cuff and acromion leading to subacromial bursitis. This may leads to difficulty in doing daily activities like tying turban, combing your hair and dressing up.
Rotator cuff tendinitis and Tendon tear: A tendon is like a cord that connects muscle to bone. Its injury can be actue, because of the over head activities during work, trauma or sports or chronic, because of arthritis or repetitive wear and tear due to age. The partial tear or tendinitis can result into difficulty in movement, pain more at night time, doing daily activities as in bursitis. In complete tear, patient is unable to lift his arm along with pain in shoulder.
Impingement syndrome: Shoulder impingement occurs when the top of the shoulder blade (acromion) puts pressure on the underlying soft tissues when the arm is lifted, the acromion rubs, or “impinges” on, the rotator cuff tendons and bursa. This can lead to bursitis and tendinitis, causing pain and limitation of movement.
Recurrent shoulder dislocation: It usually occurs in young adult. Ligament, tendons and muscle around shoulder become loose or torn, that can recurrent dislocation and feeling of pain, unsteadiness when arm is raised or moved away from the body.
Arthritis: Shoulder pain can also result from arthritis. The most common type of arthritis in the shoulder is osteoarthritis, also known as “wear and tear” arthritis. Often people will avoid shoulder movements in an attempt to lessen arthritis pain. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.
Magnetic resonance imaging (MRI) and ultrasound. These imaging studies create better pictures of soft tissues and help in diagnosis of rotator cuff tear and glenoid labral tears.
Treatment generally involves rest, altering your activities,painkillers and physical therapy to help you improve shoulder strength and flexibility in most of cases. Modalities like steroid injection in the joint, may give some relief by decreasing inflammation but can cause early destruction of joint. So, this should be avoided.
Certain types of shoulder problems, such as recurring dislocations and rotator cuff tears, may not benefit from exercise. In these cases, early surgery is recommended. Gold standard is the arthroscopic shoulder surgery, which includes the processes like removing the under surface of acromion (top of shoulder blade) to remove impingement, removal of bursa, use of anchors to fix the tendon to bone, through 2-3 small incisions around the joint. The anchors used are of two types -non absorbable (titanium) and absorbable (biocomposite). It is usually a day care procedure and patient will get complete range of motion, the very next day. The patients have to follow a strict physiotherapy regimen after this procedure. About 95 percent people usually get relief by this process.
Last modality is the shoulder replacement, which is only indicated in the severe arthritis or massive irreparable rotatorcuff tear.
(The author is consultant Max Mohali)