by Dr. Anjuli Desai

Shoulder pain accounts for 12 out of every 1000 primary care office visits. This could largely be attributed to the fact that the shoulder joint is the body’s most mobile joint. In fact, shoulder and neck pain account for 18% of all insurance disability payments made for musculoskeletal pain. Some factors which predispose a patient to shoulder pain include unstable glenohumeral joints, weaknesss of scapular stabilizers, abnormal posture, and hypomobility of the cervical and thoracic spine.

It should be noted that most cases of shoulder pain usually resolve spontaneously within a month. Furthermore, nearly all patients improve within 3 months when treated with an appropriate combination of analgesics such as non-steroidal anti-inflammatories, 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 good demonstration of fractures, infections, tumors, tendonitis and arthritic conditions, such as 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 are known as EMG/NCS, and give your provider an idea of how your nerve and muscles are functioning, and whether they are damaged.   Shoulder pain is often complicated by neck radiation and nonspecific arm radiation and electromyography can help to determine from where the pain originates.

Below is a list of the 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, in cases of acute shoulder pain, most cases spontaneously resolve 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 adequate to make a diagnosis, electrophysiologic studies (EMG/NCS) may help to provide more information. If your shoulder is unstable, surgical treatment may be indicated. Your Pain Management provider at Capitol Pain Institute will help to formulate a diagnosis and treatment plan, which is specifically 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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