Shoulder Pain Talk

Shoulder Pain

Shoulder Therapy has been proven to be quite effective for shoulder pain. The purpose of shoulder therapy is to strengthen essentially the other muscles of the rotator cuff. Shoulder therapy does this by using numerous small muscle exercises and that is why shoulder therapy does not typically involve a lot of heavy weight.

The shoulder therapy will particularly work on the subscapularis and Infraspinatus muscles that will draw down the humeral head and allow it to sit better in its socket. By doing this, the shoulder therapy will essentially take pressure off a superspinatus allowing the superspinatus to heal and not become impinged upon. Shoulder therapy typically will last for 6, 8, 12 weeks and involves specific exercises under the guidance of a physical therapist. Doctors will typically not prescribe their own shoulder therapy to a patient and will utilize a physical therapist because of the complexities of shoulder movements.

Shoulder therapy has proven to be quite effective for shoulder pain particularly due to rotator cuff tendonitis. Shoulder therapy will frequently allow someone to avoid surgery. Like all good therapy, shoulder therapy will teach the patient to perform the exercises at home in an on-going manner.

Shoulder MRI

Frequently the doctor will get an MRI of the shoulder. MRI is different than x-ray in that it looks at the soft tissue. A great majority of shoulder pain is due to problems with the tendons and the shoulder MRI gives great definition of the tendons as they come out from the medial shoulder and attach to the bones of the upper arm.

Shoulder MRIs are essentially required prior to surgery so that the surgeon can plan the surgery and frequently utilized before physical therapy to help therapists plan an exercise regimen.

MRI of the shoulder is an exam that typically takes about 25 minutes in the scanner.

Nighttime Shoulder Pain

Nighttime shoulder pain is a frequent part of rotator cuff tendonitis. Nighttime shoulder pain occurs fairly early on in the process. The patient will frequently complain of disturbed sleep. Nighttime shoulder pain is interesting in that during the night the body typically restores itself and does its own healing; however, during the night with this rotator cuff problems, there is actually more damage being done to the superspinatus tendon.

Nighttime shoulder pain occurs because during the day the arm acts as a traction upon the shoulder that opens up space and allows blood to flow freely to the tendons. At night, the body is horizontal and so gravity is lost as a traction force. Nighttime shoulder pain is caused by the top of the arm pinching the superspinatus tendon, and therefore, impairing blood flow and healing. This relative starvation of oxygen and blood to the superspinatus causes inflammation and this results in nighttime shoulder pain.

This is a problem for many reasons, primarily it sets up a rather vicious cycle as people tend to sleep horizontally. Typically if someone sleeps with their arm away from their head, that can make matters worse as the greater tuberosity of the upper part of the humerous will further impinge the superspinatus against the coracoacromial ligament.

Again, the nighttime shoulder pain is quite common with rotator cuff tendonitis and if this symptom is present, certainly the patient needs a medical assessment of the shoulder pain.

Shoulder Pain: A problem of Epidemic Proportions

Rotator Cuff Tendonitis

Rotator cuff tears and rotator cuff inflammation in the shoulder both fall under the umbrella term of rotator cuff tendonitis. The scope of rotator cuff problems is staggering. MRI studies, as well as cadaver studies, have confirmed that 60% of people over the age of 60 have tears in their supraspinatus (rotator cuff) tendon.

A recent Scandinavian study showed that over the course of a year, over 30% of adults will experience significant shoulder pain. In another recent Scandinavian study, a general practitioner physician will see on average 3-4 shoulder pain visits per week.

It is generally thought that 85% to 90% of shoulder pain is directly a result of rotator cuff problems. This problem is resulting in millions of doctor visits a year and more importantly significant pain and suffering from millions of people per year. The research also suggests that millions of people are not being seen by the doctor and simply suffering with shoulder pain.

This problem is unique in that it is present in essentially all age groups over the age of 18, although someone more so with increasing age.

Rotator Cuff Anatomy

The rotator cuff is comprised of four muscles and their tendons which insert at the top of the humerus or arm bone. The rotator cuff function along with the deltoid to elevate and rotate the arm. The four muscles of the rotator cuff are complex and are critical in allowing for the shoulder’s incredible range of motion; more than any other joint in the body.

The most frequently injured of the rotator cuff tendons is the supraspinatus. The supraspinatus tendon sits on the top of the shoulder and exits the supraspinatus fossa as it turns into tendon going underneath the coracoacromial arch.

This tendon is subject to significant forces of compression as the shoulder does pass under the coracoacromial ligament and that compression can lead to inflammation. Inflammation can lead to weakness, weakness can lead to rotator cuff tears, and all of these can cause significant shoulder pain.