Shoulder Pain: Causes and Cure

shoulder public domainIs that pain in your neck really a pain in your neck, or could it be a shoulder injury in disguise? Racquetball players are no stranger to arm and other injuries suffered by athletes, but locating the cause of shoulder pain can be difficult to identify as a number of problems can lead to the discomfort. Here avid racquetball player and physician, Dr. Richard Honaker, takes some of the mystery out of shoulder injuries, and whether they should be rested, treated, or ignored.

The rotator cuff is a group of four muscles and their tendons which surround the shoulder joint, attaching the upper arm to the shoulder and chest. They are named the Supraspinatus,  the Infraspinatus, the Teres Minor  and the Subscapularis. The motion results in rotation at the shoulder joint. Problems of the rotator cuff can become a curse to an athlete. Injuries often result from repeated overuse, especially involving use of the arm above the head. This motion results in impingement of the head of the humerus bone in the upper arm against the rotator cuff tendons. This impingement syndrome ultimately leads to inflammation and pain. The various bursa cushions, which are liquid filled sacs that cushion the muscles against the bones, can also become inflamed and result in bursitis and rotator cuff tendonitis.

With rotator cuff inflammation and tendonitis, pain will usually be noticed on the extremes of rotation as one externally rotates (demonstrated by trying to scratch high up on your back with the back of your hand). Abduction of the shoulder involved raising the arm out as if it were a wing flying. At the extremes of motion, an inflamed tendon will be stretched and cause pain. Comparing the bad side to he good side will show any limitation of motion which often occurs at approximately impingement and irritation of an inflamed rotator cuff.

Tears of the rotator cuff often occur over a long period of time with repeated small injuries, but may also occur with one acute injury. To diagnose this significantly debilitating injury often requires an arthrogram in which dye is injected into the shoulder joint and x-rays are taken to see if there is leakage through a torn rotator cuff. Surgical intervention is often necessary.

For the usual overuse syndrome involving rotator cuff tendonitis and impingement syndrome, rest the injured shoulder and apply ice in the acute phases and heat later on. For pain that has been present for several weeks, applying alternating half-hour periods of ice and heat. Using anti-inflammatory drugs such as Mortrin, Indocin, Naprosyn, etc can help reduce inflammation. Physical therapy is often helpful, as well as cortisone injections in resistant cases.

You should not treat your own rotator cuff injury too long by resting the shoulder, as scar tissue can form. This can result in a condition called “adhesive capsulitis” which is a reduction in the flexibility of the capsule around the shoulder. This results in a lack of range of motion called a “frozen shoulder.” This is a difficult problem to cure, often requiring prolonged physical therapy and sometime surgical manipulation to “unfreeze” the shoulder.

Shoulder pain is a difficult syndrome to pin down as it can be caused by numerous problems. Rotator cuff tendonitis is one of the most common, however tendonitis of the biceps tendon, arthritis, various bursitis syndromes, and pinched nerves in the neck (masquerading as shoulder pain) can confuse the issue. Mild injuries will usually take care of themselves. More sever injuries may require a significant curtailment of activities for healing.

By International Racquetball Tour (IRT) contributor, Richard A. Honaker, M.D., F.A.A.F.P. who is a Family Practice Physician in Carrollton, Texas, which is a Dallas suburb. He is an avid racquetball player.