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Shouldering the Pain

Dr. David Lintner
Orthopedic surgeon
The Methodist Hospital

Reaching to the top shelf at the grocery store isn't a heroic feat, but it can feel like one if shoulder pain limits your range of motion. "Shoulder pain is a common complaint because we use our arms for so many activities," says David Lintner, M.D., an orthopedic surgeon at The Methodist Hospital. "Anyone can have shoulder problems. But women and athletes who perform repetitive overhead motions such as swimming or tennis are more likely to experience conditions such as frozen shoulder or multidirectional instability."

Shoulder Pain Dynamics
The shoulder joint is made up of a ball and socket. Ligaments, tendons and muscles, which surround the joint to create a protective cap, work to keep the ball and socket in place. When all the soft tissue works together, you can lift, carry or move with relative ease. Overworking these muscles can cause discomfort, but it usually subsides fairly quickly. But when pain doesn't go away or worsens, it could be due to frozen shoulder or multidirectional instability (loose joints). Here's a look at these conditions.

Frozen shoulder. Also known as adhesive capsulitis, frozen shoulder occurs when the connective tissue around the shoulder thickens and tightens, resulting in restricted movement. It develops gradually, in three stages: painful, frozen and thawing. The first stage is painful, and range of motion becomes limited. During the second or frozen stage, pain diminishes, but range of motion remains decreased. During the thawing stage, range of motion improves.

Causes are unclear, but an injury or prolonged immobility is sometimes the root. Lintner says, "Women, especially those over 40, are nearly 70 percent more likely than men to have this condition. It also is more common in those with diabetes or thyroid disorders." If left untreated, the condition may resolve itself in one to three years. Treatment is geared toward accelerating its resolution and usually involves physical therapy to preserve range of motion and anti-inflammatory medication to relieve the inflammation. Treatment can help relieve the condition within a year, but it mostly maintains muscle flexibility and mobility.

Multidirectional instability. Shoulder instability occurs when the ligaments and tendons are unable to keep the ball of the joint in its socket. The joint can either dislocate completely or slip partially out of the socket (subluxate).

Chronic recurrent instability happens when the torn ligaments and tendons associated with a previous dislocation fail to heal properly. It is more common among athletes – swimmers, tennis and volleyball players and pitchers – who perform repetitive overhead motion. They can stretch the ligaments so severely that it always feels as though the shoulder will dislocate.

"Treatment usually begins with physical therapy that strengthens the surrounding muscles to keep the shoulder in place," Lintner says. "Temporarily avoiding the aggravating activity may also be recommended. If strengthening is not enough to allow return to pain-free activities, arthroscopic surgery may be necessary."

For more information about these conditions and treatment, call 888-850-2302. To learn more about sports injury prevention, call now and order "Leading Medicine," a free, 30-minute television special produced by The Methodist Hospital.

< Winter 2009