Steamboat Pilot & Today

You don't have to be a major league pitcher to sustain a significant shoulder injury. Most of us have experienced shoulder pain from more regular activities such as snow shoveling or a brisk fall into the back of a mogul.

If you have pain that lasts more than several weeks, it could be serious and should be evaluated. The shoulder is a complex joint and requires an accurate diagnosis to apply the correct treatment. Some common causes of pain and disability are rotator cuff tendonitis or tear, instability, separation and frozen shoulder.

Rotator cuff bursitis, or tendonitis, can occur at any age and results from inflammation of the tendons that elevate and rotate the shoulder. In young athletes, it is most commonly seen in sports requiring repetitive shoulder motions such as baseball, swimming and tennis.

But as we get older and the rotator cuff weakens, inflammation in the tendons can occur for no apparent reason, or as a result of only mild trauma. The first symptom may be a dull ache in the lateral arm that becomes worse when you reach up or back to put on a coat or a shirt.

A more significant form of rotator cuff tendonitis is impingement syndrome. This is a more chronic condition that is a result of bone spurs pinching the rotator cuff, causing a constant mechanical irritation. People with impingement syndrome are probably more prone to developing a rotator cuff tear.

Rotator cuff tears become more common as we get older. The rotator cuff simply thins and weakens over time and becomes more prone to injury. Additionally, some people ignore the symptoms of impingement syndrome and end up with a painful and weak arm after the cuff has already torn.

For tendonitis and mild impingement syndrome, treatment will typically include activity modification and rotator cuff stretching and strengthening exercises. For more severe pain, injections may become necessary to reduce pain and improve mobility. If symptom relief from therapy and injections is temporary, the shoulder can be decompressed with arthroscopic surgery to remove the bone spur and inflamed tissue.

Because rotator cuff tears do not heal on their own, they need to be repaired surgically. Magnetic resonance imaging will help define the size of the cuff tear and the quality of the tendon and muscle. These factors affect the ability to repair the rotator cuff and the expected outcome. As the rotator cuff tear gets larger, repair becomes more difficult and the results with repair become less predictable. The sooner a tear is diagnosed, the better.

A common diagnosis in younger patients is instability. Instability occurs when the structures supporting the shoulder joint become torn, allowing the ball to shift or slide away from the socket.

The most severe form of instability is a shoulder dislocation. The initial treatment for instability is rest and rehabilitation. Unfortunately, once the shoulder is loose or has dislocated, it is more prone to repeated dislocation and may need to be repaired.

A shoulder separation is different from a dislocation. A separation occurs at the AC joint at the top of the shoulder where the shoulder blade meets the collarbone. This usually occurs from a fall directly on the point of the shoulder. A majority of the time, an AC separation is treated with rest and gradual return to activities.

Adhesive capsulitis, or "frozen shoulder," typically occurs after age 50 and is more common among women and people who have diabetes. This condition frequently occurs spontaneously or after mild trauma and can mimic tendonitis initially. The main difference from tendonitis is that the shoulder becomes progressively stiffer until it is frozen.

To avoid permanent stiffness and disability, the best treatment involves a program of physical therapy to break down the scar tissue in the joint that is causing the stiffness. Injections into the joint are typically very helpful to reduce the discomfort in this painful condition. The earlier treatment starts, the better.

Many shoulder injuries are more significant than they seem. If pain, stiffness or weakness persist, don't shrug these symptoms off. Have your shoulder evaluated.

Orthopaedic surgeon Andreas Sauerbrey, M.D., is chief of surgery at Yampa Valley Medical Center. He is Fellowship-trained in shoulder, elbow, wrist and hand surgery.