Martin R Coleman, MD
Arthritis – Although not seen as often as knee or hip arthritis, I may diagnose arthritis of the shoulder when a patient comes to me complaining of an achy, stiff shoulder. Arthritis is a condition that may come with age but may reflect a specific inflammatory condition such as Rheumatoid arthritis or gout. The result is a decrease in cartilage covering the joint surfaces in our shoulder. Patients feel pain and stiffness as the joint becomes more inflamed. Eventually, the cartilage can wear away entirely, causing bone to rub on bone. The body’s reaction to this is to increase the amount of synovial fluid in the joint which may result in visible swelling. We tend to work through this at first, but at some point the pain can be overwhelming.
I treat arthritis of the shoulder joint with ice or heat, NSAIDs, oral or injectable steroids and physical therapy during the mild to moderate stages. During the later stages, arthroscopic surgery may help to remove bone spurs and treat related rotator cuff symptoms. Finally, a conventional or reverse total shoulder replacement may be the only answer for the patient with severe, end-stage arthritis.
Sports Injury – Individuals can injure their shoulders acutely during sports, like being tacked in football and falling hard on a shoulder. Other cases are from chronic overuse, like a pitcher in baseball, throwing pitches repetitively. These two sports may be well known for causing shoulder injuries, but it may surprise you that tennis, swimming and volleyball also have very high incidences of shoulder injury, due to the level of rotation and intensity with which the shoulder is used. These painful injuries can range from fractures or dislocations to the more commonly seen tears of the rotator cuff or labrum, the rim of cartilage around the shoulder socket that provides stability for the shoulder. My approach is to examine each case thoroughly and choose the proper treatment. Some cases will be managed conservatively, without surgery, while other patients will need complex surgery and prolonged recovery to get back in action.
Trauma –Motor vehicle accidents or falls are typically how non-sports injuries occur to the shoulder. In both an MVA and a fall, we instinctively tend to throw our arms out to brace ourselves during impact and to protect our face and head when falling. While that protective mechanism may help protect our brain, our shoulders often bear the consequences of that action. Fractures, dislocations, torn tendons and ligaments or some combination of the above may happen as a result. We have come a long way with treatments for shoulder trauma and can expect good results in most cases. Surgery may be required to put the pieces of the injured shoulder back together, and patients with a traumatic injury typically can expect an extended period of recovery with a gradual progression of exercises and physical therapy designed to improve strength and range of motion.
Work – Work can cause shoulder pain, especially if you have a job like painting, construction, electrical work, or others that frequently require you to reach above your head. Alternatively, operating heavy equipment can also be bad for your shoulder due to the repetitive impact. Any job that puts significant stress on your shoulder over time can cause shoulder pain. Addressing shoulder pain from work is challenging and should be done in cooperation with your employer and your orthopaedic physician. We try to analyze the work causing the shoulder pain and explore making adjustments to limit the damage to the shoulder. An evaluation of the mechanics of a given activity, known as ergonomics, can help us suggest modifications that can avoid further injury. We will often use a combination of home exercises and formal physical therapy to address these problems. We find that strengthening the muscles around the shoulder, including the rotator cuff, while improving flexibility can make a real difference in treating these injuries. In collaboration, we should be able to find ways to keep you on the job and help you to be productive while also decreasing your shoulder pain. As a last resort, especially if a patient has suffered a rotator cuff tear, surgery may be required.
Referred Pain –Some patients come into the office complaining about pain in their shoulder that is not caused by a shoulder problem at all. Sometimes, patients will come to me for a consultation about their pain and, after reviewing x-rays and carrying out a thorough physical exam, I conclude that the pain in their shoulder is actually caused by a problem in their neck (cervical spine). That is called referred pain or radiculitis. It can represent nerve compression from bone spurs, herniated discs or a combination of both. Treatment generally starts with anti-inflammatory medicines and physical therapy. However, if the pain doesn’t improve with conservative treatment, I may refer the patient to one of our spine specialists for further consultation.
Conclusion- Due to improvements in medical and surgical treatment, the vast majority of shoulder pain cases can be successfully treated. When shoulder pain interferes with your daily routine or especially if it affects your sleep, you should make an appointment to see me for a consultation.
Make an appointment with Dr. Coleman or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.
