Many American’s suffer with shoulder pain for several different reasons. Shoulder pain can be the result of rotator cuff tear, bursitis, tendonitis, labrum tear, frozen shoulder, osteoarthritis and impingement. Physical therapy is usually the first line of care and the gold standard in treating shoulder pain. Physical therapy can restore active range of motion, reduce inflammation, pain and restore stability and strength.
Rotator cuff tear is either incomplete (partial) or complete tears (full thickness) (McKinnis, 2014). The cause of rotator cuff tear could be from traumatic injury or from progressive tendon tearing during overhead repetitive activities (McKinnis, 2014). The rotator cuff is made up of 4 muscles, subscapularis, supraspinatus, infraspinatus and teres minor. The most common tendon tear is the supraspinatus muscle. Imaging to diagnose a rotator cuff tear is MRI or US.
Shoulder bursitis is usually a gradual onset of pain caused by repetitive activities resulting in inflamed bursa. Shoulder pain is usually worse lying on affected side. The most cost effective and useful imaging modality to diagnose shoulder bursitis is US (McKinnis, 2014). Shoulder tendonitis also known as shoulder impingement is caused by repetitive overhead activities or trauma. Pain is usually gradual and worse with resistance. At initial injury (RICE) rest, ice, compression and elevation is useful in pain relief. Again US is the least expensive imaging modality to use to diagnosis shoulder tendonitis and / or impingement (McKinnis, 2014).
Labrum tear is usually from shoulder trauma injury causing pain with overhead activities, and instability. There are two types of labrum tears SLAP involving the superior labrum and Bankart involving the inferior labrum. Treatment is usually NSAID’s and RICE rest, ice, compression and elevation. If pain persist and shoulder is increasingly unstable surgery may be needed to restore stability. Imaging to diagnosis shoulder labrum tear is MRI (McKinnis, 2014). Frozen shoulder is a gradual increase in pain that cause loss of joint movement and can occur after shoulder injury or lifting something heavy. Physical therapy is the first and best treatment for pain and restoring joint mobility. Imaging for diagnosis is usually plain radiography and MRI (McKinnis,2014).
Osteoarthritis is the most common reason for shoulder pain in glenohumeral joint and acromioclavicular joint. Osteoarthritis of shoulder generally is gradual onset of pain and loss of mobility and responds to NSAID’s and physical therapy to resolve pain and immobility. Imaging to diagnosis shoulder OA is plain radiography which is the least expensive, then MRI followed by CT (McKinnis, 2014). Shoulder pain is extremely common in both men and women of all ages. Surgery is usually the last resort and should be avoided if possible. Physical therapy is the gold standard of care and most effective treatment to restore range of motion, strength, function and resolve pain.
References
McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging.