Spontaneous Shoulder Pain

As an Orthopedic Surgeon, the most common history my patients give me as to the cause of their shoulder pain is that “it just started one day”…”I woke up with it”…or I must have slept on it wrong”. Most shoulder pain or complaints do not start with a traumatic event or mishap. There is a tendency for shoulder pain to arise from unusual activities such as “spring cleaning” or “raking & bagging leafs in the fall”. The patient may notice that once the pain starts, certain activities aggravate the pain more than others. For example, women often complain that an overhead activity such as doing their hair or hooking their bra behind their back aggravates their pain. Men complain of pain when lifting weights such as military presses or incline bench presses. Jobs around the house that require overhead positioning of the arms, such as cleaning the gutters, painting the ceiling, putting up wall board, or washing windows can often aggravate. Once the pain starts, it tends to persist although it can wax & wane in severity. Almost every patient with shoulder pain will complain of pain at night or trouble sleeping. More times than not, the affected shoulder are their favorite side to sleep on. The patient noticing the pain more at night may be nothing more than the lack of other stimuli such as sound & light that would distract the patient’s attention during waking hours.

The above description and presentation is prototypical for the most common shoulder problem seen in an orthopedist’s office, called “Impingement Syndrome”. In years gone by, patients with shoulder pain were often told that they were suffering from bursitis or tendinitis. Bursitis means swelling of the subacromial bursa above the shoulder joint. Tendinitis means swelling of the muscle-tendon unit known as the rotator cuff, which is located just underneath the bursa. Impingement Syndrome encompasses both structure’s involvement i.e., bursitis plus tendinitis. Impingement Syndrome also suggests the notion of crowding or pinching of these structures when the arm is brought up into an elevated position. As these structures are pinched, they are irritated causing them to swell and take up more space. As they take up more space, they are more easily pinched with overhead activities, therefore in a sense, the problem becomes self-perpetuating. That is why I have interviewed patients that have had Impingement Syndrome for 18 months to 2 years. Repetitive pinching and irritation of the rotator cuff can lead to partial and full thickness rotator cuff tears. This is especially true with middle-age, as the blood supply to tissues becomes diminished the older one becomes. Rotator cuff tears are most often treated with surgical repair.

Treatment of Impingement Syndrome is usually effective when treated in its initial stages. Not allowing the shoulder to become stiff (Adhesive Capsulitis) is an important aspect of treatment. AntiInflammatory medications, physical therapy, and cortisone injections will eliminate the pain in the majority of cases. Impingement Syndrome does have the ability to recur or come back after successful treatment. If the pain returns quickly after, successful treatment of the pain proves resistant to non-operative treatment, there is an operation designed to help. The operation is called a Subacromial Decompression and can be done effectively with an arthroscope. The operation entails removing the offending bursa and resecting a portion of a bone called the acromion. The bursa will actually regenerate with time. The new bursa will have a bigger space to live in and is therefore less likely to get pinched. Recovery from such surgery is often in the 3-6 week range.