Treating shoulder pain

Thanks for joining us for a discussion with Dr. Paul Christo of Johns Hopkins about shoulder pain. The shoulder is the most mobile joint in the human body, according to the National Institutes of Health, so it's no surprise that many people suffer from rotator cuff issues, arthritis, tendonitis, frozen shoulder and more.

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. He also has a radio talk show Saturday nights on WBAL.

Read the transcript below.

Note: Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

Learn about other pain topics in Pain: Time to Take Charge.

 Health chat: Shoulder pain(05/04/2011) 
Baltimore Sun Health: 
Hi, Dr. Christo will join us at noon but feel free to add your questions to the queue now.
Wednesday May 4, 2011 11:29 Baltimore Sun Health
Baltimore Sun Health: 
Hi, welcome to our chat on shoulder pain. We have Dr. Paul Christo of Johns Hopkins with us to take your questions. We'll get to as many as we can within the hour -- there are several already in the queue. And if we have a bunch on the same topic, we'll move on to address a broad range of shoulder pain issues.
Wednesday May 4, 2011 12:02 Baltimore Sun Health
dr christo: 
Hope everybody is doing well.
Wednesday May 4, 2011 12:02 dr christo
[Comment From TheresaTheresa: ] 
I've had two rotator cuff surgeries on my right shoulder several years apart due to different tears. The last one, not arthroscopic, was 9/24/10. After six months of physical therapy with two different therapists, I could only raise my arm shoulder height. The test for RA was negative. I can raise it using my other hand, so it's not frozen. It has severe crepetis (sp?). I've tried, cinnamon & honey, Joint Solutions (pills), Glucosamine w/Chondroitin, SAM-e, Celebrex, 12 gin-soaked raisins a day, acupuncture, and most recently laser treatments. All these proved fruitless. I don't have much pain at rest, but my motion is quite limited. I don't want a total shoulder replacement as I am able to function with pain pills. I m only 63 years old and am generally very, walking, shopping etc., This restriction is affecting every aspect of my life. Is there anything else you could suggest I try? I'm becoming more and more depressed and would appreciate any ray of hope you might have to offer. Oh, I forgot to mention that I was diagnosed with severe degenerative osteoarthritis in my shoulder.
Wednesday May 4, 2011 12:02 Theresa
dr christo: 
Theresa, it sounds like you’re mainly concerned about restricted motion rather than pain. If you¿re weak, then make sure that the physical therapist address strengthening the rotator cuff muscles. If the weakness is due to neurological injury, then a consultation with a neurologist would be important. Sometimes, a test called an EMG/NCT evaluation is performed to assess nerve and muscle problems. Maybe this is something to consider. I¿m sorry to hear that you¿re feeling depressed. Many of my patients with pain feel the same way, but they find support from psychologists that specialist in pain who do cognitive behavioral therapy.
Wednesday May 4, 2011 12:08 dr christo
[Comment From AnonymousAnonymous: ] 
I sleep on my sides and as I have reached my 60's, it has become painful in my shoulders. Really sore. Besides sleeping on my back, how can I reduce the soreness?
Wednesday May 4, 2011 12:09 Anonymous
Baltimore Sun Health: 

Here are some shoulder pain websites for further reading:

Wednesday May 4, 2011 12:10 Baltimore Sun Health
Baltimore Sun Health:

