“Why do I have constant shoulder pain?” Health expert shares causes and treatment

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"Shoulder pain is often labelled as a frozen shoulder. This incorrect diagnosis is the reason why shoulder pain becomes long-standing and the standard approach to its treatment fails," says Dr Chintan Desai, MS ortho, shoulder surgeon.

He lists down some key causes behind shoulder pain in people and what treatments are available to treat the different kinds of shoulder conditions.

Common causes of shoulder pain
The following are some common causes of shoulder pain that restrict shoulder movements. Under these causes, the problem is in the shoulder itself.

The shoulder joint is made up of the ball and socket joint, the capsule, and the rotator cuff muscles and tendons. Conditions affecting any of these structures cause shoulder pain.

Adhesive capsulitis or frozen shoulder
Shoulder Dislocations
Rotator cuff Tendonitis or tendon inflammation
Rotator cuff tears
Shoulder joint arthritis

Other major causes that can sometimes be hard to identify include:

Risk of heart attack: It is the chest pain that radiates to the left shoulder

Cervical spondylosis: A neck pain that radiates to the shoulder and arm associated with tingling numbness

Gallbladder inflammation: Irritation of the diaphragm caused due to an inflamed gallbladder radiates to the right shoulder.

Treatment for shoulder conditions
The first step towards treatment is to understand the root cause of pain. Clinical examinations and investigations like X-rays and MRIs help us get an accurate diagnosis.

For frozen shoulder or adhesive capsulitis
This is a common cause of pain for the 40 - 60-year-old age group. These patients also have associated diabetes or hypothyroidism. The reason for stiffness is the thickening of the capsule. The muscles and labrum (meniscus-like tissue in the shoulder) structure are normal in MRI. It is only then that a diagnosis of a frozen shoulder is confirmed. Traditional treatment in the form of physiotherapy and medication is time-consuming and takes up to 2 years for the shoulder movements to return. The latest and most successful treatment is keyhole surgery in which the thickened capsule is released. The advantage of this surgery is that the patients start making movements easily in 1 week and gain back strength in 1 month.

For shoulder dislocation
In a patient with shoulder dislocation, the ball slips out of the socket. This is an emergency case and requires immediate treatment to put the ball back into the socket. However, this is not the final treatment. When the shoulder dislocates it causes a tear in the labrum. Hence the shoulder continues to remain unstable and has a 90 per cent chance of another dislocation. However, this condition can be permanently corrected with surgery. There are several procedures described in studies though the latest treatment offers the best results. Under this treatment, the dislocation is corrected enabling patients to make easy movements.

Shoulder arthroscopy and bankart repair are the latest keyhole surgeries to repair the torn labrum after a dislocation. They are most successful if done early after the first dislocation when the quality of the labrum is good.

Latarjet is another method of operation that is performed in patients with recurrent dislocations and for high-demand athletes like wrestlers or kabaddi players. This involves transferring a small piece of bone to the front of the socket.

For rotator cuff tendonitis/inflammation
Rotator cuffs are 4 muscles and tendons in the shoulder. This is the commonest cause of shoulder pain. The overhead movements are painful and the best way to treat it is with an ultrasound guided injection to allow the medicine to be delivered exactly to the inflamed tissues. Physiotherapy is recommended after the injection to improve strength.

For rotator cuff tendon tears
Tendon tears cause significant shoulder dysfunction. They occur after an injury caused due to lifting weight or after falls. They may also be age-related wear and tear. Complete tears and over 50 per cent partial thickness tears are best treated by a keyhole surgery called arthroscopic rotator cuff repair. The results are excellent if done early. If these tears are left untreated, they worsen the condition and the quality of the tissue deteriorates with time. This is when shoulder joint wear and tear begins leading to a condition called rotator cuff tear arthritis. Once a patient reaches this stage of the disease, the only option is shoulder replacement.

For shoulder arthritis
A patient who is over 60 years of age with a painful and stiff shoulder should be investigated for shoulder joint arthritis. Shoulder replacements are the only way to permanently treat a worn-out joint. Shoulder arthritis or wear and tear is of two types, arthritis with normal muscles and tendons and arthritis with torn muscles and tendons. The material or implant required for a successful surgery is different for these two types of arthritis.

Timely treatment can help you to get rid of shoulder pain and improve shoulder movement and quality of life. It is crucial to consult a doctor at the earliest.

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