Shoulder Pain

What might be the cause of my recurring shoulder pain?

Sometimes, if I put my weight on my left hand to get up or support myself, I’ll end up getting a pain in my shoulder that lasts for a few days. It hurts to twist my arm and put on a coat, or to lift my arm with my elbow out slightly to the side. The pain seems localized in the front of my shoulder, slightly below the bone, in the muscle surrounding my humerus. It’s a real discomfort and the pain will remain even with my arm being held still. Any ideas?

The two most likely causes are tendinitis or a rotator cuff tear. Make an appointment with your primary health care provider or an orthopedist. They can have you do some maneuvers in the office to try to discern between the two problems. If there is any question to the diagnosis, an MRI will be done to make a definitive diagnosis.

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Shoulder Pain and Rotator Cuff Injuries: Getting More Info

When you go into your physician with complaints of longstanding shoulder pain, he may or may not recommend imaging of the shoulder. The fact of the matter is much of shoulder pain can be diagnosed without the use of any imaging technologies. However, if the physician is interested in finding more information, the specific technology that he uses depends upon his own diagnosis and the questions he is trying to answer.

It is because of the different results that will come from each type of imaging technology that physicians can simply go through a process to decide which tool to use – a process of elimination according to what each reveals.

Plain x-rays – the old fashioned x-rays – will give you good information about the bones. Is there any arthritis? Are there any bone fractures? In deed, in one of the fairly common problems called calcific tendonitis, one of the tendons becomes calcified and essentially starts to turn to bone – this is a phenomenon that can be picked up on x-rays. Certainly cancer, tumors, all these things, if they involve the bone, can be picked up on plain x-rays as well. However, the ability of an x-ray to reveal cancer is restricted because if it is not within the bone, than cancerous bodies escape the attention of the basic x-ray film.

Magnetic Residence Imaging, or MRI, is technology that’s been around since the early 80s and it is the best way we have to look at soft tissues. This means that the MRI will reveal tumors that are not involved in the bone, and even more information about the soft tissues in the area being surveyed. An MRI will also show abnormalities, ruptures, or inflammation of the tendon – all which are hidden to an x-ray. The MRI technology will also reveal bone fractures that are not seen on plain x-rays – which happens up to 10% of the time. When it comes to an MRI, it essentially gives the most information without any cutting into the shoulder to look at it.

Ultrasound is a new modality, and it is very useful. You do need to understand its limitations. Ultrasound will basically tell you how someone superspinatis tendon is. Now, keep in mind, the superspinatis tendon is where most of the problems originate with the rotator cuff. And many times, we will get an ultrasound if we want to find out if its’ worth while to try to treat someone conservatively. Basically, if a superspinatis tendon is just showing partial tears or inflammation or swelling, then this person will likely get better without any type of surgery. Even moderate tears can shown on ultrasound, can very frequently be healed without surgery; however, if there is a complete tear in the tendon then there is actually retraction on both sides – so there is basically a separation between the tear – there’s not a great place for physical therapy in my opinion. So, the ultrasound is a one trick pony, but it can be quite practical and can give us a dream life if we really push the non-surgical rehabilitation aggressively.

By being aware of what each imaging technology reveals about the tissues and bones underneath the skin, doctors are able to get a lot more information about a shoulder condition without having any invasive procedure. Whether its an x-ray, MRI or ultrasound, all are informational tools physicians can use to help patients who are suffering from long-term shoulder pain.

About the Author

Michael Carroll, MD is a board certified family physician with a special interest in sports medicine and pain management. He is the founding partner of Creekside Clinic, LLC, a progressive primary care center in Traverse City, Michigan and a member of both the American College of Sports Medicine, and the American Academy of Family Physicians. He also holds special interest in long-term shoulder pain, rotator cuff injuries, and rotator cuff tendonitis and has done work to provide more treatment options to patients.