Why Does My Shoulder Hurt?

Jose A. Padilla, MD, FAAOS
Joint Reconstruction & Trauma
Chippewa Valley Orthopedics
& Sports Medicine, Eau Claire

Frequently, in the scope of my practice, I meet with patients that are concerned to hear that they will receive different treatment for their shoulder problem than what was prescribed for a neighbor or relative. “Why can't I just have an injection?” or “Why can't I get an MRI scan?” are questions asked by patients when seeking my help for shoulder pain. The many possible conditions afflicting the shoulder and the even longer list of treatment choices makes it easy to understand the confusion facing patients when asking their provider, “Why does my shoulder hurt?”

With the refinement of arthroscopic equipment and techniques during the last 20 years, our understanding of the shoulder and its maladies and our ability to diagnose and treat problems of the shoulder has expanded tremendously. Today, arthroscopy allows us to more clearly differentiate between problems and define specific treatments.

The shoulder is a term referring to the area where our arm meets our torso. It encompasses four joints – the glenohumeral or true shoulder joint, the acromioclavicular joint -where the collarbone meets the shoulder, the subacromial joint or space – where much of the rotator cuff pathology occurs, and the scapulothoracic joint – where the shoulder blade rides on one's torso. The shoulder has some 30 muscles acting upon it, but usually patients are seen for problems with the four muscles comprising the rotator cuff. However, physicians must be aware of all the other muscles and the problems that can be associated with them. For example, the commonly seen rhomboid tendinitis (pain along the shoulder blade) or the rarely seen pectoralis tendon rupture of weight lifters.

In seeing a patient for the first time, a physician wants to know the history of the pain, when the pain occurred and what aggravates it, duration, location, how severe and so forth as he/she attempts to narrow the list of potential diagnoses down to four or five. Specific tests or treatments then reduce this to a final diagnosis for eventual treatment options. The physician might order blood work, x-rays, CT scans, bone scans, MRI scans or perform a needle aspiration of the shoulder for further evaluation. Sometimes, arthroscopy (tiny camera inserted into a joint) is employed for diagnostic purposes. All of these tests may be considered and ordered based on the individual patient and their initial examination.

The shoulder can also be afflicted with pain that is referred to it from another area. The most common source of referred pain to the shoulder is from a pinched nerve in the neck. Physicians must be vigilant for other referred type pains, including lung cancer (Pancoast Tumor), and even gallbladder disease! The patient, therefore, seeking help for shoulder pain should expect a physician to ask them questions and carry out a thorough examination as he/she begins the detective work to answer the question: Why does my shoulder hurt? Hopefully, as this process unfolds, not only will the question be answered, but a solution to the problem will be provided.

For information on shoulder problems or to schedule an appointment with Dr. Padilla, Chippewa Valley Orthopedics and Sports Medicine, Eau Claire, contact www.cvosm.com or 800-322-1747. Dr. Padilla also sees patients in Chippewa Falls, Cumberland, Durand & Shell Lake.