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The Shoulder

150_shoulderMany patients come into our office complaining of Rotator Cuff Tears, when in fact very few actually have a tear. There are several etiologies to shoulder pain; Adhesive Capsulitis (frozen shoulder), Subacromial Bursitis, Supraspinatus Tendonitis, Glenohumeral Instability, Chondrocalcinosis, Osteoarthritis, Gout, Lyme Arthritis, Bicipital Tendonitis, Ganglion Cyst are but a few possible causes of shoulder pain. It is best to think of cause of injury/pain and age in making generalizations for diagnosing shoulder pain.

Cause of Injury/Pain

Overuse

Subacromial bursitis
Supraspinatus tendonitis
Bicipital tendonitis
Impingement syndrome

Forceful Trauma

Glenhumeral instability
Adhesive capsulitis
Fracture
Rotator cuff tear


Insidious Onset

Lyme Arthritis
Adhesive capsulitis
Ganglion cyst
Tumor

Age

Glenohumeral instability
Subacromial bursitis
Supraspinatus tendonitis
Bicipital tendonitis
Impingement syndrome
Ganglion cyst
Lyme Arthritis
Adhesive capsulitis
Chrondrocalcinosis
Gout
Rotator cuff tear
Osteoarthritis

Diagnosing Shoulder Problems

The art of diagnosing shoulder problems is to relate the two above with a good history from the patient and a comprehensive shoulder exam. Believe it or not, there are over 50 shoulder exam tests that can be done by the examining physician alone, without the use of x-rays, MRI’s, or arthrograms. The latter test may be used to confirm a clinical suspicion or in difficult cases, to aid in the diagnosis, but a patient’s history of injury/pain and a good shoulder directed physical examination will usually suffice in making a diagnosis and treatment plan. Many of these problems are approached in a non-operative manner with medications, rest, ice, and physical therapy suplemented with cortisone injections on occasion. If an operation is needed, most of these conditions can be treated by arthroscopic (scope) techniques, with limited incisions and usually done as a same day surgery.

Initiating early treatment for shoulder problems is often the best curative course. If you recognize these symptoms, you should make a prompt appointment to have it evaluated further by your primary care physician or an orthopedic surgeon.