Ask the Expert: Dr. Edward Craig, Shoulder Surgeon, Answers Your Questions on Shoulder Pain

by Dr. Edward Craig
shoulder pain causes and treatment

Q1. What would cause sudden shoulder pain only in the front of the shoulders? Sometimes accompanied by redness and heat. Mostly occurring at nighttime.

Many problems in the shoulder cause pain in the front of the shoulder and most difficulties are made worse at night and can interfere with sleep. The problems can include rotator cuff tendinitis or tear, frozen shoulder, calcium deposits in the tendon and problems with the biceps tendon. You should speak with your physician to determine the cause of pain.

Q2. I play tennis every weekend for the past several years. My shoulder started to hurt after the last game. What can I do to treat the pain and prevent a rotator cuff tear? 

Before playing tennis, make certain you do a general body warm-up and stretch both arms in preparation for play. After tennis, ice the shoulder for 10-15 minutes. If pain persists, over the counter anti-inflammatory medications such as ibuprofen or Aleve can be helpful. The rotator cuff usually tears from a process of normal aging, wear and tear and sometimes overuse. Keeping the shoulder flexible with stretching range of motion exercises is important. There are also a number of rotator cuff strengthening exercises that can be done to maintain the tone and strength, and these are also helpful in preventing damage. It’s important to consult with your physician to determine the treatment.

Q3. My shoulder stiffens up and this sometimes makes movement painful. How would you treat the pain?

Most times, stiffness and restricted range of motion is the cause of pain in and of itself. The cause of the stiffness frequently is irritation of the tendons. If the problem is pain and stiffness (this has been called frozen shoulder and adhesive capsulitis), stretching exercises, ice and judicious use of anti-inflammatory medication usually restores flexibility and relieves pain. Working with a physical therapist is often helpful to achieve these goals. If the problem persists, evaluation of the shoulder by your doctor, with imaging studies such as x-ray or MRI may well be warranted. Consult with your physician and/or physical therapist.

Q4. I have shoulder arthritis. The pain is moderate. When would you recommend shoulder replacement for someone with this kind of condition?

The main indication for shoulder replacement is pain that interferes with quality of life and that is not relieved by non-operative means. Each person has his/her own definition of moderate pain and pain threshold, but in general, most people who have shoulder replacement do so because pain is severe—often interfering significantly with sleep, activities of daily living or recreation. There may be other treatment for moderate pain rather than joint replacement, such as mild stretching exercises, anti-inflammatory medication or injections into the joint of such medications as cortisone. Consult with your physician.

Q5. What’s the difference between a shoulder dislocation and separation?

The anatomy of the shoulder includes a ball (head of the humerus) that rests against the socket (glenoid fossa). The head of the humerus is held in the glenoid socket by soft tissues. On top of the shoulder is a bump where the collarbone (clavicle) meets the shoulder cap (acromion) to form a joint (acromioclavicular joint). The clavicle is held in place against the shoulder cap by a series of soft tissue ligaments.

Dr. Edward Craig, Shoulder Surgeon

Dr. Edward Craig, Shoulder Surgeon

With a shoulder dislocation, the main ball and socket of the joint is affected, and the ball moves out of the socket, partially or completely. When this occurs with trauma, most often the soft tissues which hold the ball in the socket are damaged, permitting the ball to go out of the socket, or dislocate.

A shoulder separation does not involve the main ball/socket, but involves the small joint (bump) on top of the shoulder where the collarbone meets the shoulder cap. When the ligaments holding the collarbone against the shoulder cap are damaged, the collarbone no longer is kept in place and “separates” from the shoulder cap. Thus a shoulder separation is not part of the main ball/socket joint, and is usually less painful and less serious than a dislocation.

Next week Dr. Brion Reichler, Neurologist, will answer your questions on gait and balance disorders. Write your questions on the wall or email socialmediacontact@hss.edu.