Wednesday May 4, 2011 12:10 Baltimore Sun Health
Baltimore Sun Health:
Wednesday May 4, 2011 12:10 Baltimore Sun Health
dr christo: 
Dear Anonymous, Shoulder pain is a common complaint and affects up to 66 % of the general population. Most patients have what¿s called shoulder impingement problems: bursitis, rotator cuff problems, and bicepts tendon irritation. You may have some bursitis or muscular strain. It doesn¿t sound like the pain bothers you when you¿re not sleeping. You could consider an anti-inflammatory medicine (e.g, motrin, naprosyn, celebrex) before bed, but make sure you talk to your doctor before starting one. Heat therapy to the shoulder area can also soothing. If the pain worsens or you begin having problems with arm movement, see you doctor for a complete evaluation.
Wednesday May 4, 2011 12:15 dr christo
[Comment From MaggieMaggie: ] 
I am a 65 yr. old who was reasonably fit and active until three months ago. I was recently diagnosed w/polymyalgia rheumatica, and while all major joints are affected (knees, hips,etc.) the worst problem seems to be pain in both shoulders and limited use of arms for lifting, performing household tasks, opening items,grooming, dressing, etc. I was referred to a rheumatologist and was placed on a course of prednisone for about six weeks. After this offered no relief or symptom abatement, I was administered steroid injections in both shoulders. I received some temporary relief in one shoulder but no improvement in the other. I am now involved in a treatment program involving physical therapy 3X's a week. The shoulder pain is such that proper sleep is very difficult to obtain and the condition seems to "flare-up" when I am in a supine position. I feel best when standing and moving about, albeit slowly. What treatments for this painful condition seem to be most effective? Thank you for your response.
Wednesday May 4, 2011 12:15 Maggie
Baltimore Sun Health: 
While Dr. Christo works on his answer, here is some more info on polymyalgia rheumatica, an inflammatory disorder:
Wednesday May 4, 2011 12:17 Baltimore Sun Health
Baltimore Sun Health:
Wednesday May 4, 2011 12:18 Baltimore Sun Health
dr christo: 
Dear Maggie, polymyalgia rheumatica is an inflammatory disorder involving pain and stiffness in the hip or shoulder area.The cause is unknown and the treatment is usually steroids. It may take one or more years of steroid treatment to really help with the symptoms. Some patients find relief from tramadol (ultram), or even opioids. If you have evidence of inflammatory arthritis, diclofenac gel (joints of arms and legs) or diclofenac solution (knee) are approved to reduce the pain of osteoarthritis of the joints. But, since you¿re taking a steroid, using an anti-inflammatory should be done cautiously.
Wednesday May 4, 2011 12:21 dr christo
[Comment From CarolineCaroline: ] 
I suffer from chronic pain in my right shoulder and arm due to the repetitive stress of using a computer. The pain then became exacerbated by driving with my right arm on the wheel. I¿ve seen 9 doctors, a chiropractor, and an acupuncturist and the pain persists. I have had anterior cervical disc replacement (5/6) and surgery for thoracic outlet syndrome (rib dissection, etc.) to no avail, although both the neurosurgeon and the thoracic surgeon promised that I would be pain free following the surgeries. The shoulder orthopedic surgeon I went to see said the MRI showed no tear in the rotator cuff, just inflammation, and surgery would not resolve the problem. (I saw him before I was diagnosed with thoracic outlet syndrome). The pain is proportional to the amount of time I spend typing and/or driving. It is most noticeable when I raise my arm above the shoulder. This has been a problem for over 5 years. The only thing that has brought relief in all this treatment (included physical therapy) has been oral steroids. Is there any hope for me? The weakness, pain, debilitation has been increasing.
Wednesday May 4, 2011 12:22 Caroline
dr christo: 
Dear Caroline, your pain may be due to persistent problems associated with thoracic outlet syndrome. I do see patients who say that their symptoms persist or even change following this surgery. I have used drugs like neurontin and nortriptyline to help ease this discomfort. If the MRI showed inflammation of the rotator cuff, then it may respond to a subacromial bursa injection with a small dose of steroid and local anesthetic. It can be challenging to differentiate what is exactly the source of your pain because you have several conditions that can cause it. It could be from your neck as well because C5-6 can produce pain along the shoulder.
Wednesday May 4, 2011 12:31 dr christo
[Comment From RebeccaRebecca: ] 
I'm in the process of recovering from a bilateral adhesive capsulitis diagnosis. I've recently completed over 3 months of physical therapy (my insurance max limit) and have made good progress. My range of motion is fine for most everyday activities but I still have limitations when it comes to physical exercise and tend to guard my shoulders closely. Is there a certain time frame of recovery from a condition like this? I want to continue working out the tightness on my own before considering other medical options..but I worry about waiting too long and my shoulder limitations becoming permanent.
Wednesday May 4, 2011 12:32 Rebecca
dr christo: 
