Who To See For Shoulder Pain
Shoulder pain is a common problem that affects millions of people every year. The shoulders are important joints because they allow the upper arm to move in various directions and provide stability for other parts of the body. There are many different types of shoulder problems, including rotator cuff injuries, dislocation, fracture, infection, arthritis, bursitis, tendonitis, impingement syndrome, osteoarthritis, among others.
The shoulder is made up of several bones. The clavicle (collarbone) connects the shoulder blade with the breast bone. In turn, the shoulder blade attaches to the spine at the hip joint. Below the shoulder blade is an interclavicular membrane called the subacromial space. This area contains fluid that lubricates the shoulder during movement. The supraspinatus muscle starts behind this space and inserts into the greater tubercle on the acromion, which protrudes from the scapula (shoulder blade). Together these structures form the glenohumeral joint, where the humerus (upper arm bone), head of the humerus, and the coracoacromial ligament connect the shoulder girdle to the rest of the body [sources: Mayo Clinic; WebMD].
When the joint between the shoulder blade and the neck becomes injured, it’s known as a cervical strain. When the joint between the shoulder blade and the chest wall is affected, it’s referred to as a thoracic strain. And when the joint connecting the shoulder blade to the pelvis is hurt, it’s called a lumbar strain. Each of these strains has its own treatment method.
If you have experienced shoulder pain, make sure you consult your doctor before beginning any physical therapy regimen or exercise routine. Your physician may refer you to an orthopaedic specialist — someone trained in treating musculoskeletal disorders such as those affecting the shoulders and elbows. Orthopedic doctors are also known as physicians, surgeons, sports medicine experts, physical therapists, physiatrists, and so on. They often work in hospitals, but some choose to practice their profession out of hospital settings. Many are available through referrals by family practitioners, chiropractors, physiotherapists, athletic trainers, physical educators, massage therapists, yoga instructors, psychologists, personal trainers, nurses, and occupational health professionals. If necessary, they might even be found in specialty clinics or offices dedicated to rehabilitation.
But if you’re suffering severe trauma, an accident victim, or someone whose injury doesn’t respond to conservative measures, don’t despair. You still have options. Read on to find out how to get a second opinion.
Types of Shoulder Problems
Treatment for Shoulder Pain
Complications From Surgery
Types of Shoulder Problems
There are dozens of conditions that affect the shoulder, ranging from minor sprains and bruises to serious structural ruptures and fractures. Some of the more common ones include:
Rotator cuff tear – A full thickness tear of the supraspinatus muscle, one of four muscles in the rotator cuff. It occurs most commonly in patients over 40 years old and can cause significant disability, particularly when it involves the infraspinatus and teres minor muscles, rather than just the supraspinatus muscle.
Impaction syndrome – Occurs when the undersurface of the humerus impacts against the underside of the acromion. Symptoms include sharp pain with direct pressure applied to the lateral side of the shoulder and stiffness after moving the arm.
Subluxation/dislocation – Also known as superior labrum anterior posterior (SLAP) lesion. It refers to a partial or total separation of the cartilage that covers the top part of the ball-and-socket type joint at the base of the upper arm bone. SLAP lesions can occur in isolation or as part of a larger condition.
Bursitis – Swelling around the bursa sac surrounding the long bone of the forearm. Bursitis is typically caused by repetitive movements and poor posture.
Osteoarthritis – Degenerative disease of the synovium that results in breakdown of cartilage and formation of calcium deposits within the joint capsule. Osteoarthritis usually develops slowly over time, although sudden onset is possible following trauma, infection, or inflammation.
Frozen shoulder – Causes stiffness and loss of range of motion due to fibrosis of the underlying tendons. Typically begins about six weeks after surgery.
Arthritis – Includes osteoarthritis, rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and gout. Arthritis causes swelling, tenderness, redness, and warmth in the affected areas.
Ganglion cyst – A collection of fluids under the skin that forms around a hard mass. These fluid collections can become infected and inflamed, causing pain and discomfort.
Rupture of the subscapularis tendon – Rupture of the tendon that connects the lesser tuberosity of the upper arm bone (humerus) to the scapula (shoulder blade) can lead to chronic pain and limitation of motion.
Sprain – Muscle spasm resulting from damage to the supporting tissue, either directly or indirectly, such as a torn ligament or fracture.
Stretch injury – Most often seen in athletes, especially runners, who overextend themselves suddenly and lose balance.
Injury to the deltoid muscle – Injury to the muscle that extends across the front of the shoulder, forming the ‘jaw’ shape. The primary function of the deltoid muscle is to extend the arm downward toward the floor.
Neuropathy – Damage to peripheral nerves that transmit signals from brain to muscle and organ systems. Neuropathies are divided into acute, progressive, and demyelinating neuropathies.
Joint hypermobility – Hypermobile joints are joints that easily bend, allowing increased movement. Joint hypermobility can result in repeated microtrauma, leading to degenerative diseases later in life.
Severe bruising and bleeding – Bruises vary greatly in size and color. Bleeding can occur when there is a breakage of blood vessels underneath the skin.
What Happens During an Exam?
Your initial visit to see your doctor should consist of a thorough history and physical exam. Here are some key questions he or she will want answered:
How did the pain develop?
Have you had similar symptoms in the past?
Does anything limit your ability to move your arm normally?
Do you have fever or chills?
Are you pregnant?
Has anyone been sick recently?
Did an injection, medication, or x-ray produce this symptom?
Have you ever had cancer or diabetes?
Have you used alcohol, tobacco, or illicit drugs?
When was the last menstrual period?
During the course of your examination, the doctor will check your reflexes, heart rate, temperature, and blood pressure. She’ll listen to your chest, lungs, abdomen, and hear your heart using a stethoscope. Next, she’ll examine your eyes, ears, nose, throat, teeth, mouth, tongue, and neck. She’ll inspect your back, buttocks, lower limbs, hips, and feet. Finally, she’ll take a detailed medical history and perform a neurological assessment.
She may also ask whether you’ve tried to self-treat the pain or seek care elsewhere. If not, she may recommend getting a referral to another professional specializing in treating musculoskeletal disorders.
Some other things to keep in mind:
Don’t lie down until told to do so. Lying flat restricts circulation and makes breathing difficult.
Take all medications prescribed to you, even over-the-counter medicines. Don’t stop taking them without consulting your physician.
Avoid smoking; it hinders healing and weakens lung function.
Keep appointments for follow-up visits.
Be honest about your lifestyle habits and previous injuries.
After your appointment, you should receive a written diagnosis along with information regarding your specific condition. Treatment plans may involve manual manipulation, injections, diagnostic testing, physical therapy, and so on. Your doctor will give you advice on maintaining good nutrition, managing stress, and strengthening the muscles and joints. Follow his or her instructions carefully.
Complications From Surgery
Surgery is never risk-free, nor does it always yield positive outcomes. While rare, complications can arise, sometimes requiring additional operations or procedures. Patients should discuss all potential risks associated with the procedure with their surgeon beforehand.
Here are some examples of complications that could happen during or after surgery:
Delayed wound healing – Inadequate blood supply to the wound site.
Wound dehiscence – Failure of the sutured incision to remain intact.
Surgical site infection – Infections of the surgical incisions.
Blood clotting problems – Clots can form inside the veins returning oxygenated blood to the heart. This increases the likelihood of stroke, pulmonary embolism, deep vein thrombosis, and potentially death.
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