Topics: Facebook Notes, Orthopedics, Rehabilitation and Fitness
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Ramon Mendez says:

Tengo una Capsulitis adhesiva y algo mas,
deseo realizar una consulta con usted, ya sea
en Miami o Nueva York, ya que soy Dominicano, Buenas Noches, a la espera de su respuesta

Ramon Mendez says:

Deseo una consulta con usted, sobre una capsulitis y algo mas.

Buenas Noches

HSS on the Move says:

Ramon,

Gracias por su interés en HSS, hemos hecho llegar su solicitud al Centro Internacional. Para su referencia, también puede comunicarse con ellos directamente al (212) 606-1186 o al correo electronico: international@hss.edu.

helen says:

I have had rotator cuff arthroscopic surgery on left shoulder. 3mos ago. in PT
still in pain.
Now have bicipital tendontis in rt shoulder had seroid injection . what are the options for this new shoulder. How about botox inection i am 76 yrs old and cannot turn steering wheel in car

HSS on the Move says:

Dr. Craig says, “The options for the problem on the unoperated shoulder depend on what the specific problem is. Usually, when someone has had rotator cuff surgery on one side, and gets biceps tendonitis, the other shoulder may be getting rotator cuff pain as well (30% get cuff pain on other shoulder). Options include: PT and light strengthening exercises, activity modification, anti-inflammatory medication by mouth, and steroid injection into shoulder. To my knowledge there is no role for botox injection for either biceps or rotator cuff problems.” A more specific course of action can be determined for you with a consultation. If you”d like to make an appointment with us, please contact Physician Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp

This is the right site for anybody who would like to find
out about this topic. You understand so much its almost tough to argue with you (not
that I actually would want to…HaHa). You certainly put a new spin on a subject that has
been written about for ages. Wonderful stuff, just
wonderful!

Mariette Zenor says:

Wonderful stuff, never hurts to try and see a chiropractor.

Joseph Bilotta says:

I have had an MRI which shows a torn rotator cuff. May I send the MRI for you to review for what course of action to
take. I had it reviewed by an orthopedic doctor in Pawleys Island, SC. He recommends surgery with the possibility of shoulder replacement surgery now or in the future.
I had my back operated on by Dr. Camissa about 14 years ago at the HSS.
Thank you for your consideration of this matter.

HSS on the Move says:

Hi Joseph, please email us at socialmediacontact@hss.edu so we can further assist you. Thank you!

Kathleen says:

My 82 year old mother-in-law received excellent treatment by you ( rotator cuff surgery) about 10 years ago. Her knee has deteriorated since the accident ( shoulder and knee injury from fall). Who do you recommend? She is on a walker and getting stronger but the knee has become a real issue for mobility. Her situation would improve more if she was more mobile. Medicare patient.

HSS on the Move says:

Hi Kathleen, thanks for reaching out. We shared your note with Dr. Craig and his office. Additionally, if your mother-in-law wishes to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for assistance.

robert amato says:

I’m 54 years old. love lifting weights.pretty much a workout fanatic.played high school and college football and also was an electrician for 25 years. even though I have alotv of arthritis in my shoulders I’ve always been able to adapt my workouts so that I’ve been able to lift without much pain at all. recently ,the day after a workout my left shoulder is really hurting. i.m sure I tore something. an orthopaedic doctor told me a few years back that I probably will eventually need shoulder replacement surgery. I’m terrified of this surgery because I don’t know if i’ll be able to lift weights anymore. working out is something I’ve always done and hopefully will contine to be able to do.is it possible in your opinion that if I do opt to have surgery that I’d be able to keep lifting weights and still be able to do work on and around the house which I love doing

HSS on the Move says:

Hi Robert, thank you for your question. Dr. Edward Craig, Orthopedic Surgeon, says “It is certainly understandable that you would be cautious regarding shoulder replacement surgery. A few thoughts: While you may have torn something (tears of tendons are seen on MRI scan, not X-ray), it is probably more likely if you have arthritis in the shoulder that you stirred up a damaged joint. There are other options for shoulder pain from arthritis besides shoulder replacement, such as medication by mouth and cortisone injection into joint – both of which may give you enough relief that you do not feel an operation is necessary.” If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for assistance.

