Painful Shoulder Syndrome
William Brainard, MD, is orthopedic surgeon on staff at Banner Estrella Medical Center. His office can be reached by calling 623-327-4144.
Question: I have shoulder pain that has been diagnosed as Painful Shoulder Syndrome. I’m in good physical shape, so how did I get this?
Answer: “Painful Shoulder Syndrome,” medically known as subdeltoid bursitis, is one of the most common problems seen by primary care, physicians and orthopedic surgeons. It rivals low back pain in its frequency.
Marked by severe pain, it often prevents restful sleep and interferes with activities of daily living. Doing one’s hair, slipping into a T-shirt, working at a computer terminal or reaching up to an upper cupboard may become virtually impossible.
As the pain persists, use of the shoulder decreases and lack of mobility may lead to a condition called adhesive capsulitis, or “frozen should syndrome.” Though usually self limiting, this severely restricted or blocked movement may last for months and require manipulation of the shoulder under anesthesia to help restore function.
An inflammatory process similar to arthritis, Painful Shoulder Syndrome involves the soft tissues interposed between muscle and bony prominences. This bursal tissue, which is normally thin and filmy, becomes swollen and sensitive to pressure from the overlying muscle’s activities. Instead of lubricating and facilitating muscular activity, it becomes a painful impediment to muscle function, sometimes leading to disuse atrophy of the muscle, and “frozen shoulder syndrome.”
The ultimate cause is unknown but it is frequently associated with rotator cuff tears, arthritis of the acromioclavicular joint and overuse activities of the shoulder. There are also anatomic variations of the bony elements of the shoulder, predisposing one to subdeltoid bursitis.
When bursitis persists or recurs, X-rays or an MRI (magnetic resonance imaging) of the shoulder may be necessary to determine the underlying cause. These findings may dictate surgical treatment of an underlying problem before the bursitis subsides. Fortunately, this represents a small percentage of the total number of subdeltoid bursitis cases.
Most bursitis of the shoulder can be diagnosed clinically without X-ray or MRI and treated conservatively, non-operatively. If you have pain in the front or outer side of the shoulder which increases when lifting your arm away from your body, reaching across your body or behind your back, you may have subdeltoid bursitis.
When a burning sensation exists, examination of the neck should be carried out to rule out nerve root irritation in the cervical spine.
Initial treatment of Painful Shoulder Syndrome consists of warm showers to the shoulder, massage and anti-inflammatory medications such as Ibuprofen (Advil/Motrin), Aleve (naproxen), aspirin or other over-the-counter anti-inflammatories. Tylenol may relieve the pain but does not address the primary inflammation. Moist heat in any form is helpful.
These medications and mechanical treatments are best in the early course of the disease. Formal physical therapy including ultrasound, exercise and massage could provide non invasive treatment and are also particularly effective in the early stages of “frozen shoulder syndrome.”
The most effective and rapid relief can be obtained by anti-inflammatory steroid injection, coupled with a local anesthetic. Pain relief is virtually immediate due to the local anesthetic, and the corticosteroid will continue to work for 2 or 3 weeks, often clearing the inflammation completely. The injection technique is critical and should be done antiseptically by a physician familiar with the procedure. It is easily accomplished in an office setting, and when the pain is gone, you will understand the old saying, “it feels so good when it quits hurting.”