Shoulder pain is one of the most common problems Dr. Likover treats as an orthopedic surgeon. There are three common causes of shoulder pain. They are:
- Rotator cuff tear
- Rotator cuff impingement bursitis or tendinitis
- Frozen shoulder also known as Adhesive Capusulitis
Before any of these can be diagnosed, the orthopedic surgeon has to make sure the problem is not coming from the neck, as many neck problems cause referred pain to the shoulder. This is usually done by examining the patient and by asking if the pain is elicited by moving the shoulder or the neck.
- Tearing of the rotator cuff is a very common cause of shoulder pain. It can be caused by a fall, by picking up something too heavy, or an athletic injury. Sometimes as a result of aging, the cuff tears without any traumatic injury. Rotator cuff tear is diagnosed by examining the patient and by MRI. Most rotator cuff tears require arthroscopic or open surgery to correct, as it has been found that the cuff tends to tear more and more if left untreated, plus in most cases the pain does not go away until the tear is fixed. Below see the arthroscopic photo of a rotator cuff tear. Basically what is seen is a hole in a soft tissue structure, the cuff, with bone showing through.
The pain of rotator cuff tear is caused by the humerus bone rubbing on the underside of the clavicle bone or acromion, due to the hole in the cuff. Dr. Likover does a great deal of rotator cuff surgery which is done as an outpatient procedure. Most cuff tears can be fixed with arthroscopic technique. Massive tears sometimes are best fixed with a three inch incision. Results of rotator cuff tear surgery are generally excellent in terms of reducing the pain from the tear.
- Rotator cuff impingement tendinitis is an even more common problem than rotator cuff tear. In this day and age of people working out, lifting weights and playing sports such as tennis, softball or golf it is easy to overuse the shoulder and cause inflammation of the space between the rotator cuff and collar bone. This inflammation causes a painful swelling of the shoulder bursa. In this case a structural tear or hole in the cuff is not present. Basically a “sore throat” of the shoulder develops with internal redness, swelling and fluid collection. The pain from this condition can be treated with anti-inflammatory pills, a cortisone shot into the shoulder bursa, and rest of the arm. The pain usually subsides in days. Most cases of impingement go away without surgery. In a few cases the inflammation continues or returns following treatment. This failure of treatment is usually caused by a bone spur on the underside of the collarbone (acromion) that continues to rub the rotator cuff regardless of treatment and causes continuing pain. The older one gets, the larger the bone spur tends to grow. If pain persists, arthroscopic surgery to remove the bone spur is a very effective treatment for this problem.
- Frozen shoulder is third most common cause of shoulder pain. A patient usually remembers some sort of vague injury, then progressive increasing pain occurs with difficulty sleeping and increased loss of motion to when the patient presents to the doctor, the shoulder is usually very stiff with major loss of shoulder motion and major pain upon attempting to move the shoulder through a full range of motion. The primary treatment for frozen shoulder is physical therapy and stretching exercises. Nothing really lessens the pain very well and it takes a long time to get over this condition. Usually by a year to a year and a half after onset of symptoms the pain goes away and full motion returns. Anti-inflammatory pills and one cortisone shot may help, but this is a frustrating condition for me to treat, as patients are not happy and not easily improved. If stiffness persists, a manipulation of the shoulder under anesthesia may help, once the acute inflammation stage has passed, which usually takes four to six months from the onset of the condition.