| Patients with inflammatory types of arthritis such as | | | | of the shoulder blade) can reproduce the pain in some |
| rheumatoid arthritis and psoriatic arthritis often have | | | | patients. This condition is called impingement. |
| shoulder problems. However, more often than not, a | | | | Imaging procedures such as x-ray may be helpful in |
| patient presenting with shoulder pain to the | | | | some instances. For example, it can show calcium |
| rheumatologist will have another reason besides the | | | | deposits in tendons or show severe arthritis in the AC |
| arthritis for the discomfort they are feeling. | | | | joint. |
| The shoulder is a complicated and complex joint | | | | The preferred imaging procedure for suspected |
| consisting of the interaction of two major bones | | | | rotator cuff disorders is MRI; however, ultrasound is |
| forming the glenohumeral joint- the joint that joins the | | | | becoming more popular as a cost-effective alternative |
| upper arm bone to the shoulder blade. The | | | | to MRI. Some studies have indicated that diagnostic |
| acromioclavicular joint which joins the clavicle | | | | ultrasound is actually more precise than MRI for |
| (collarbone) to the shoulder blade is also part of this | | | | detecting rotator cuff tears. |
| complex. The muscles that help move the shoulder | | | | Conservative treatment is usually initiated for most |
| consist primarily of the rotator cuff muscles and their | | | | patients with chronic shoulder pain. This treatment |
| associated tendons: supraspinatus, infraspinatus, | | | | should consist of modification of daily activities such as |
| subscapularis, and teres minor. | | | | reduction of overhead activity in patients with rotator |
| The biceps muscle and tendon are also responsible for | | | | cuff disease, glenohumeral osteoarthritis, or adhesive |
| shoulder movement as is the deltoid muscle. The | | | | capsulitis. |
| shoulder complex is held together via a complicated | | | | Cross-body shoulder movements such as swinging a |
| network of ligaments and tendons that allow the | | | | baseball bat, tennis racket or golf club should be limited |
| shoulder to have the widest range of motion of any | | | | among patients with AC arthritis. |
| joint in the body. The shoulder complex is surrounded | | | | Non-steroidal anti-inflammatory drugs are frequently |
| by small fluid filled sacs, called bursae that help to | | | | used and can be effective. |
| cushion the shoulder joint and allow more purposeful | | | | Injections of glucocorticoids (“cortisone”) |
| gliding motions of the joint. | | | | into the space beneath the acromion are also useful |
| Shoulder pain is responsible for about 16% of all | | | | for reducing inflammation. Injections of glucocorticoids |
| complaints having to do with muscles or joints. | | | | directly into the glenohumeral joint are effective in |
| Shoulder pain becomes defined as being chronic if it | | | | reducing pain and increasing function among patients |
| lasts 6 months or longer. Age is a general predictor of | | | | with adhesive capsulitis. These injections need to be |
| cause. In patients younger than 40 years, shoulder | | | | guided using either ultrasound or fluoroscopy to be |
| instability and mild rotator cuff disease are more | | | | effective. |
| common. Older patients usually have conditions such | | | | Adhesive capsulitis should be treated with a |
| as adhesive capsulitis (frozen shoulder), osteoarthritis, | | | | combination of steroid injections as well as physical |
| and more advanced rotator cuff problems. | | | | therapy. Referral to an orthopedist for either |
| Pain located at the top and front of the shoulder is | | | | manipulation of the shoulder under general anesthesia |
| usually due to problems related to the AC | | | | or arthroscopy is recommended for patients with |
| (acromioclavicular) joint - that is, the joint that joins the | | | | adhesive capsulitis who do not respond to 2-3 months |
| collarbone to the shoulder blade. | | | | of therapy. |
| By contrast, pain involving the outside of the upper arm | | | | Osteoarthritis of the glenohumeral joint may respond to |
| near the shoulder joint is often due to bursitis involving | | | | NSAIDS and injections into the glenohumeral joint. |
| the bursa located beneath the deltoid muscle or to | | | | Physical therapy may also be useful but it should be |
| tendonitis affecting the rotator cuff. | | | | done gently since too vigorous therapy can aggravate |
| A diagnosis starts with the history. During the history, | | | | this condition. |
| the physician will inquire as to the location and duration | | | | Patients with acute massive rotator cuff tears are |
| of pain, whether the pain is present at night, and what | | | | fairly easy to diagnose and should be referred to an |
| types of body positions and movements aggravate | | | | orthopedist as quickly as possible to ensure a good |
| the pain. | | | | surgical outcome. Massive tears that have been |
| In addition the range of motion of the shoulder will be | | | | present for 6 weeks or longer are often difficult to |
| assessed. There are two methods for measuring | | | | repair. |
| range of motion. Active range of motion is the range | | | | Patients with small tears of the rotator cuff often |
| of motion a patient can perform on their own. Passive | | | | respond to conservative treatment. |
| range of motion is what the patient can do with the | | | | Newer techniques involving the use of tenodesis |
| assistance of the physician. | | | | (“irritating” the tendon to stimulate |
| Problems like tendonitis and bursitis will show that a | | | | bleeding) followed by ultrasound guided injection of |
| patient has limited active range of motion but relatively | | | | platelet rich plasma to help with the healing process |
| normal passive range of motion. | | | | may allow patients with rotator cuff tears to avoid |
| Loss of both active and passive range of motion | | | | surgery. This same procedure is being evaluated for |
| suggests adhesive capsulitis or glenohumeral arthritis | | | | arthritis processes as well. |
| (arthritis affecting the joint that joins the humerus | | | | Patients with rotator cuff tears not responding to more |
| [upper arm bone] to the scapula [shoulder blade]). | | | | conservative measures can be referred to an |
| Certain maneuvers designed to “pinch” | | | | orthopedist. |
| the rotator cuff against the acromion (the outside part | | | | |