by Dr. Anjuli Desai

Shoulder pain accounts for 12 out of every 1000 primary care office visits. This is largely attributable to the shoulder joint being the body’s most mobile joint. In fact, shoulder and neck pain account for 18% of all insurance disability payments made for musculoskeletal pain. Factors predisposing a patient to shoulder pain include unstable glenohumeral joints, weakness of the scapular stabilizers, abnormal posture, and hypomobility of the cervical and thoracic spine.

Most cases of shoulder pain resolve spontaneously within a month. Furthermore, nearly all patients improve within 3 months when treated with an appropriate combination of analgesics, such as nonsteroidal anti-inflammatory drugs, moderate rest, and avoidance of stressors. Additional measures that may help provide shoulder pain relief include heat, massage, ultrasound, electrical stimulation, and passive physical therapy.

Shoulder pain can persist beyond 6 months in a small percentage of patients. Once you present to your Pain Management provider for management of your shoulder pain, she or he will perform a physical exam, which includes checking for focal areas of tenderness in the affected shoulder, range of motion, reflexes, sensation, and strength. Based on these findings, an imaging study may be ordered. Imaging provides a useful means of demonstrating fractures, infections, tumors, tendonitis, and arthritic conditions, including inflammatory and non-inflammatory arthritis. Correlation of the imaging studies with the clinical syndrome facilitates diagnosis and management decisions.

If needed, electrophysiologic studies of nerve and muscle may be ordered by your Pain Management provider to differentiate peripheral neuropathy, primary muscle disease, and radicular syndromes. These studies, known as EMG/NCS, provide your provider with an assessment of how your nerves and muscles function and whether they are damaged.   Shoulder pain is often complicated by radiating neck and arm pain, and electromyography can help determine the origin of the pain.

Below is a list of some of the most common causes of shoulder pain:

• Rotator Cuff Impingement
• Rotator Cuff Tendonitis / Tear
• Traumatic ligament, capsular injury
• Adhesive Capsulitis
• Bicipital Tendonitis
• Instability of the glenohumeral joint
• Subacromial Bursitis
• Acromioclavicular Joint Injury
• Suprascapular Nerve Entrapment
• Inflammatory and Non-inflammatory Arthritis
• Tumor
• Infection

In summary, acute shoulder pain typically resolves within 1 month and, with conservative treatment, within 3 months. If your shoulder pain does not improve with conservative treatment, your Pain Management clinic may order imaging studies such asplain films, MRI, and CT to obtain more information regarding the possible cause of your shoulder pain.   If these are not sufficient for diagnosis, electrophysiological studies (EMG/NCS) may provide additional information. If your shoulder is unstable, surgical treatment may be indicated. Your Pain Management provider at Capitol Pain Institute will help formulate a diagnosis and treatment plan tailored to your individual needs.

References

1. P Croft, D Pope, A Silman. The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group Br Med J, 313 (1996), pp. 601–602.
2. Nygern A, Berglund A, von Koch, M. Neck-and-shoulder pain, an increasing problem. Strategies for using insurance material to follow trends. Scand J RehabilMed Suppl 1995; 32:107-12
3. Kuijpers T, van der Windt DA, van der Heijden GJ, Bouter LM. Systematic review of prognostic cohort studies on shoulder disorders. Pain 2004;109:420–31.
4. van der Windt DA, Koes BW, De Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 1995;54:959–64.

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