Bud Thomas says:

I had a “hemi” last year because the cup was too worn to attach anything

also a reverse could not be done

I have 60% mobility with pain

any thoughts/

thank you

HSS on the Move says:

Hi Bud, thank you for reaching out. Dr. Edward Craig, Orthopedic Surgeon, says: “It must be recognized that the primary purpose of arthroplasty of the shoulder, whether total shoulder, reverse arthroplasty, or hemiarthroplasty is pain relief, rather than mobility, motion, or function. That is because mobility to a great extent is related to the health of the soft tissues, including rotator cuff, which moves and stabilizes the implant. That said, the track record of hemiarthroplasty, while it tends to neither be as predictable nor complete as total shoulder or reverse, has been good over the years. There are many possible causes of continued pain after hemiarthroplasty, including infection, incomplete rehabilitation, rotator cuff tearing, implant position, nerve dysfunction, shoulder instability, wear on the glenoid that was not resurfaced, and others. Sometimes we do not find a cause for ongoing pain. What should be done will always depend on trying to establish the cause of the pain. Infection workup might include blood work, aspiration of the joint, or even biopsy. Rotator cuff tear might be evaluated by MRI scan, nerve injury by electrical studies, etc. A plain x-ray to look at implant position and remaining glenoid socket bone is certainly a good place to start. If necessary, a CT scan is sometimes helpful to assess remaining bone. Occasionally, a socket which has been considered to have inadequate bone for a new surface may be able to be handled by smaller glenoid implants, or even custom designed ones to take advantage of available bone. My suggestion is to discuss with your doctor whether any of the above are considerations. If none of these retake to your situation, sometimes an anti-inflammatory medicine or even a cortisone injection in the rotator cuff area or even the joint itself can be considered.” It is important to consult with your treating physician. If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

Bud Thomas says:

thank you for the reply saw surgeon on 2/18/14 xrays ok starting anti inflam’s, decreasing each day over the course of 1 week

thanks again

Gayle Jaeger says:

Developed increased shoulder pain, have had x-ray and MRI. Was told I had ”massive” tear in rotator cuff tendon, given medication which did not work (severe pain at night, took a variety of pain killers, none great). Returned with pain, given cortisone shot (which has allowed me to sleep w/o pain but not a permanent solution). Rotator cuff repair not solution since I have osteoarthritis as well as muscle damage (”muscle has turned to fat”). So REVERSE Total Shoulder Replacement is recommended so Deltoid muscle is used. Why isn”t Deltoid muscle degraded?

HSS on the Move says:

Hi Gayle, thank you for reaching out. Dr. Lawrence Gulotta, Orthopedic Surgeon, says: “In a patient with ‘cuff tear athropathy,’ which is what you are describing, the deltoid is usually preserved. The deltoid tendon is relatively large when compared to the rotator cuff, and therefore it is stronger and less likely to tear.” It is best to consult with your treating physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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April 15, 2014 at 4:57 pm

Anjie was born with a number of challenging conditions, including bilateral PFFD- a birth defect affecting the pelvis- and a left club foot. She came to HSS when she was a baby and received treatment from a team of professionals including Dr. Daniel Green and Dr. Roger Widmann, HSS Pediatric Orthopedic Surgeons, and Glenn Garrison, Director of Prosthetics & Orthotics. Anjie began intensive physical therapy when she was only 1, and started working with Magdalena Oledzka as her primary therapist 6 years ago. Now at 13, she has a better prosthetic fit, decreased pain and was even able to walk down the aisle as a bridesmaid in her sister's wedding! We're very proud of her! #transformationtuesday #pediatrics #orthopedics #HSS

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