Importance of the Shoulder

The shoulder is critical in the function of the upper extremity, linked to the cervical spine, thorax, and axilla. Given the intricacies and areas involved, shoulder pain can be complex. With the highest mobility of any joint in the human body, the shoulder is predisposed to musculoskeletal disorders and injuries.

Who Gets Shoulder Pain?

Shoulder pain is most prevalent in the middle age group (45-64 years) owing to age-related degenerative changes and rotator cuff pathology. Personal risk factors predisposing to shoulder pain are: age, smoking, and obesity, repetitive use, abnormal posture, physically demanding jobs, and psychosocial factors.

Types of Shoulder Pain

Shoulder pain is a common complaint in Pain Medicine. Understanding the acute and chronic disorders that often cause shoulder pain is extremely important because many of them can be treated without referring our patient to an orthopedic doctor or subspecialist.

Depending on the condition the presentation can have a different profile:

  • Adhesive capsulitis (frozen shoulder) presents with shoulder pain and stiffness with intact rotator cuff strength.
  • Inflammatory arthritis presents with pain and stiffness with multiple joint involvement, erythema, warmth, swelling, tenderness, and decreased passive and active range of motion, (ROM) in the affected joint.
  • Rotator cuff tear is, generally, a condition of the elderly. Rotator cuff injury could also be suspected in the younger patient with repetitive overhead movements. It manifests as a progressive anterolateral shoulder pain; often associated with night pain, weakness and decreased ROM.
  • Synovial chondromatosis may be asymptomatic or cause pain, limited ROM, swelling, joint effusions, and mechanical symptoms.
  • Labral Tear is known as a Labral Injury. The SLAP lesion (superior labrum anterior and posterior) and some other glenoid labral tears are common in throwing athletes who present with a painful shoulder that clicks or pops with motion. Patients often have a positive “clunk” test, mainly in the overhead position. They may have tenderness to deep palpation over the anterior glenohumeral joint and signs of laxity or instability. Plain films are often normal, and MRI arthrography may be needed to view the torn labrum. For patients who do not respond to rest, NSAIDs and physical therapy, arthroscopic or open surgical repair may be the last resort.