The Painful Shoulder
The painful shoulder is a common presentation. It is the 3rd commonest musculoskeletal cause for GP consultation and affects 1.2% of the overall population.
This can be related to injury but may also occur spontaneously. The diagnosis is still predominantly dependant on a good history. Shoulder examination helps to confirm or further narrow the potential conditions. However, examination can be confusing for those who do not commonly deal with the shoulder. There are several described tests but in the majority, these are not specific and/or sensitive. Investigations, such as Xrays, ultrasound scans and now MRIs, have given us the opportunity to confirm the diagnosis and be in a position to advise the patient as to the best possible treatment option.
Shoulder arthroscopy (key-hole surgery) was popularised in the 1980s. This was initially used predominantly as a diagnostic procedure. Shoulder arthroscopy has provided us with the opportunity to investigate the shoulder in a dynamic way and has identified diagnoses that were not previously known or understood, such as SLAP lesions and posterior impingement.
Today, although its use for diagnosis has diminished (due to the development of non-invasive methods), it remains a vital tool in our armoury. At the same time, most therapeutic shoulder operations can now be performed arthroscopically. This has become possible thanks to the pioneering work performed by our predecessors and due to advances in technology and equipment.
It is not uncommon to have shoulder pain labelled as ‘Frozen Shoulder’ by many. However, this term is usually reserved to a particular condition also known as ‘Adhesive Capsulitis’. This is but one of many conditions that can cause pain in the shoulder. Other conditions you may hear of include: shoulder impingement, bursitis, tendonitis, instability or dislocations, rotator cuff disease or tendon tear, arthritis, etc.
It is important to take a detailed history. Several factors such as the patient’s age, the onset and timing of pain, associated stiffness and a history of injury all help to provide a diagnosis but can also determine the course of treatment. It is important to remember that an injury to the shoulder may lead to fracture, tendon tear or dislocation. If a shoulder remains very painful or lacks movement after an injury, despite adequate rest and a normal Xray, then tendon or ligament injury is suspected. In these situations, it is important to seek expert advice.
In the majority of cases, non-surgical treatment should be considered first. This may include rest and pain killers, activity modification and physiotherapy. For certain specific conditions, shoulder injection can be considered. In the situation where these treatments fail to improve the symptoms or may not be appropriate, then surgery should be considered.
This term refers to key-hole surgery of the shoulder. This type of surgery not only offers the patient very small scars, it also improves the pain after surgery. This leads to faster recovery and earlier discharge, allowing the patient to recuperate in the comfort of their own home. With the exception of shoulder replacement for arthritis and fracture fixation, most shoulder conditions can now be treated arthroscopically.
Whilst I practice a wide range of surgical techniques on the shoulder, elbow, hand and wrist, I would always tailor my treatment to the individual needs.