The English language bears a special romance for the shoulder. We all need a shoulder to cry on -especially when we shoulder life’s burdens. A shrug of the shoulders shows indifference – the cold shoulder, hostility. The broad shoulders of Atlas support the world, while the fortunes of the Dodgers rest on the $215 million dollar left shoulder of Clayton Kershaw.
The shoulder’s exceptional freedom of movement comes at the expense of strength and stability. While of the bones of the hip fit together like a ball in a cup, the shoulder blade (scapula) and humerus (arm bone) merely lie side-by-side. Surrounding muscles and tendons stabilize the joint, and guide its movements. The joined tendons of the shoulder muscles form the rotator cuff.
Soreness in the shoulder is a common problem treated by the rheumatologist. Parts of the rotator cuff may be pinched, inflamed, or torn. When the arm is elevated away from the body, the cuff and the main bursa of the shoulder are entrapped between the humerus bone and the ligament forming the roof of the shoulder capsule. Over a lifetime of use, this repeated squeezing of the tendons causes degeneration. Occasionally, calcium deposits form in the damaged tendon. Tears can develop when the weekend warrior over-stresses a weakened cuff.
Not all shoulder pain comes from the shoulder. Pinched nerves in the neck or under the arm can simulate shoulder pain. Sometimes, pain in the shoulder signals disease in the heart, lung or gallbladder!
X-rays of the painful shoulder may show calcium deposits or arthritis, but are usually normal. Ultrasound examination can demonstrate evidence of tendinitis or bursitis and may show calcium deposits. Magnetic resonance scanning (MRI) provides the most detailed examination of the muscles, cartilage and tendons of the shoulder joint.
For most patients, rest, anti-inflammatory medication and physical therapy give relief. Injection of anesthetic and a cortisone-like medication can be dramatically helpful, particularly when using ultrasound guidance to improve precision. Arm slings can be helpful when the pain is intense, but prolonged used should be avoided, as this can lead to severe restriction of movement, a condition known as frozen shoulder. Exercises must be carefully chosen and supervised by a therapist. Overzealous aerobics and other routines may prolong the soreness. A coach or trainer may be needed to correct a faulty golf or tennis swing.
Surgery offers a variety of options in difficult cases. Bulky calcium deposits can be removed, and tears repaired through the arthroscope. Removal of a portion of the ligament and bone at the roof of the joint can relieve pinching of the rotator cuff tendons. New techniques have improved the success of joint replacement surgery for patients with advanced arthritis of the shoulder.
These days, no one need shoulder the burden of shoulder pain.
Here are some suggested references for more information on this topic:
Alan R. Schenk, M.D. FACP