Philosophy on Shoulder Pain
Shoulder pain can occur from either overt injury – fracture, tendon rupture, ligamentous, capsular, or cartilage injury – or from overuse. Obviously these are broad strokes, and exceptions exist, but this is a simple way to explain it. Fractures can be clavicular fractures (collarbone or clavicle), or proximal humerus fractures. A broken bone creating pain is fairly self explanatory, and many of these injuries often require shoulder surgery. Tendons around the shoulder include the rotator cuff as well as the biceps tendon. These are the usual culprits for pain around the shoulder created by tendons, and soemtimes result in rotator cuff surgery. Ligamentous rupture or ligament tears usually occur in the face of shoulder instability. Traditional orthopaedic dogma dictates that shoulder instability is painless; however, one of my mentors, Dr. Pascal Boileau, largely proved that this can be untrue in a subset of patients resulting in what he termed an “unstable painful shoulder” or UPS. What is not contested is that shoulder dislocations or partial dislocations (so called subluxations) are painful, just the resulting instability afterwards is questioned as a pain generator.
Fortunately, shoulder surgery, always in my hands arthroscopic surgery can solve this issue. AC separations or shoulder separations can be painful and are usually from ligamentous ruptures as well. These can usually be treated without the need for surgery, although depending on the severity they may require surgical management. Capsular issues usually present as a “frozen shoulder” or adhesive capsulitis, which may very well have a genetic basis and possibly lead to frozen shoulder surgery. This rarely does require a surgical intervention, but when it does, again I perform this arthroscopically. Cartilage injuries can create loose bodies which respond very favorably to shoulder surgery with arthroscopic surgery used to remove these objects that can prevent normal shoulder function. More major cartilage injuries are likely related to arthritis development, and will require a shoulder replacement.
Overuse injuries can present as a rotator cuff tendonitis, which is called impingement, and this will usually respond well with nonoperative management, but an arthroscopic surgery can treat this very readily as well.
Does your Shoulder Pain need Shoulder Surgery?
Call 206-668-6100 and ask for an appointment with Seattle’s Premier Shoulder Specialist, Dr. Daniel Grant Schwartz to find out; or contact us for more information.