When You Can’t Shrug Off the Pain

Dr. George Trappey IV, Orthopaedic Surgeon and Shoulder Specialist

Your shoulders carry the weight of the world – both literally and figuratively – so it's not surprising that shoulder pain is a very common problem. Shoulder injuries can be caused by sports activities that involve excessive overhead motion like swimming, tennis, pitching and weightlifting, and by everyday activities like washing walls, hanging curtains, and gardening.

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion to the arm – from scratching your back to throwing the perfect pitch. Mobility has its price, however. It may lead to increasing problems with instability or impingement of soft tissue resulting in pain. You may feel pain only when the shoulder is moved, or all of the time. The pain may be temporary and disappear in a short time, or it may continue and require medical diagnosis and treatment.

Many people choose to suffer rather than seeking medical help for shoulder pain because they fear surgical treatment may be needed. But there's no need to just accept the pain, and surgery is not the only option.

Many people know very little about joint pain and assume it is a natural part of aging, but that joint pain can occur at any age result from many different causes. Sports injuries, accidents and arthritis are all common causes of joint pain, but it's a mistake to diagnose yourself. You can't always tell if the pain is actually in the joint or in the tendon or other tissue surrounding the joint. The best advice is to see a physician to determine the cause and treatment recommendations. Seeking treatment early can actually reduce the risk of permanent joint damage and the potential need for surgery.

Most shoulder problems involve the soft tissues – muscles, ligaments and tendons – rather than bones. The most common causes of shoulder pain are tendinitis, bursitis, injury or arthritis. Other much more rare causes are tumors, infection and nerve-related problems.

Non-surgical treatment options for shoulder pain range from lifestyle changes to therapy and medications. Ninety percent of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise and medication.

Lifestyle changes can include losing weight and exercising. Exercise can help with joint pain. All too often, people with joint pain don't exercise, which actually causes the joint to weaken further and their condition to deteriorate. Working with your physician and a physical therapist to determine what exercises are best for you is key to decreasing pain and increasing flexibility.

Other lifestyle modifications that can help shoulder pain include avoiding overexertion, altering activities and not smoking. Smoking has an effect on bone health and response to treatment.

If lifestyle changes don't ease your pain, medication for pain and inflammation may be needed. These include over-the-counter medications such as aspirin, acetaminophen or non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen. There are also new options in prescription medications for joint pain if over-the-counter medications do not provide relief.

Injections are another treatment option. Corticosteroids can be injected into the joint to reduce inflammation, thereby reducing pain, but these are only a short-term solution. Long-term use of steroid injections can be dangerous, masking discomfort and causing bone loss.

There is also research that alternative remedies such as glucosamine and chondroitin sulfate may help relieve joint pain. Derived from crustacean shells, glucosamine supplements are thought to replace missing fluid and promote the growth of cartilage, thereby helping to repair joints. Chondroitin sulfate, often taken in conjunction with glucosamine, may help cartilage from breaking down to begin with. While the scientific jury is still out on these supplements, there is enough anecdotal evidence to suggest that they help some people enough to make them worth the investment.

If shoulder pain continues or becomes worse after non-surgical treatment, then surgery may be recommended. There are many new surgical options that are less invasive and provide quicker recovery than shoulder surgery in the past. Our first goal is to treat the problem without surgery, but there are times when surgery is the most effective way to relieve pain and restore more normal function. But the patient is the boss when it comes to making this decision. They know when their pain and limited activity have reached the point where they are ready to have surgery.