shoulder pain Archives | Mathew Mazoch, MD

Bone & Joint Clinic of Baton Rouge | Sports Medicine


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All Posts Tagged: shoulder pain

Shoulder Separation and AC Joint Pain

Introduction to AC (Acromioclavicular) Joint Pain and Shoulder Separation

Some joints in the body are more likely to develop problems than others, one of these joints is the acromioclavicular joints (AC joint).  Falls on the point of the shoulder often cause injury to the AC joint (often called a shoulder separation).  Wear and tear degeneration causes the cartilage that cushions the joint to wear out. This type of arthritis is called osteoarthritis.  The acromioclavicular (AC) joint in the shoulder is a common spot for osteoarthritis to develop. Injury or degeneration of the AC joint can be painful and can cause difficulty using the shoulder for everyday activities.

 

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This diagram shows the ligaments that are commonly injured in a separated shoulder.

 

 

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Frozen Shoulder and Adhesive Capsulitis Treatment

What is frozen shoulder?

Frozen shoulder, also called adhesive capsulitis, is a painful condition in which the movement of the shoulder becomes limited.

Frozen shoulder occurs when the strong connective tissue surrounding the shoulder joint (called the shoulder joint capsule) become thick, stiff, and inflamed. (The joint capsule contains the ligaments that attach the top of the upper arm bone (humerus) to the shoulder socket (glenoid), firmly holding the joint in place.

The condition is called ‘frozen’ shoulder because the more pain that is felt, the less likely the shoulder will be used. Lack of use causes the shoulder capsule to thicken and becomes tight, making the shoulder even more difficult to move — it’s ‘frozen’ in its position.

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The image shows some of the relevant anatomy involved in a frozen shoulder

Who is at risk for developing frozen shoulder?

Age: Adults, most commonly between 40 and 60 years old.

Gender: More common in women than men.

Recent shoulder injury: Any shoulder injury or surgery that results in the need to keep the shoulder from moving (ie, by using a shoulder brace, sling, shoulder wrap, etc) Examples include a rotator cuff tear; and fractures of the shoulder blade, collarbone, or upper arm.  However, even overuse and minor injuries that cause people to voluntarily immobilize the arm can contribute to the development of frozen shoulder.

Diabetes: Between 10% and 20 % of individuals with diabetes mellitus develop frozen shoulder.

Other health diseases and conditions: stroke, hypothyroidism (underactive thyroid gland), hyperthyroidism (overactive thyroid gland), Parkinson’s disease, heart disease.

Stroke is a risk factor for frozen shoulder because movement of an arm and shoulder may be limited. Why other diseases and conditions increase the risk of developing a frozen shoulder is not clearly.

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What are the signs and symptoms of frozen shoulder?

Symptoms of frozen shoulder are divided into three stages:

The ‘freezing’ stage: In this stage, the shoulder becomes stiff and is painful to move. The pain slowly increases. It may worsen at night. Inability to move the shoulder increases. This stage lasts 6 weeks to 9 months.

The ‘frozen’ stage: In this stage, pain may lessen, but the shoulder remains stiff. This makes it more difficult to complete daily tasks and activities. This stage lasts 2 to 6 months.

The ‘thawing’ (recovery) stage: In this stage, pain lessens, and ability to move the shoulder slowly improves. Full or near full recovery occurs as normal strength and motion return. The stage lasts 6 months to 2 years.

How is frozen shoulder diagnosed?

To diagnose frozen shoulder, your doctor will:

  • Discuss your symptoms and review your medical history.
  • Conduct a physical exam of your arms and shoulders:
    • The doctor will move your shoulder in all directions to check the range of motion and if there is pain with movement. This type of exam, in which your doctor is moving your arm and not you, is called determining your “passive range of motion.”
    • The doctor will also watch you move your shoulder to see your “active range of motion.”
    • The two types of motion are compared. People with frozen shoulder have limited range of both active and passive motion.
  • Imaging tests, such as X-rays, magnetic resonance imaging (MRI) and ultrasound, are usually not needed to diagnose frozen shoulder. They may be taken to look for other problems, such as arthritis, rotator cuff tear, labral tear, and tendinitis.

