When people complain about shoulder pain, many assume that the rotator cuff is the source of their pain. But unless you are a major league pitcher or quarterback or have spent a career in a job that requires repeated overhead arm motions, the cause of the pain could be something else.
Note: Any sense of pressure, pain or aching sensation in your chest or arms that spreads to your jaw, neck, shoulders or back should be evaluated immediately, as these may be signs of a heart attack.
But in those cases where the pain develops over time, the shoulder pain may be more likely the result of a number of different, much more benign conditions. These include:
- Bursitis or tendonitis, which is inflammation of the bursa sacs or tendons in the shoulder joint.
- Cervical radiculopathy occurs when the nerve root in the cervical spine becomes inflamed or pinched, resulting in pain, numbness or weakness that may radiate into the shoulder.
- Dislocated shoulder occurs when the upper arm bone (humerus) pops out of the cup-shaped socket that’s part of the shoulder joint.
- Frozen shoulder can develop after surgery (such as a mastectomy), stroke or recovery from a broken arm or collarbone that has limited the movement of the arm.
- Osteoarthritis occurs when the cushioning cartilage in the shoulder joint breaks down, usually as the result of wear-and-tear.
- Rotator cuff injuries, including tears, affect the muscles and tendons that surround the shoulder joint and keep the head of the upper arm bone firmly within the shallow socket of the shoulder.
- Separated shoulder occurs when the ligaments that hold the collarbone (clavicle) to the
shoulder blade become stretched or torn.
- Sprains, stingers or burners (minor brachial plexus injuries) are common in contact sports, although they may be caused by inflammation or tumors.
Diagnosis and Treatment of Shoulder Pain
Following a thorough physical exam and review of the patient’s medical history, the physician may order one or more imaging tests to get a better view of the shoulder joint and assess the exact source of the pain. These tests might include an x-ray, MRI or CT scan of the shoulder. In cases of suspected nerve injury, a small needle electrode may be inserted into the shoulder area during a test known as electromyography (EMG).
Once the physician has determined the reason for the shoulder pain, there are numerous treatments that can offer significant relief.
Depending on the severity and cause of the pain, most physicians will recommend a conservative treatment approach at first. This may include over-the-counter anti-inflammatories, the application of ice alternating with heat on the shoulder, and physical therapy.
Non-surgical Treatment Options
When conservative measures fail to bring relief, however, an interventional pain specialist can offer several treatment options for chronic pain related to conditions such as shoulder arthritis, cervical radiculopathy and bursitis and tendonitis.
Cervical epidural steroid injections deliver powerful steroids that are highly anti-inflammatory and help reduce the irritation—and pain—caused by inflamed nerves in patients with cervical radiculopathy.
A suprascapular nerve block is an injection of a local anesthetic and steroid to block the nerves that influence pain in the shoulder.
Steroid injections into the shoulder area of anti-inflammatory cortisone can address a number of conditions, including arthritis, bursitis, frozen shoulder, rotator cuff impingement or tendinitis.
Shoulder pain can significantly limit the ability to work—or play—and should not be ignored, especially since there are several ways to provide long-term relief and improve the patient’s quality of life.
Dr. Ioannis Skaribas is fellowship-trained and double board certified in Pain Medicine and Anesthesiology. He has been performing minimally invasive treatments to address chronic pain for more than 25 years and is nationally recognized for his expertise in diagnosing and treating difficult cases of complex chronic pain.