Here are the Causes of Recurrent Shoulder Pain
Injury to the soft tissues – muscles, tendons and ligaments – is the most common cause of shoulder pain.
- Degenerative disc disease
- Herniated disc
- Torn rotator cuff
- Shoulder Impingement Syndrome (Frozen Shoulder)
Whiplash is an injury to the neck caused by a severe jerk to the head – typically only backward or forward or both – usually experienced in an automobile accident. Symptoms of whiplash may not be felt for days and may reoccur weeks later.
Degenerative Disc Disease is the degeneration of the intervertebral disc – osteoarthritis of the spine – typically occurring in the neck or lower back. Symptoms re-occur and worsen as the spine loses flexibility and bones pinch a nerve in the shoulder – causing pain or weakness.
A Herniated Disc occurs when a spinal disc slips out of place – bursts. A herniated discs causes the misalignment the vertebrae and pressure is placed against the nerves of the spine. Nerve impingement may cause recurring pain and stress to the spine and radiate to the shoulder.
Bursitis occurs when the bursae – sacs over the joints and muscles providing cushion to the shoulder’s joints and muscles – become swollen, stiff and painful after an injury.
The Rotator Cuff is a group of tendons supporting the shoulder. These tendons can be injured during lifting or repetitive use over a long period of time.
Shoulder Impingement Syndrome (frozen shoulder) is the chronic loss of range of motion due to a rotator cuff injury.
Here’s a guide to what might be wrong and whether or not it’s a cause for concern.
Slight pain with elevation and when playing overhead sports is common. The four tendons that make up the rotator cuff and the biceps tendon, (the combined musculature that drives the shoulder motions) can be inflamed by activities such as throwing, shooting basketballs, and lifting bags over head. The tendons are covered by a thin layer called a bursa, which swells when irritated. The bursitis is filled with inflammatory components that irritate the nerve fibers sending pain signals to the brain. Eliminating the overhead activities and mild use of anti-inflammatories usually cures the mild bursitis, or tendonitis, and solves the problem. Exercises to strengthen posture are also commonly used by our physical therapists to fix mild shoulder irritations. Slumping at your desk, reaching for your mouse, hunching over your keyboard, can all put extra strain on the shoulder, neck or back and may be the cause of your shoulder pain. Stand with your shoulders at or behind your hips with your belly button tucked in and notice the difference.
Pain that does not go away or pain that occurs with every activity indicates that the key tissues are irritated enough that they are sending pain signals even without motion. This degree of inflammation precedes more structural injuries such as tears of the tissue or early arthritis. Treated fully, the tears and the arthritis can be prevented. The treatments are often injections of growth factors from platelets, and lubricating fluid called hyaluronic acid. Physical therapy focuses on shoulder mechanics and muscle strengthening, and sports specific training to help fix the activity that might be causing the injury. Often we see throwers with slight errors in their throwing mechanics or golfers with swing abnormalities that bring on the problems, and correction of the swing fixes the pain. We avoid cortisone as there is clear evidence that it weakens the tissues of the shoulder if used too frequently.
Pain at night or pain not improving with therapy after 4 weeks are red flags. Pain radiating down the arm or up to the neck or to the back are also worrisome for injuries not just in the shoulder but sometimes of the neck. These injuries need to be worked up with careful physical exams, x-rays and MRIs. A full tear of the rotator cuff often will present with night pain, since when you roll over you push the arm up into the socket through the rotator cuff tear. Pain radiating down the arm or up to the neck can sometimes be from the discs in the neck or the nerves at the front of the shoulder called the brachial plexus. Instability of the shoulder, with the shoulder popping in or out of the joint is another area that is best treated with early repair of the torn ligaments.
Fortunately most of the torn tissue problems in the shoulder can be repaired under a local block with an arthroscope as an outpatient procedure. Only the severe arthritis cases require bionic replacement. The biologic treatments of anabolic stimulation of the tissues with injections, exercise, physical therapy and activity coaching are becoming more effective, more targeted and more widespread. The key is to treat them early before full tearing of tissues leads to disability
Call Dr. Raj, for all your shoulder issues. He is the best orthopedic surgeon in Los Angeles and Hollywood. Athletes and celebrities alike trust his as their go-to orthopedic surgeon. He gets the job done right the first time.