Shoulder problems and pain. Mr Richard Bryant answers your FAQs...
Why do I get shoulder problems?
The shoulder is a very complex arrangement of bones, joints and muscles that allow a huge amount of movement of your arm. As a result, the balance of how the shoulder works can be easily upset, with shoulder pain being quite common. There is often confusion about where pain in the upper arm comes from, with many people experiencing discomfort down the arm rather than over the shoulder itself. The location of the pain varies greatly from person to person (sometimes going as far as the hand) but the majority of shoulder problems actually cause pain down the side of the arm, especially on movement. Other conditions can cause pain over the back of the shoulder and neck/back conditions often cause pain that spreads from the spine down over the top of the shoulder and to the shoulder blade. This overlap in pain distribution from different conditions explains why diagnosing specific problems can be difficult in the shoulder region.
What is causing my shoulder pain?
There are many conditions that can affect the shoulder causing a combination of pain, weakness and stiffness. However, certain shoulder problems occur more frequently at a particular age.
In the under 40s instability
of the shoulder (joint dislocation or feeling like it is popping out of joint) is a common problem. This usually happens after an injury but can start happening without any obvious trigger.
For 40-60 year olds frozen shoulders
and subacromial impingement
are the most common causes of pain. A frozen shoulder is a painful, stiff shoulder usually starting without injury. Subacromial impingement causes pain down the side of the arm, usually worse with lifting the arm up or twisting.
In the over 60s damage to the rotator cuff muscles (deep shoulder muscles that help move and stabilise your shoulder) is very common. This can either be wear and tear of the muscle or the detachment of the muscle to the bone (rotator cuff tear).
Although we do see arthritis of the shoulder at this age, it is less common than muscle problems or arthritis
of the hip/knee.
What can be done?
As treatment is dependent on an accurate diagnosis, referral to physiotherapy for assessment and investigation is often done early on. Standard x-rays in combination with an ultrasound (if needed) will help find a diagnosis in the majority of cases, at which point the decision may be to treat in primary care with an exercise programme/ injections or to refer to an orthopaedic surgeon for further review. Injections of steroid (Cortisone) into the shoulder are performed for both diagnosis and treatment.
Although the majority of people will settle with basic measures, it takes quite a long time to improve. Changes may take weeks with home exercises and full potential from physiotherapy/injections may take up to 3 months. It is therefore important to be patient and compliant with advice given. There are some conditions that require prompt surgical intervention and treatment guidelines used by the GPs and physiotherapists recommend early referral to a surgeon if indicated. These include:
Acute rotator cuff tear in <60s with marked weakness
Severe arthritis not settling with pain killers
Severe shoulder stiffness with marked loss of function
An unstable shoulder that keeps dislocating
Severe intractable pain that can’t be controlled with pain killers, especially with a history of weight loss, night sweats or cancer.
What if it doesn’t settle?
Some people do require surgery to improve their symptoms and the majority of operations are performed with keyhole surgery. Whilst surgery for dislocations, impingement, frozen shoulders and rotator cuff tears is usually done as a day case with the aim to begin moving the arm quickly, it still takes quite a long time to recover from surgery. Whilst most of the discomfort may have settled in the first 6 weeks, it can often take 3 months to get back to normal day-to-day function and up to a year until final recovery. The exact rehabilitation programme and time depends on the surgery performed. Shoulder replacements for arthritis may not be as commonly done as in hips or knees, but provide good pain relief and restoration of function.
If I want to know more?
There are often written guides for shoulder problems that you may be given by your GP/physiotherapist and there is plenty of reading on the internet. I would recommend visiting the Shoulderdoc website
as this has a wide range of reading material, illustrations and video clips for all the common shoulder problems.
For more information or to book an appointment with Mr Bryant, just call our Private Patient Team on 0114 263 2114. An initial consultation is £200 if you don't have health insurance. You will need a referral letter from your GP or you can see one of our Private GPs quickly for this if you prefer.
Copyright Richard Bryant, 2017.