Ask The Expert // Shoulder Pain

June 26, 2008|By Holly Selby

So you've had a nagging pain in your right shoulder ever since you aced the final set against your former college roommate?

It perhaps is little consolation to learn that you are far from being alone. Indeed, an estimated 20 percent of Americans will have shoulder pain of some type in their lifetimes, says Dr. Steve A. Petersen, co-director of the division of shoulder surgery at the Johns Hopkins School of Medicine's Department of Orthopedic Surgery.

Annually, about 4 million Americans will seek medical care for aches, strains, arthritis or trauma to their shoulders.

What are the most common injuries to the shoulder?

The most common types of injuries are related to overuse of the shoulder, primarily to the rotator cuff.

Shoulder arthritis can occur from everyday wear and tear, but it is more likely to occur in people who are in their late 50s and 60s, whereas rotator cuff injury is more likely to occur in individuals in their 30s and 40s. With aging, rotator cuff overuse can evolve into rotator cuff tearing; it is like a slowly fraying rope.

Why are shoulders seemingly so prone to injury?

The shoulder is the body's least-constrained joint, so it has the greatest range of motion. The downside of this is that the [wide range of] motion puts strain on the muscles that move it through that motion. And the increased range of motion also means the shoulder is the most unstable joint in the body and so is prone to injury.

The rotator cuff also is [particularly] susceptible to overuse injuries because its blood supply is poor, and you need a good blood supply to allow for repair after everyday activities. Of all the tendons in our bodies, the rotator cuff tendons are the most commonly torn, often resulting from its overuse and limited ability for repair.

What are some other activities that might lead to shoulder pain?

All of the "overhead" or "collision" sports (football, rugby, basketball), particularly baseball and tennis. Swimming is an excellent example of a sport that demands repetitive use of the arm and a wide range of motion. But pitching puts the shoulder into the position in which it is most susceptible. A reason that throwing is so [potentially injurious] to the shoulder is the amount of acceleration required to throw overhead is 10 times greater than the amount of acceleration required for your legs to sprint. To keep your arm in the socket particularly when you are releasing the ball puts unbelievable strain on the shoulder.

What can you do to protect your shoulders?

It is important to warm up before you do any exercise. Stretch to maintain your range of motion and do strengthening exercises for your shoulder to stay in condition.

Let's say you've played a lot of tennis, and now your shoulder hurts. When should you consult a doctor?

Pain that results from an activity and that can be relieved with nonprescription medications (Tylenol, aspirin products) and ice or heat can usually be tolerated and is not really a warning signal.

People who have continuing pain, pain at night and associated restricted motion or use of the shoulder that isn't relieved by modification of activities, rest and ice should get attention from a physician.

Obviously, if you have a specific injury to your shoulder - an accident or severe pain that limits your actions - a visit to an orthopedic specialist would be advised.

What might the treatment for a shoulder injury be?

For the most part, treatment can be nonoperative and might include nonprescription anti-inflammatory medications for pain, ice and therapy that includes strengthening the muscles of the upper back, chest and shoulders.

Occasionally, selective shoulder injections help alleviate pain and allow the therapy to be more effective. These [injections] can include small doses of cortisone and are directed toward the primary cause of pain.

And if the shoulder still is painful?

There are surgical measures that are often helpful. These can include arthroscopic or more traditional open procedures. It is often assumed that you can advance the postoperative rehabilitation quicker after arthroscopic surgery, but that isn't necessarily true. Healing occurs through a process independent of the technique performed, and post-operative therapy after shoulder surgery is similar for arthroscopic and open surgical methods. Postoperatively, a sling may be required for protection for several days to two to three months, depending on the procedure performed.

Shoulder replacements are an effective way of treating advanced, painful arthritis. In fact, shoulder replacement surgery has been found to be as successful as hip and knee replacements, with fewer complications and a shorter hospital stay.

ONLINE

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