Dear Rebecca, adhesive capsulitis or frozen shoulder can take months to years to improve and for the shoulder to regain motion. The gentle stretching in therapy and at home is important and be careful about aggressive stretching. If the stiffness worsens or doesn¿t get better, the orthopedist may consider arthroscopic release or even moving the shoulder joint under anesthesia. Arthroscopic release of the tightened capsule may be of more benefit.
Wednesday May 4, 2011 12:36 dr christo
[Comment From BettyBetty: ] 
I have an old injury to the shoulder when I was thrown from a horse and shattered the shoulder. This is like 45 years ago! Recuperation took a long time but it went pretty well for several years. Now I have so much pain in that shoulder and have consulted a orthopedic doctor about this. First visit he said it was tendonitis. A year or so later he said arthritis. Would surgery be an option of getting rid of this constant pain. If so usually what does that consist of--outpatient or inpatient surgery? Thanks for any help
Wednesday May 4, 2011 12:37 Betty
dr christo: 
Dear Betty, surgery is generally used for things like shoulder dislocation, fracture, and significant rotator cuff tears. Typically, conservative treatments like physical therapy, anti-inflammatory medicines (motrin, etc), or steroid injections are used before proceeding to surgery. Many shoulder surgeries are performed as an outpatient today and it just depends on the specific surgery the orthopedist is recommending. Surgical treatment can be quite effective in reducing pain, but accurate diagnosis is important. Also, a careful postoperative therapy course is essential for good surgical results.
Wednesday May 4, 2011 12:42 dr christo
[Comment From Tina McDanielTina McDaniel: ] 
Hello - I was told I had a Torn Rotator Cuff and surgery is the only option. But I hear that the recovery and PT is the worst. Is there any other options?
Wednesday May 4, 2011 12:44 Tina McDaniel
dr christo: 
Dear Tina, the rotator cuff consists of four muscles that hold the glenohumeral joint (shoulder joint) in place. Mild rotator cuff tendinitis can respond to anti-inflammatory medicines, range of motion exercises, and strengthening exercises. An injection with steroid and local anesthetic into something called a bursa can shrink inflamed tissue and facilitate rehabilitation. If these treatments fail to provide sufficient relief, the arthroscopic or open (open up the shoulder joint area) surgical repair may be needed. As mentioned earlier, a careful postoperative therapy course is essential for good surgical results and this facilitates a tolerable recovery period.
Wednesday May 4, 2011 12:51 dr christo
[Comment From JerryJerry: ] 
I have arthritis of the shoulders. An x-ray show very little cartiledge remaining. A surgeon recommended shoulder replacement. I am extremely active and over the past six months have had a high level of pain. So far have not been able to mitigate the pain. Don't want to get into heavy medication. Any recommendations?
Wednesday May 4, 2011 12:52 Jerry
dr christo: 
Dear Jerry, surgery may indeed be the best option for you given the extensive cartilage loss. A less “potent” medication called tramadol could be helpful in reducing your pain. Steroid injections into the joint or into the bursa may provide some benefit. Diclofenac gel (topical anti-inflammatory) could be trialed around the shoulder but it¿s not specifically studied for the shoulder. Other oral anti-inflammatory medicines could provide benefit. Ultimately, opioids (morphine, oxycodone, fentanyl patch, etc) may be a last option for adequate pain control.
Wednesday May 4, 2011 12:58 dr christo
[Comment From KellyKelly: ] 
I play lots of sports but the most recent problem is in my throwing shoulder playing softball. It hurt last season, I took a few months off and then when I went to warm up with throw #1 this season I had popping a shooting pains. Is there an easy stretch or something that could help or do I need to see a doctor for a diagnosis? Thanks!
Wednesday May 4, 2011 12:59 Kelly
dr christo: 
Dear Kelly, if the pain persists I would seek evaluation by a doctor. It may be a rotator cuff injury (tear or rupture of one of the tendons-usually the suprapinatus muscle). The doctor will do an exam and use specific physical exam tests to try to sort out the source. Also, you will likely get an x ray of the shoulder because a lot of information about shoulder problems can be seen with this image.
Wednesday May 4, 2011 1:05 dr christo
[Comment From SteveSteve: ] 
I have been told I have bursitis in my right shoulder, and I continue to have ongoing pain, low-level, in both shoulders. What should I have my primary care physician do?
Wednesday May 4, 2011 1:08 Steve
dr christo: 
Dear Steve, shoulder bursitis can be eased with an injection of steroid alone or combined with local anesthetic. Anti inflammatory medications are helpful as well. Only if the bursa irritation becomes chronic and the tissue thickens, and if you don¿t respond to previous therapies will surgery be considered.
Wednesday May 4, 2011 1:13 dr christo
dr christo: 
Thank you for your questions. I hope the chat was helpful.
Wednesday May 4, 2011 1:14 dr christo
Baltimore Sun Health: 
That's all the time we have for today. Thanks for all of your questions. We'll be back in 2 weeks on another pain topic.
Wednesday May 4, 2011 1:14 Baltimore Sun Health