What are some common musculoskeletal problems that cause shoulder pain?

The shoulder requires a large range of motion, and thus is inherently less stable than most other joints and places it at greater risk of injury.

“Rotator cuff impingement” is a very common condition in which one develops pain with elevation of the arm or with overhead activity, as the tendons or bursa are impinged between bony or ligament structures.

Commonly, impingement is caused by overuse and impaired shoulder mechanics. If this occurs for a length of time, one can develop rotator cuff tendonitis, biceps tendonitis, and bursitis.

These structures also undergo normal aging, and subsequently are more prone to injury. In some patients, impingement can be caused when calcium crystals build up in the rotator cuff tendons, a condition called calcific tendonitis.

Significant rotator cuff tears can cause pain and weakness. If one has pain and stiffness, one may be suffering from inflammation and tightening of the shoulder capsule, a condition called adhesive capsulitis (frozen shoulder).

In the older population, shoulder arthritis can be a source of pain and stiffness. In the athletic population, especially in a sport that requires throwing, the ring of cartilage that lines the shoulder joint, called a labrum, can become injured and cause pain.


How is it diagnosed?

History and physical examination are most important.

X-rays can be helpful to rule out bone and joint problems and to confirm the diagnosis of arthritis. Calcium can be seen in x-rays in patients with calcific tendonitis.

For most soft tissue problems, such as rotator cuff tears, tendonitis, and bursitis MRI or high definition diagnostic ultrasound are helpful.

For labral tears, an injection of dye into the joint (arthrogram) is usually required.


How is it treated?

Treatment typically begins with activity modification, rest, and use of modalities such as ice.

To treat pain, either Tylenol or NSAIDs (anti-inflammatories) such as Ibuprofen or naproxen can be considered. If that does not help, manual treatment with a physical therapist, chiropractor, or massage therapist can be helpful in conjunction with therapeutic exercises to improve muscle control, flexibility, imbalance, and strength.

In resistant cases, injections of corticosteroids (steroids) and numbing agents may be considered. Surgery is an option for some conditions resistant to conservative care.


Are there alternative treatment options?

Some patients find benefit from acupuncture, dry needling, and natural medications.

Injection of platelet rich plasma (PRP), one’s own blood cells that contains natural healing proteins called growth factors, has shown promise to treat certain peripheral joint conditions such as tendonitis and arthritis. Our physiatrists can perform PRP injections when indicated.