MEDICAL MATTERS: Shoulder pain can be early sign of arthritis or other injury

“I saw my Doctor about my shoulder pain. He took an X-ray and told me ‘nothing is wrong’.”

A more appropriate response would have been, “there’s nothing broken”. Most sources of shoulder pain are not obvious on an X-ray. The shoulder is a remarkable joint with more movement than any other joint in our body. Thus, diagnosis of the specific cause of pain in the shoulder can be difficult.

The earliest signs of arthritis in the shoulder typically appear in the joint connecting the collar bone to the shoulder blade (acromio-clavicular or AC joint). In the absence of injury, this joint can show signs of arthritis on x-ray as early as age twenty-five. Pain associated with this joint is increased with lying on the side, using the arm at shoulder height or higher, pulling things toward you or away from your body. The pain does not make motion impossible but the use of the shoulder increases the pain.

Rotator cuff tears may be partial or complete. Risk factors for rotator cuff problems include male gender, high blood pressure and elevated cholesterol. Trauma is also a major cause, fall on shoulder or outstretched hand, shoulder dislocation, lifting or pulling heavy objects. Partial tears are more painful, full thickness tears result in loss of motion and weakness. Many partial tears do not require surgery. Full thickness tears will not heal without surgery. But with therapy, the patient may regain an acceptable motion and use, depending on the patient’s needs.

A cartilage ring surrounds the socket of the shoulder. This cartilage ring, the rotator cuff and the joint capsule provide a stable joint with an extensive range of motion. Tears of this cartilage ring cause pain and mechanical symptoms. They usually result from shoulder dislocation or an unexpected pulling injury to the arm. The bicipital tendon, one of two tendons to the bicep muscle is attached to this cartilage ring. Tears of the bicipital tendon are common. Usually the result of lifting heavy objects. Tears of this tendon usually do not require surgery. The patient will lose ten to fifteen percent of strength bending the…

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