Shoulder Pain
What is it, Where is it coming from, and Why me?
W
hether you are the dad
nominated as pitcher for
the little league team, a
busy homemaker or an
individual confined to
a desk space, there are plenty of opportunities for tasks to flare up bothersome shoulder pain. It can be stressful not knowing where to start when
attacking musculoskeletal pains. Do
you use over the counter creams/rubs,
ibuprofen, Tylenol, heat, ice or what?
If your shoulder hurts, you may not understand why. Perhaps you felt a pop
and have been miserable ever since.
Did you sleep awkwardly, experience a
car accident or simply do nothing at all?
I will summarize four commonly seen
causes of shoulder pain and outline surgical and nonsurgical solutions for each.
The shoulder is a complex ball and
socket joint made up of articulations
between the humerus (ball) and the glenoid (socket) of the scapula (shoulder
blade). Other notable articulations exist between the clavicle and the acromion, commonly called the collar bone
joint, and between the shoulder blade
and the rib cage. Most causes of shoulder pain erupt from these three areas.
The rotator cuff is made of four muscles and their tendons as they form a
sling around the ball or head of the
humerus. These small muscles are responsible for the basic rotating and
lifting motions of the arm. Patients less
than 40 years of age often experience
some accident or trauma resulting
in a cuff tear, while patients greater
than 60-65 years of age rarely recall
any insult. Smaller cuff tears only pull
a portion of the fibers away from the
bone, while larger tears are full thick-
By Jeremy Urbanczyk, D.O.
ness tears. Individuals with partial
tears can sometimes function with no
symptoms, while those with full thickness tears generally have significant
pain and limitations.
Basic X-rays can display suggestive
signs of cuff trauma, however, MRI is
the gold standard for identifying tears.
A conservative approach to rehabilitate partial tears involves a steroid injection above the tendon and a short
course of physical therapy. If pain persists and your quality of life or work is
affected, surgery is typically indicated.
Dr. Urbanczyk performs rotator cuff repairs arthroscopically, which aims to
provide an easier recovery than that
experienced with more invasive open
surgical repairs. Some partial tears are
able to be trimmed or debrided, thus
relieving pain and avoiding a lengthy
post-operative course of therapy.
Impingement syndrome or bursitis is
another commonly encountered disorder. Bursae are small pads of tissue that protect vulnerable tendons or
bones in the body. The bursa above
the rotator cuff is quite susceptible to
irritation as it is “impinged” between
the underlying cuff and the roof of the
shoulder. This phenomenon creates
inflammation within the bursa, resulting in pain radiating down the side of
the arm. Conservative injections and
therapy typically provide relief when
managing this ailment.
Arthritis can exist in the ball and socket
joint and also in the collar bone joint.
Osteoarthritis, or wear and tear arthritis, is the most common, followed by
other less common forms such as rheumatoid or psoriatic arthritis. Arthritis
exists when the shiny cartilage cushion
is worn away exposing the underlying
bone, thus resulting in a cascade of inflammation within the joint. Anti-inflammatories and steroid injections aim to
decrease this inflammatory process. Patients who are not responsive to these
measures are possible candidates for
shoulder replacement. A metal ball replaces the head of the humerus, while
a plastic cup replaces the worn glenoid. Dr. Urbanczyk performs both the
standard replacement and the more recently introduced reverse total shoulder
replacement. Individuals with standard
replacements are capable of enjoying
most moderate recreational activities
with few limitations.
Adhesive capsulitis, also known as frozen shoulder, most commonly affects
females between 40-60 years of age,
whom also suffer from another autoimmune disease such as diabetes or thyroid disease. A fair number of males
are also affected. Autoimmune antibodies label the shoulder as foreign, and
attack the lining resulting in significant
pain and a pronounced decrease in
motion. The disease will always run its
course and eventually thaw out, however, proper treatment can help speed the
recovery. This often involves manipulating the arm under anesthesia to break
through the adhesions. The individual
then completes a two week course of
therapy and is generally pain free with
normal return of motion.
Dr. Urbanczyk is a board certified orthopedic surgeon, practicing in Sherman, TX since 2012. You can
schedule a consultation with Dr. Urbanczyk by calling 903-957-2009.
TEXOMA AREA Living Well Magazine | FALL 2015
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