Acute and persistent shoulder pain can affect both young and old; however, the causes can be quite varied and require a meticulous diagnostic process to understand the fundamental problem leading to a solution. Young and active patients often feel that shoulder pain stems from activity overuse. While this could be the reason, it is important to understand why.
Current exercise routines usually emphasize strengthening the deltoid muscles, while the rotator cuff is widely ignored. This leads to instability syndrome, which can cause pain and, even worse, a mechanical deficiency of the shoulder joint. If the pain is a chronic problem without a history of a traumatic event, the patient will usually respond to strengthening therapy. Such therapy will require great diligence from both the patient and the therapist.
An acute injury, such as a fall or an impact on a raised arm, can lead to a different type of injury that might require treatment. When an acute injury leads to persistent pain, we frequently order an MRI, which is a diagnostic tool that examines the soft tissue of the shoulder in depth.
X-rays examine only the bone structure, and results usually show a normal image in people with shoulder pain symptoms. An MRI frequently indicates the severity of the soft tissue injury and can determine if continued conservative treatment (anti-inflammatories, cortisone injections, and therapy) is required, or if surgical intervention is warranted. A torn cartilage or a ruptured tendon will usually not improve on its own; therefore, a different solution would be necessary.
In the current era of medicine, we can resolve many of these problems through arthroscopic surgery. This procedure allows for the visualization of the joint by means of a small camera inserted through tiny perforations in the skin of the joint. This method minimizes scarring, improves the surgeon’s visualization of the problem, and allows for a faster recovery. In certain cases, an open incision may be required depending on the severity and location of the problem.
Older patients frequently attribute their shoulder pain to “arthritis”. In fact, arthritis in the shoulder joint is rather unusual. Arthritis is the loss of cartilage in a joint that leads to bone-on-bone grinding. This condition, osteoarthritis, is most commonly seen in the knee, hip, and even the base of the thumb, but it is very rare to find it in the shoulder.
The most common cause of shoulder pain in older individuals is known as Impingement Syndrome. Bursitis is often an element of this syndrome. Bursitis, a term so frequently used, is much more accurate in describing this problem than the term “arthritis”. With age, blood flow to the rotator cuff decreases, and small micro-tears in the tendon lead to tendonitis or bursitis, which is an even larger tear.
IMPINGEMENT SYNDROME
This condition may respond to conservative treatment of cortisone injections to reduce bursitis, or therapy to strengthen the intact rotator cuff.
A full tear in the rotator cuff implies that the torn tendon has separated from the bone; in this case, it will be physically impossible for the patient to lift the arm, or they will experience severe pain when attempting to do so.
Impingement Syndrome is characterized by feeling pain when the arm is raised, pain that worsens at night, and an inability to lie on the affected shoulder.
Once the pain becomes chronic and does not respond to therapy or other conservative treatments, surgery is indicated. Some smaller tears can be repaired through arthroscopy, but larger tears are usually repaired through a traditional incision. Most interventions require one month of immobilization with a sling and several months of postoperative therapy directed by the surgeon.
THE IDEAL SPECIALIST
The shoulder is a demanding joint and requires patience from both the affected individual and the surgeon in charge. Recovery is commonly not fast, but diligently adhering to the therapy protocol will, in most cases, lead to good results and a functional shoulder with minimal or no pain.
The key to treating an aching shoulder is to find the ideal specialist and undergo a physical examination of the affected part ordered by the surgeon. Therapy often plays a primary role in the recovery of this particular joint. Arthroscopic techniques allow for a faster recovery with minimal pain if surgery is indicated.
