How long will shoulder pain last

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Shoulder pain is an extremely common complaint, and there are many common causes of this problem.

It is important to make an accurate diagnosis of the cause of so that appropriate treatment can be instituted.

The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff. This may last several weeks to several months. Early treatment with physical therapy, anti-inflammatory medication, and injections can speed up the healing process.

Rotator cuff tears occur when the tendons of the rotator cuff separate from the bone. Small to medium sized tears may heal with rest, physical therapy, and steroid injection. Steroid injections are being used less since steroid weaken tendon tissue. The preferred treatment is ultrasound-guided needle tenotomy with platelet-rich plasma, a minimally invasive procedure that heals tendon tissue. Using this approach, most rotator cuff injuries heal within several weeks. In cases where the pain is accompanied by significant weakness and inability to perform activities of daily living, a surgical consultation may be needed.

'Adhesive capsuliitis,' is a common condition that leads to stiffness of the joint. Physical therapy and stretching are extremely important aspects of treatment. This condition may last several months.

Calcific tendonitis is a condition where calcium deposits form within a tendon -- most commonly within the rotator cuff tendons. Treatment of calcific tendonitis depends on the extent of symptoms. Since this is extremely painful, most patients seek medical attention quickly. Physical therapy and injections can help this problem. Ultrasound guided needle lavage has been shown to be particularly useful.

Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition. This almost always requires surgical intervention.

A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula. Relocation of the shoulder is important. Depending on the extent of damage to the supporting structures, the shoulder may be more prone to future dislocation. Pain management for the acute situation is helpful.

Also called an AC separation, these injuries are the result of a disruption of the acromioclavicular joint. This is a very different injury from a dislocation! Immobilization and physical therapy can help. Recuperation takes about 4 to 6 weeks.

A Bankart lesion is a type of labral tear most commonly due to dislocation of the joint. The labrum is a lip of cartilage within the socket of the scapula that helps stabilize the head of the humerus. Bankart lesions cause problems of persistent instability. This requires surgery and takes several months to heal.

A SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand.

Shoulder arthritis is less common than knee and hip arthritis. Physical therapy, medications, and injections are helpful. Recently viscosupplementation has been shown in some studies to be of benefit. The most exciting news is that autologous stem cells have been used with great success to heal this problem. End-stage disease requires replacement.

A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint. Acute ruptures may benefit from surgery. In the older patient, a biceps tendon rupture may be managed without surgery. Healing may take several weeks.

General tips:

•Rest: The first treatment for many common conditions that cause shoulder pain is to rest the joint, and allow the acute inflammation to subside. It is important to be cautious when resting the joint, because prolonged immobilization can cause a frozen shoulder.
•Ice and Heat Application: Ice packs and heat pads are among the most commonly used treatments for shoulder pain.
•Stretching: Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain.
•Physical Therapy: Physical therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.
•Anti-Inflammatory Medication: Non-steroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with shoulder pain caused by problems such as arthritis, bursitis, and tendonitis.

For more comprehensive treatment of rotator cuff tendonitis, a percutaneous needle tenotomy with autologous tissue grafting may help prevent surgery. This is a procedure where a small needle is used to irritate the rotator cuff under ultrasound guidance. Then, a small amount of platelet rich plasma obtained from the patient's own blood is injected in order to stimulate healing. Platelets are blood cells that contain numerous growth and healing factors.

For more information about tendonitis visit our sister site: Tendonitis and PRP

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