The shoulder is a complex, highly mobile joint designed to provide the highest amount of motion of any joint in the body. In its simplest form, it is a ball and socket joint surrounded by a variety of ligaments, tendons, and muscles that are responsible for moving the arm. There is a complex arrangement of nerves and blood vessels in the shoulder region to supply sensation, motor control, oxygen, and nutrients to the skin and muscles of the arms. This joint must be mobile enough for a wide range of functions of the arms and hands, but stable and strong enough to allow for actions like lifting, pushing, and pulling.
The two main mechanisms of shoulder pain are acute injuries and chronic pain conditions generally from overuse or strain. The shoulder is a complex joint consisted of muscles, tendons, ligaments, cartilage, and a joint capsule, all of which can be injured or overused to cause pain. Examples include rotator cuff tendinopathy or tears, arthritis, bursitis, and frozen shoulder.
The location and character of shoulder pain symptoms may vary and give us clues as to what is causing the problem. These include:
At your initial evaluation your physician will take a comprehensive history and physical exam. These are the most important pieces of information to help narrow down all of the causes of your pain
Next, an x-ray of the shoulder is important to understand the boney contours and alignment of the joint. You can identify misalignment of the joint, fractures, shoulder dislocations, and subluxations, and osteoarthritis, to name a few conditions that cause shoulder pain.
A CT scan is a more advanced kind of x-ray that gives much more detailed information about the bones and joint spaces. You can also get more information about soft tissue structures like muscles or blood vessels than with standard x-rays
An MRI uses magnetic fields to better detail all of the soft tissues structures of the shoulder like muscles, tendons, nerves, and blood vessels. You also get details on the quality of the cartilage and if there is stress in the bone potentially causing symptoms. Sometimes, dye will be injected into the joint itself to provide more detail about intra-articular problems like a labral tear or focal cartilage defects.
Ultrasound is an imaging modality that uses sound waves to create pictures of all of the structures in the shoulder. The advantage of this is to get real time information about the shoulder; both while you are sitting still and while you are moving. All of the above image modalities cannot provide any of the same information an ultrasound can while you are moving!
Blood work can sometimes be useful to determine if there is an underlying medical issue causing your shoulder pain, such as autoimmune conditions or infections.
When a patient is seen at the Virginia Spine Institute by our shoulder specialists, a comprehensive exam is completed to better understand the underlying cause of shoulder pain. Often conservative treatments are started initially which include physical therapy, non-steroidal anti-inflammatory medications, and activity modification recommendations. If symptoms are ongoing despite these conservative therapies your shoulder specialist may recommend a steroid injection for both diagnostic and therapeutic purposes. At the Virginia Spine Institute our specialists use some of the most up to date and advanced treatment options for our patients including regenerative medication. Some of these regenerative options include stem cell therapy, Platelet-Rich-Plasma (PRP) treatment, Prolotherapy, and Microfragmented Adipose injections. Often these regenerative options are tried prior to surgical intervention and the patient is able to avoid a shoulder surgery. Our specialists will discuss all the available treatment options with you and the associated risks and benefits of each.
Dr. Niteesh Bharara
Director of Regenerative Medicine
Orthopedic Specialist - Non-Surgical Sports Medicine