Chronic Shoulder Pain Affects the Young and Not-So-Young

When shoulder pain lasts for more than six months it is considered to be chronic. Before treating this pain, we must first rule out neck problems, because neck issues can cause pain to the shoulder.

The causes of chronic shoulder pain are varied and tend to differ in patients…often depending upon whether they are under or over age 40. Younger, more active patients are apt to develop labral tears and muscle strains, while older patients are prone to rotator cuff tears, acromioclavicular (AC) joint arthritis and shoulder arthritis.

Treatment begins with conservative, non-surgical measures for both groups.

Overhead athletes such as tennis players, volleyball players and pitchers can develop labral tears due to the extreme motions of their shoulder joints. This is a tear in the soft fibrous tissue rim that helps stabilize the joint.

Our first line of treatment is physical therapy to strengthen the muscles around the shoulder joint. Patients may choose to continue the exercises on their own after a few sessions. This type of tear can be managed by certain injections as an adjunct to the physical therapy protocol.

A common complaint among patients over 40 is shoulder weakness with worsening pain, which may be symptoms of rotator cuff tears. An MRI can confirm a rotator cuff tear. Depending on the severity of the tear, we can begin treatment with steroid injections followed by a six weeks of physical therapy and rehabilitation.

If therapy fails, we proceed to arthroscopic rotator cuff repair, followed by range-of-motion exercises and then strengthening. The shoulder may begin to feel normal in one year.

Arthritis is the progressive loss of cartilage and it can develop in the shoulder joint. This can cause motion loss and chronic shoulder pain as this condition worsens over time. We start managing it with rehabilitation, strengthening exercises and steroid injections.

In extreme cases when debilitating shoulder pain does not respond to treatment and significantly impacts a patient’s quality life, we suggest that those patients consider shoulder replacement. This is obviously a major surgery and not for everyone.

Do you have undiagnosed chronic shoulder pain? The sooner you address it, the easier it will be to treat through conservative, less invasive means.

Omar Perez, MD, is a Methodist Physician Group Orthopedic Surgeon and Sports Medicine Specialist.

Author
Dr. Omar Perez Dr. Omar Perez, MD with the Methodist Physician Group Orthopedic and Spine Center in Merrillville, Indiana specializes in orthopedic surgery, especially shoulder procedures, and sports medicine. During his career, Dr. Perez has treated world-class athletes in the NFL, NBA, and NCAA, as well as working with a number of major league baseball organizations. His specialty training includes both pediatric and adult sports medicine, so he’s been on the sidelines for many local recreational athletes, too.

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