What are the treatments for frozen shoulder?

Treatment usually involves pain relief methods until the initial phase passes. If the problem persists, therapy and surgery may be needed to regain motion if it doesn’t return on its own.

 Some simple treatments include:

Hot and cold compresses. These help reduce pain and swelling.

Medicines that reduce pain and swelling. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), and acetaminophen (Tylenol). Other painkiller/anti-inflammatory drugs may be prescribed by your doctor. More severe pain and swelling may be managed by steroid injections.

Physical therapy. Stretching and range of motion exercises taught by a physical therapist.  This is often a key component of the treatment for frozen shoulder.

Home exercise program. Continue exercise program at home.

 

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The help of a therapist is often key for improvement with a frozen shoulder

If these simple treatments have not relieved pain and shoulder stiffness after about a year trial, other procedures may be tried. These include:

Manipulation under anesthesia: During this surgery, you will be put to sleep and your doctor will force movement of your shoulder. This will cause the joint capsule to stretch or tear to loosen the tightness. This will lead to an increase in the range of motion.

Shoulder arthroscopy: Your doctor will cut through the tight parts of your joint capsule (capsular release). Small pencil-sized instruments are inserted through small cuts around your shoulder.

These two procedures are often used together to get better results.

Can frozen shoulder be prevented?

The chance of a frozen shoulder can be prevented or at least lessened if physical therapy is started shortly after any shoulder injury in which shoulder movement is painful or difficult. Your orthopaedic doctor or physical therapist can develop an exercise program to meet your specific needs.

What’s the outlook for frozen shoulder?

Simple treatments, such as use of pain relievers and shoulder exercises, in combination with a steroid injection, are often enough to restore motion and function within a year or less. Even left completely untreated, range of motion and use of the shoulder continue to get better on their own, but often over a slower course of time. Full or nearly full recovery is seen after about 2 -5 years.

Final thoughts on frozen shoulder

Frozen shoulder can cause severe pain and greatly affect function, quality of life and sleep.  Appropriate coordinated treatment often results pain relief and an increased quality of life.  If you have any further questions about frozen shoulder or shoulder pain please don’t hesitate to schedule an appointment with Dr. Mazoch.

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Rotator Cuff Tear Repair Surgery

Overview of Rotator Cuff Tear Repair Surgery

The rotator cuff is a common source of pain in the shoulder. It refers to a group of four muscles and tendons that attach to the head of the humerus and stabilizes the shoulder as it moves in space. The most commonly affected tendon is the supraspinatus tendon.  Issues with the rotator cuff commonly cause problems with overhead activity, pain with sleeping on the shoulder, and moving the shoulder in certain motions.  If torn, the rotator cuff can cause progressive pain and disability in the shoulder.  Unfortunately, the rotator cuff has poor healing potential on its own and often requires surgical repair in many cases.

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The image shows a stylized view of the shoulder with a small anterior supraspinatus tear.

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Rotator Cuff Impingement, Bursitis, & Tendinitis

Overview of Rotator Cuff Impingement, Bursitis, and Tendinitis

Shoulder pain is one of the most common problems in patients or in athletes who deal with overhead movements of the shoulder.  One of the most common reason for shoulder pain is a problem with the rotator cuff or the surrounding tissues.  The rotator cuff is a group of four muscles that attach to the humeral head and the scapula and help move the shoulder in space.  The rotator cuff and overlying bursa can sometimes become inflamed if the rotator cuff muscles hit the undersurface of the acromion.

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Biceps Tear or Injury

Introduction to Biceps Tears or Injuries

The biceps muscle goes from the shoulder to the elbow on the front of the arm. Two separate tendons connect the upper part of the biceps muscle to the shoulder, the long head tendon and the short head tendon.  The long head of the biceps connects the biceps muscle to the top of the shoulder socket, the glenoid.  The long head of the biceps tendon runs within the bicipital groove.   The short head of the biceps connects on the corocoid process of the scapula.  The lower biceps tendon is called the distal biceps tendon and it attaches to the radial tuberosity in the forearm.  The biceps is most commonly injured at the long head and more rarely it can be injured at the distal biceps tendon.  Depending on where it is injured and the finding depends on how the injury needs to be treated.

