By far, the most common reason for shoulder pain is what is known as impingement syndrome. It is also known as rotator cuff bursitis or tendinitis.
The shoulder has an incredible range of motion with most of the shoulder stability coming from the rotator cuff and the cartilage structures around the joint. As a person lifts up the shoulder, there is a soft tissue structure called the bursa that sits on top of the rotator cuff muscle and allows it to glide under the bone of the shoulder called the acromion.
At times, the soft tissues can rub up against the acromion bone and lead to inflammation. This may either be due to the way that the acromion is shaped or just a simple function of overuse.
With inflammation of the bursa, typically patients feel shoulder pain with activity and some with rest as well. Eventually, the problem can lead to inflammation of the rotator cuff tendon itself along with some tearing of the tendon. So the term impingement derives from the fact that the soft tissue structures are getting pinched, or impinged, up against the bony acromion.
Thankfully, over 90% of patients with impingement syndrome are able to receive adequate pain relief with conservative treatment. On physical examination, the doctor will notice pain with resisted forward flexion of the shoulder as well as other provocative maneuvers that put the shoulder in a position where the soft tissues rub up against the acromion.
The best diagnostic test for impingement syndrome is actually an injection of numbing medicine into the area underneath the acromion, called the subacromial space. If significant pain relief is achieved within minutes after this injection, the diagnosis for impingement syndrome is fairly easy to make.
Initial treatment consists of physical therapy exercises along with over-the-counter anti-inflammatories and Tylenol. Additional treatment may consist of a subacromial cortisone injection. The injection along with the anti-inflammatories by mouth typically relieves the pain for weeks to months at a time. The injections may be repeated every few months.
Usually with activity modification along with the medications and the injection, pain relief is adequate. If a particular sporting activity such as golf is causing the problem, then taking a break from the sport and then gradually working back into it would be prudent.
For those 5 to 10% of individuals who do not respond to these conservative measures,
then arthroscopic shoulder surgery is indicated. This outpatient procedure involves cleaning out the inflamed bursal tissue, along with shaving down the acromion bone to prevent impingement in the future.
This subacromial decompression surgery has an extremely high success rate and usually allows patients to go back to normal physical activity within a few months.
If you are experiencing shoulder pain as a result of an injury at work or from an auto accident, let Arizona Injury Medical Associates help you. The practice has a Double Board certified Worker’s Compensation pain doctor who specializes in the nonoperative care of painful conditions.