Prompt treatment can overcome chronic shoulder problems

Since the first surgical procedure performed on the shoulder around 460 B.C., the problem of the painful shoulder has plagued society.

Today, over 1 million Americans visit a physician each year because of shoulder pain. According to Bureau of Labor Statistics, more than 96,000 shoulder injuries or conditions causing lost workdays in private industry were reported in 1996. Many more hours of productivity are lost due to this complaint even when the suffering employee is at work but limited in movement, and some unfortunate workers never get complete relief from the problem.

Proper diagnosis and management of the painful shoulder are vital to an individual's recovery. Often, chronic problems can be avoided with prompt, accurate treatment.

The nature of the shoulder anatomy makes it a likely candidate for a variety of problems. Injury, disease and general wear and tear can put an employee off work or impair productivity. Shoulder movement is so closely related to other parts of the body, such as the back and neck, that problems are sometimes secondary to conditions that start elsewhere.

The root cause of shoulder pain may be obvious, but often more extensive testing is required to pinpoint the problem. If a thorough examination is not made, a patient may be treated for a condition that is actually secondary to the root cause of the pain. This is especially true in younger patients, 15 to 35 years of age.

Accurate diagnosis begins with a physical examination. An initial inspection can detect swelling or prominence in the joints, muscle atrophy, misalignment or asymmetry in the shoulder area. Range of motion tests help determine the extent of the problem. Other specific tests can pinpoint problem areas.

If the problem is not readily diagnosed, other non-shoulder examinations can yield important information. Examinations of the neck, lymph nodes, nerves, thoracic outlet, carpal tunnel, as well as neurologic and vascular areas, may reveal causes or contributing factors to the painful shoulder.

While each case is different, there are certain common diagnoses relative to age:

15-35 years of age

* Instability -- This is excessive play between the uppermost portion of the arm and the socket; can be due to injury or weakness of the ligaments; generally characterized by recurrent shoulder dislocation or partial dislocation.

* Impingement syndrome (Stage I) -- Caused by a pinching of the bursa (fluid-filled sacs usually found near joints) in the rotator cuff; results in edema (swelling caused by an accumulation of fluid) and hemorrhage; may be secondary to instability.

* AC (acromioclavicular) joint trauma/separation -- Usually caused by a fall onto the top of the shoulder.

35-50

* Tendonitis/bursitis -- Inflammation of the tendons or bursa, which causes pain and swelling.

* Impingement syndrome (Stage I).

* Frozen shoulder (adhesive capsulitis) -- Usually starts as a slight injury or minor problem, which prevents use of the joint; shoulder becomes stiff and painful, making normal movement impossible; without treatment, condition will worsen.

Over 50

* Impingement syndrome (Stages II and III) -- Results in fibrosis and tendonitis (Stage II) or bone spurs and tendon rupture (Stage III).

* AC and SC (sternoclavicular) joint osteoarthritis -- Results in stiffness, pain and swelling.

* Shoulder joint osteoarthritis.

Treatment

Once the cause of the problem is properly diagnosed, treatment may include physical therapy, a shoulder strengthening program, medication and/or surgery.

A person's work or leisure activities may require adjustment to allow healing and to prevent recurrence of injury. The incidence of successful treatment will depend on the specific cause and the patient's willingness or ability to control environmental factors that may be contributing to the problem.

Strengthening shoulder, back and upper arm muscles is an excellent way to prevent shoulder injuries or reoccurrence of an injury. A physical therapist or occupational therapist can teach specific strengthening and stretching exercises for the shoulders.

Cooperation by employers, especially if the root cause is movement performed regularly on the job, can be a strong factor in eliminating the problem. Adjustments in workstations or duties performed can often mean the difference in prompt and full recovery. An ergonomic job-site evaluation can determine what modifications need to be made to reduce the risk of injury. Instruction in body mechanics, energy conservation techniques and work conditioning can also be beneficial.

Shoulder pain does not have to be chronic. Prompt examination and treatment can result in full recovery in many cases and noticeable improvement almost always.

Dr. Jimmy H. Conway is an orthopaedic surgeon with Oklahoma Sports Science & Orthopaedics.

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