By Andy Parsons, PT, DPT - Board-Certified Orthopedic Specialist
Shoulder pain is a common problem affecting many people across the lifespan. Lifetime prevalence of shoulder pain is as high as 66% in the general population. Pain in the shoulder can come from many different sources including arthritis, rotator cuff problems like tears and strains, or issues deep in the joint with the labrum. These are just a few of the potential sources of pain at the shoulder.
When managing shoulder pain, you have many choices including the wait and see approach, anti-inflammatory medications, steroids, injections, physical therapy, and even surgery. You can initiate care through your primary care physician, your physical therapist, or your orthopedic surgeon in most cases. Some avenues will require prescriptions and some specialists may require referral. Treatment should ultimately be chosen based on the diagnosis. Rotator cuff tendinopathy and tears are among the most common problems at the shoulder. In many cases, it makes sense to manage shoulder pain conservatively with a physical therapist prescribing stretching and progressive strengthening/loading strategies. X-rays and MRI tests are generally not indicated as a first line of assessment unless there was a specific traumatic injury. These tests can lead to false positive results if performed too frequently or too early in care. A good orthopedic exam from your physical therapist or orthopedic surgeon can give you much information and options for management. Working your way from most conservative treatment up to the most invasive is appropriate with most musculoskeletal problems.
In people aged 60-80 years old, 20-30% have rotator cuff tears at any given time. Typically, one third of the tears are symptomatic and two thirds are asymptomatic. About half of the asymptomatic tears may become painful over time. Recent quality studies show that people with rotator cuff tears that do not undergo surgery get similar results to those that opt for surgery. This outcome may depend if the tear was traumatic or more chronic in nature. Arthritis in the shoulder generally responds to stretching, hands on manual therapy, and NSAID drugs. Total shoulder replacements are a more invasive option if more conservative measures have failed. Multiple factors determine what care path you choose including your preferences, diagnosis, and what treatment you have tried in the past. Either way, you have options to improve your condition.
Andy Parsons is a physical therapist at ProMedica Defiance Total Rehab at ProMedica Defiance Regional Hospital. You can call 419-783-6943 for more information.
Images source: CDC [Public domain], via Wikimedia Commons
** This information is not intended to replace the advice of a physician/ physical therapist.