By Ivette Guttmann, MD | Health matters: What to do about nagging shoulder pain

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Shoulder pain is a common complaint among the patients I see and the causes are just as unique as the patients seeking help.

Pain can stem from any number of things, including injuries from a fall, arthritis, or even an overuse injury. In some cases, you can get what's called "referred pain," which is usually felt in the upper arm but originates from the shoulder.

How you treat the pain depends on what's causing it. Here's a look at three of the most common conditions we see at SVMC Orthopedics and some typical treatment options.

Osteoarthritis

The most common type of arthritis, osteoarthritis of the shoulder is basically wear and tear. It occurs when the cartilage that covers the top of the bone deteriorates or wears away. It usually occurs in people over age 50 but may occur in younger people as the result of an injury or trauma, such as a fracture or dislocation.

Regardless of the cause, osteoarthritis is characterized by pain while moving the shoulder or after moving the shoulder. Your range of motion may be limited due to pain, and you may also experience some clicking or creaking in the joint while moving it. Many patients also experience increased pain at night.

While there is no cure for osteoarthritis, there are a few ways to manage the pain.

Over-the-counter medication can help ease pain and make it easier to sleep soundly at night. Topical creams, ice, and heat are all adjuncts to help decrease your discomfort.

I also recommend patients begin physical therapy to strengthen the muscles around the joint and provide stability, which in turn will help decrease the pain. The stronger the muscles, the less pressure is put on the joint and the less pain you're likely to experience.

As a last course of action, intra-articular injections with cortisone or even platelet-rich plasma (PRP) may be recommended. Derived from the patient's own blood, PRP has been found to be effective at reducing pain and increasing function in joints affected by osteoarthritis. However, this is a relatively new treatment that is not currently covered by insurance plans.

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Rotator Cuff Damage

The group of muscles and tendons that connect the arm to the shoulder are referred to as the rotator cuff. In addition to holding your arm in place, the rotator cuff makes it possible to raise your arms over your head. Because space is tight in the shoulder, it's not uncommon for the tendons to rub against bone or ligaments. This friction is called impingement syndrome and causes inflammation in the rotator cuff. Activities like swinging a tennis racket or golf club, swimming, painting overhead, and other activities where there is overhead or repetitive movement can lead to pain.

Most patients describe the pain as a dull ache that gets worse at night. You may also experience some arm weakness and find it difficult to do things such as brushing your hair or even reaching behind you.

Depending upon the severity of the damage, treatment may range from a combination of rest, ice, and over-the-counter medication to physical therapy, cortisone injections, or possibly surgery.

Bursitis

Bursitis is an inflammation of the bursa—small fluid-filled sacs that surround various joints in your body, providing a sort of cushion that helps reduce friction during movement.

Bursas in the shoulders can become irritated from a range of things, including lifting a bag of groceries or a taking a fall skiing. Repeated movement and motion can further inflame the bursa and lead to bursitis.

People with bursitis often complain that it hurts to move the joint and that the affected area is tender to the touch. In cases where the inflammation is severe, a cortisone injection may be recommended as well as physical therapy.

Because there are so many moving parts in the shoulder, it's important to get an accurate diagnosis and treatment plan. If you're experiencing pain, call SVMC Orthopedics to schedule an appointment. The sooner we see you, the sooner we can look for ways to help you regain your mobility and restore your active lifestyle.

Ivette Guttmann, MD, is a sports medicine physician at SVMC Orthopedics and also sees patients at Northern Berkshire Orthopedics in Williamstown, Mass., and Twin Rivers Medical, P.C., in Hoosick Falls, N.Y.


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