Why does my shoulder hurt? A comprehensive explanation of shoulder pain
Shoulder pain is very common. It can be an “ acceptable” pain when you grab a book from the library or when you brush your hair and this pain can be very severe. Patients are awakening in the night and they cannot move their shoulder.
The shoulder joint works mainly in rotation. It is composed from bones, tendons and ligaments. So why does my shoulder hurts during movement?
The main reason is the subacromial impingement. What does it mean? The shoulder muscles called the rotator cuff muscles contact frequently a bone named the acromion. This frequent contact creates tendinitis and inflammation called bursitis. This pain can be moderate or severe. So when you have shoulder pain during movement it’s either a tendinitis or bursitis due to the subacromial impingement.
The classic treatment of this condition is to give patients Non-steroidal anti-inflammatory drugs (NSAID) and to start physical therapy to avoid recurrence. Sometimes the patients are cured during several days and sometimes it takes a little bit longer (few months).
We can offer a novel therapy that gives an excellent result and the patients are cured much quicker. In general I use an ultrasound machine in my daily practice in order to be more accurate. When I see a big bursitis or a severe tendinitis I propose to patients an Infiltration under ultrasound guidance. So what does it mean? I generally put a topical anesthetic agent on the skin and under ultrasound guidance I insert a needle and put a drug in the bursa (around the inflammation). This drug can be a steroid shot or a natural treatment (platelet rich plasma- PRP). It reduces the pain and inflammation and patients can continue their physical therapy. In my opinion this is the only way to reduce the pain very quickly. It resolves generally the next day. It avoids taking medication and it saves time.
Why do I do it under ultrasound? It enables me to be more accurate. Most surgeons do the infiltration blindly without guidance and in my opinion most of the drug will not reach the desired goal and the patients will continue to feel pain. So if you feel pain after a blind infiltration, it means that the drug didn’t go where the inflammation is. It is not because we use “cortisone shots”!
After this quick efficient treatment patients are relieved quickly.
Is Arthroscopic surgery indicated in this case?
Like all diseases if we have pain recurrence it’s because the inflammation is very severe and we have a very important contact between the shoulder tendons and the acromion. In these rare cases we do subacromial decompression. We remove a part from the acromion (bone spurs) to decompress the space and remove this abnormal contact by arthroscopic surgery.
In the next blogs we will discuss other reasons for shoulder pain! Stay tuned !