SHOULDER PAIN

In focus – individuals above 40 years of age Shoulder pain is one of the common health issues and accounts for about 20-30 % of patients seeking treatment. Though common, it is often neglected till it becomes severely disabling. Shoulder pain in individuals over the age of 40 years is often due to frozen shoulder, rotator cuff problems and degeneration or arthritis of the shoulder joint / joints around it. Often pain from the cervical spine (Cervical spondylosis) can also cause shoulder pain.

Frozen shoulder or Adhesive capsulitis refers to thickening and tightening of the capsule/ tissue covering the shoulder joint resulting in pain and restriction of movements (stiffness). Individuals affected with this condition often find it difficult to comb the hair, wash their back, wear a shirt and to reach things above head level. This condition is commonly seen in persons with diabetes, thyroid issue and high cholesterol levels. The pain and stiffness can last up to two to three years without proper treatment. Treatment involves anti-inflammatory – analgesic medications, manipulation therapy, shoulder rehabilitation physiotheraphy program, wax therapy and surgical release.

Rotator cuff impingement refers to irritation / inflammation of rotator cuff (the four muscle tendons that move the shoulder joint) due to rubbing of these tendons against the irregular / arthritic bony surfaces. Rotator cuff tears either partial or complete, leads to inability to lift the arm and pain. Rotator cuff disorders are often related to activity like lifting weights, repetitive work with arm in particular position like writing on a board, painting or use of heavy instruments. Rotator cuff issues are treated with rest, work modification, mobilisation and phased shoulder rehabilitation program, intra articular injections to reduce inflammation and in some instances arthroscopic surgery to remove the inflamed tissue, bony prominence and repair the tendon tear.

Arthritis of the shoulder joint or acromioclavicular joint refers to degeneration of the joint causing pain, swelling and restriction of activity. Acromiclavicular arthritis can lead to rotator cuff impingement and tears. Treatment includes rest, physiotheraphy, analgesics intra articular injections and if severe may require joint replacement.

Cervical Spondylosis and Cervical disc degeneration are other common causes of shoulder pain and movement restriction. Shoulder pain in these conditions is a “Referred pain” as it not arising from the shoulder and requires treatment for the underlying neck problem for relief of shoulder pain. If a correct diagnosis of cervical spine issue is not made and if the pain is being treated as a shoulder problem alone, there may not be any pain relief in spite of several weeks of medications and physiotheraphy.

Early correct diagnosis and specific treatment directed towards the cause helps to relieve the pain and restore the function of the shoulder and arm. Treatment of associated conditions like adequate sugar control in diabetics, thyroid disorders etc. are essential for better outcomes and prevention of recurrence.

Dr. Kanniraj Marimuthu, Junior Consultant – Orthopaedic