Shoulder pain is a very common condition. About 4.7% to 46.7% population suffers from it in one year. The chance of suffering shoulder pain in a lifetime is up to 66.7% and at any point in time, every 4th or 5th person has shoulder pain.
The shoulder joint is a ball and socket joint with a wide range of mobility; but it is not a single joint, it has 4 joints that work together. These four joints are glenohumeral joint, acromioclavicular joint, thoracoscapular joint and sternoclavicular joint. There are also several tendons, ligaments, bursas around the joint, and any of these alone or in combination can be a source of pain. The most important tendons are together called rotator cuff tendons. These are the tendons that lift & rotate the shoulder in different directions.
The common causes of shoulder pain are tendinopathies and tear, frozen shoulder or adhesive capsulitis, bursitis, damaged cartilages or ligaments, and arthritis of these joints. Fracture or tumor is a less common cause of shoulder pain. Sometimes shoulder pain is not because of shoulder pathology, it may be referred pain from the cervical spine, chest, or abdominal pathology.
The most common causes of shoulder pain are rotator cuff tendinopathies and frequently tendon tear is associated with these tendinopathies. These tears can be partial-thickness tears or full-thickness tears. If a tear is there in tendons, there will be pain and restricted movements of the shoulder. Among all these tendinopathies, supraspinatus tendinopathy is the most common. Surgery was the main treatment for a tear in earlier days, but regeneration therapy with platelet-rich plasma is the most popular non-operative treatment for these tears.
Diagnosis: The treatment plan depends on the exact diagnosis of shoulder pain. Apart from a thorough history and clinical evaluation, the most important bedside evaluation is the evaluation of the shoulder with ultrasonography. In the majority situation, clinical evaluation and ultrasound evaluation together make a diagnosis. X-ray, CT scan, or MRI is needed only in a specific situations.
Red flags: Dangerous diagnoses like a tumor, fracture tendon tear, or infection must be diagnosed early for better treatment outcome.
Initial treatment of shoulder pain: These are mostly conservative with simple exercises, hot or cold compress, and analgesics. But in presence of tendon tear, exercises are avoided. Conservative management is effective in most situations, but the dangerous diagnosis must be ruled out.
Interventional pain management:
PRP injections are always done under the guidance of ultrasonography to identify the pathological area and to inject exactly at the site where it is needed. For PRP injection, the patient’s own blood is taken in a kit which is then centrifuged in a special centrifuge machine, and the separated PRP is taken in the syringe for injection.
PRP injections are not effective if the patient’s platelet count is very low; if the patient is taking strong anti-platelet medicine like clopidogrel or taking a steroid for some reason.
Surgery: Surgery is sometimes needed particularly for complete tendon tear, fracture, or advanced osteoarthritis when the shoulder joint replacement may be advised.