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What doctors know: Don't shrug off shoulder pain

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Shoulder pain is a common condition that often results in concern and uncertainty for a patient. In fact, shoulder pain is so common that it affects people in all walks of life, from athletes and laborers to those leading a relatively sedentary lifestyle.

Ignoring or living with the symptoms of shoulder pain is often the first response of the patient. This is not unreasonable if the symptoms are infrequent, not severe and not long lasting. However, shoulder pain that is severe and unremitting could indicate a more serious problem that may worsen over time.

Often a medical diagnosis of a shoulder condition can be made based on the patient's history. Physicians are trained to identify the "red flags" which could indicate a more serious condition. These include constant pain, rest or night pain, weakness, and excessive popping or clicking. Also, catching or locking of a moving joint usually indicates a problem.

There are many potential causes for shoulder pain and visiting an orthopedic surgeon to obtain an accurate diagnosis is important to ensure a safe and timely recovery. An accurate diagnosis can also help focus treatment to optimize outcomes and functions.

Often shoulder pain results from sports activities with an improper warm-up or athletic technique. Sometimes it's caused by chronic conditions like repetitive activity or overuse. In fact, even constant everyday activities can lead to shoulder problems. Finally, shoulder pain can result from trauma, such as a fall onto a shoulder or an outstretched arm. Twisting of an arm and shoulder can also lead to problems.

If the symptoms are severe, frequent and long lasting, a visit to an orthopedic surgeon is imminent. Additionally, if a person has any of the previously mentioned "red flags," visiting an orthopedic surgeon for consultation is important to obtain a diagnosis and to begin treatment.

An orthopedic surgeon generally begins with a detailed history and physical examination. X-ray or other radiographic studies, such as a magnetic resonance imaging (MRI), may be required to make a diagnosis.

The treatment of shoulder pain depends on the severity and the nature of the injury. Sometimes a period of rest or activity modification will help. Ice and heat applications may be appropriate, as well. This is how overuse syndromes, sprains and strains are often treated.

Other minor injuries respond to active stretching of the muscles and tendons that surround the joint.

Some shoulder conditions respond very well to treatment with physical therapy, especially when a stretching and strengthening program is performed.

Shoulder pain caused by arthritis, bursitis and tendinitis is often treated with anti-inflammatory medications or cortisone injections. Cortisone is a powerful and effective medication that treats inflammation, a common problem in patients with shoulder pain. Depending on the problem, cortisone injections are placed in a variety of locations around the shoulder.

Whenever possible, conservative measures are preferred to surgery. However, when rest, medication, injections and physical therapy fail, maybe the next course of treatment is surgery. When surgery is the final option, the physician will explain in detail what to expect and what he hopes to achieve.

Surgical options are based on the underlying cause of the shoulder pain. For example, if bone spurs are prominent and pinch or catch tissue, these spurs can be removed. If certain structures like rotator cuff tendons are torn, they can be surgically repaired. The bottom line is that any surgical procedure will be specifically tailored to address the problem that's causing pain.

Usually, arthroscopic techniques are used to treat joint pain. Advantages of an arthroscopic approach include smaller incisions, less invasiveness, a thorough treatment, and a more predictable and rapid recovery. Arthroscopic surgery can usually be performed in an outpatient setting.

It's not advisable to ignore these aches and pains for too long. A visit to an orthopedic surgeon can pinpoint the problem, alleviate pain, and keep you healthy for years to come.

(Brian W. Fukushima, MD, is an Orthopedic Surgeon specializing in Sports Medicine. During his fellowship he served as a team physician for the Utah Warriors Arena Football Team and the U.S. Ski and Speedskating Teams. He focuses on all aspects of arthroscopy, knee and shoulder surgery.)

(WhatDoctorsKnow is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at http://www.whatdoctorsknow.com.)

Copyright © 2014, The Baltimore Sun
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