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This diagram shows the basic anatomy of the biceps tendon in the arm.

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SLAP Tear in the Throwing Shoulder

Introduction to a Slap Tear in the Throwing Shoulder

The shoulder has the most range of motion of any of the major joints in the body. Maintaining stability in this highly mobile and versatile joint requires a finely tuned combination of many structures in the athlete.  The socket (glenoid), the cartilaginous rim around the socket (labrum), the capsular ligaments, and the rotator cuff muscles all play a role in stability.

A frequent cause of pain or instability of the throwing shoulder is a labral tear.  A particular kind of labral tear involving the superior labrum is a SLAP (Superior Labrum Anterior to Posterior) tear.  This tear originates where the long head of the biceps tendon attaches to the labrum and glenoid.

SLAP tears can be traumatic, from overuse, or degenerative.  Repetitive forces such as those seen with overhead and/or throwing athletes are frequently responsible for SLAP lesions.  Other common mechanisms of injury include blows to the shoulder, a fall on an outstretched arm, seatbelt/shoulder harness injuries, or heavy lifting.  People with a SLAP tear often feel a deep-seated pain often referred to the back of the shoulder.  But depending on the extent of biceps involvement can be felt anteriorly as well.  Sudden movements or extremes of motion, especially outwards and upwards as in throwing, often bring on the pain. Occasionally, catching sensations or instability symptoms are also felt.

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Shoulder Arthritis Pain and Shoulder Replacement

Shoulder Arthritis Pain

Arthritis means “inflamed joint,” and refers to any condition of the joint in which there is damage to the smooth cartilage covering a moving surface of a joint (called the articular cartilage).  Progression of arthritis eventually leads to cartilage loss and “bone on bone” of the joint surfaces.  Cartilage damage and loss can cause pain.

After the hip and knee, the shoulder is the third most common large joint affected by arthritis.  The loss of cartilage with shoulder arthritis is frequently a source of severe pain, limited function, joint stiffness, and significant diminished of quality of life. While there is currently no cure for advanced arthritis, there are many treatments, both non-surgical and surgical, that enable the symptoms to be well treated and for patients to maintain active lifestyles.

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The image shows a patient’s x-ray with primary osteoarthritis

 

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Shoulder Dislocation & Instability

Introduction to Shoulder Dislocation and Instability

The shoulder joint consists of the rounded top of the bone in the upper arm (humerus), which fits into the socket (glenoid) — the cup-shaped outer part of the shoulder blade.  When the top of the humerus moves out of its usual location in the shoulder joint, the shoulder is said to be dislocated.

Shoulder dislocations can occur after a traumatic event or can be atraumatic in people who are loose jointed.  In a dislocation event sometimes the structures around the shoulder can be damaged and can cause labral tears or rotator cuff tears.  Proper treatment is necessary to prevent recurrent instability of the shoulder joint which can cause continued dislocations and progressive damage if not treated appropriately.

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This image shows a normal shoulder relationship of the humerus to the glenoid as well as an anterior dislocation and a posterior dislocation.

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Shoulder Labral Tear

Overview of Shoulder Labral Tear

The shoulder is made up of three bones: the shoulder blade (scapula), the humerus (upper arm bone), and the clavicle (collarbone).   A part of the scapula, called the glenoid, makes up the shoulder socket. The glenoid is very shallow and flat. The labrum is a rim of soft tissue that makes the glenoid socket deeper so that it molds to fit the head of the humerus.

The labral tissue can be caught between the glenoid and the humerus. When this happens, the labrum may start to tear or get damaged. If the tear gets worse, it may become a flap of tissue that can get caught between the head of the humerus and the glenoid and cause pain.  The labrum combined with the ligaments, tendon, and capsule all contribute to the stability of the shoulder.  When people develop a labral tear the shoulder often becomes much less stable.

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This is a look at shoulder from the side with the humerus and muscles removed. The labrum is the rim of tissue that surrounds the glenoid.

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