What is causing your shoulder pain?

Sep 12, 2016

Dana Seltzer, MD, an independent, board-certified orthopedic surgeon at Abrazo Scottsdale Campus, discusses shoulder pain.

QUESTION:  I haven’t been injured but I have shoulder pain when I raise my arm overhead.  What should I do?

ANSWER:  The most likely cause of shoulder pain is rotator cuff disease also known as shoulder bursitis.  The pain is typically felt at the top of the shoulder, and it typically radiates down the outer arm toward the elbow. Other common complaints include difficulty holding objects with your arm out in front of you, pain when reaching behind you, an inability to lie on the affected shoulder, and night pain that wakes you. Clicking and popping in the shoulder is common, and patients with chronic shoulder issues often have pain around the shoulder blade and neck pain on the same side, with associated headaches from trigger points.

Initial treatment with ice and over the counter anti-inflammatory medications as well as avoiding aggravating activities may be enough to manage the problem. If this fails to provide significant improvement, an evaluation by a physician may be helpful. Prescription anti-inflammatories and a specific rotator cuff exercise program are the mainstays of treatment, with the strengthening program designed to help keep the ball centered in the socket and alleviate the impingement with overhead activities. A corticosteroid injection can help decrease inflammation allowing patients to more effectively complete the exercise program. To be successful, the exercises should be done to the point of muscle fatigue, and not to the point of pain, in order to avoid adding to the inflammation already present. As the rotator cuff and shoulder muscles get stronger, the pain generally subsides. If it does not improve, then X-rays, an MRI or ultrasound examination may be necessary to evaluate the rotator cuff for a tear. Smaller tears can often become asymptomatic with a conservative treatment program, but as tears get larger they are progressively more likely to require surgery and have a worse prognosis. Approximately 80-85 percent of patients with impingement but no rotator cuff tear can avoid surgical intervention by following a good conservative treatment program. Much of the surgery for these problems can be done arthroscopically, but more extensive rotator cuff repairs require a full year of rehabilitation for recovery. Early treatment for shoulder pain is likely to lead to a full recovery without surgery.

Abrazo Community Health Network is presenting free orthopedic seminars. For more information, go to AbrazoHealth.com/OrthoEvents or call 855-292-9355.

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