One of the Most Common Causes of Shoulder Pain in Adults
David W. Shenton, Jr., MD, CSCS
Shoulder pain is very common in adults. The most common cause of shoulder pain for middle-aged adults and older is rotator cuff disease. The rotator cuff is a group of muscles and tendons deep in your shoulder which stabilizes shoulder and also assists with reaching, lifting, etc.
Rotator cuff disease typically presents as shoulder pain, centered at the tip of the shoulder, worse with reaching overhead or away from the body. Commonly, this will cause some night awakening with difficulty laying on the shoulder. Often, this will come on gradually, in fits and starts with vigorous or more demanding activities over the years. Occasionally an acute event such as a fall on the outstretched arm will initiate the problem. Most rotator cuff trouble can be treated successfully with conservative nonsurgical management including physical therapy, modification of activities, anti-inflammatories, possible injections, etc. However, if there is a significant actual tear in the tendons of the rotator cuff then surgical intervention may be indicated.
Historically, surgical repair of the rotator cuff has involved an incision ranging from about 2 inches long to much longer. The results were generally good but the surgical trauma could cause significant discomfort and scarring and often required hospitalization.
In recent years surgical technology has dramatically evolved to allow successful repair of even very large rotator cuff tears through small incisions, typically each less than 3/8 of an inch, done arthroscopically at an outpatient surgery center. Despite initial healthy skepticism among some orthopedic surgeons this approach has proven to be at least the equivalent of open repair with respect to long-term results. Short term, the patient has less pain and an easier recovery. Many surgeons have found this to be a welcome boon for their patients.
If you are having shoulder problems like this you may want to consider an arthroscopic approach. For further information and a list of physicians who specialize in arthroscopic shoulder procedures go to the Arthroscopy Association of North America website at aana.org. or the American Board of Orthopedic Surgery at abos.org.
