Some common diagnoses that result in shoulder pain are impingement syndrome, rotator cuff tear, biceps tendonitis, labral tear and frozen shoulder/adhesive capsulitis. Overuse through performing activities that strain the shoulder may contribute to all of these diagnoses. Poor posture, shoulder instability, muscle imbalances and activities such as throwing, swimming and overhead lifting all put increased demands on the shoulder. Adhesive capsulitis (AC) may result from shoulder inactivity due to pain or be idiopathic in nature. 

 

Anyone can be at risk for developing shoulder pain. Those who are at higher risk tend to be workers who repeatedly lift or reach above shoulder height, individuals whose work station design requires prolonged or repeated reaching or pushing on a factory line or at a computer. Athletes performing high velocity, dynamic activities such as pitching and swimming are at risk.

 

People who have autoimmune disorders, such as diabetes and sarcoidosis, appear to be at a higher risk for developing AC. Approximately 70% of those diagnosed with AC are women.

 

Most orthopedic injuries respond well to rest and ice. Avoid activities that aggravate the pain and ice for about 15 minutes a few times a day. A bag of frozen peas works well. Once the pain has begun to dissipate, you may attempt to slowly return to your previous activities. Take the time to analyze how you are completing the tasks that seem to aggravate your shoulder. Athletes should consult with their coaches and trainers about their form and mechanics to prevent any re-injuries. Workers should do what they can to adapt their space and equipment in order to put less strain on their shoulders. Physical therapists are a good resource to use should you need ideas on how to correct your mechanics and your environment.

 

Any time that a patient has a health concern it is a good idea for them to contact their physician. If there is severe pain or loss of function that limits normal activities, a doctor should be consulted immediately. Should the pain and loss of function be at a low level but persist for more than 1-2 weeks, a doctor or therapist should be consulted. Autoimmune patients that notice stiffness or pain in their shoulders should never assume that it is just a "normal ache" and will go away on its own. The severity and the time of impairment from adhesive capsulitis may be decreased if medical attention is sought promptly.

 

Most shoulder pain is treated conservatively. NSAIDS and steroid injections may be used to decrease inflammation and pain. X-rays and MRIs are used to identify the source of the pain or to rule out causes such as the neck which may refer pain to the shoulder. Physical therapy is commonly ordered to decrease pain and to increase strength. The physical therapist will perform several tests to identify specific muscle weaknesses and imbalances. The glenohumeral joint will be assessed for hyper- or hypo-mobility. He or she will then design a plan of care tailored to the patient's specific issues. This may include rotator cuff and scapular muscle strengthening. Manual treatments may be used to decrease spasm, to stretch the muscles or to loosen the joint capsule. Modalities, such as ice and electrical stimulation, are often used to decrease pain and inflammation. As treatment progresses, the therapist will add functional tasks that will prepare patients for their return to work and recreational activities.

 

Surgery is usually not necessary. Large rotator cuff tears and labral tears are at the highest risk of failing conservative management and may require surgery for the best functional outcome for the patient.

 

You should look for a clinic that has an experienced, licensed physical therapist. Patients may wish to visit the clinic to ask the therapist questions. Questions to ask include: How may patients are scheduled at the same time for one therapist? (For the evaluation it should be just one and 1-2 patients per clinician for follow-up visits.); Will I see the same therapist every visit? (Patients should usually be seen by the same therapist or in some, larger clinics they may be seen by a team of 2-3 clinicians that work together on each case.) All of the Brooks Rehabilitation Centers meet these guidelines. Brooks also has a scholarship program for individuals who have no insurance or have difficulty making their copayments.