Shoulder Pain/Impingement

1. Shoulder Pain/Impingement Matthew E. Mitchell M.D.

2. Disclaimer • Patients should discuss specific injuries with their primary care doctor or surgeon. This site is meant to give general information to patients about specific patient problems. It is impossible to individualize this discussion to specific patient issues. mattmitchellmd.com

3. Shoulder Pain • Many conditions cause shoulder pain • Extra Articular pain “outside of the joint” • AC (acromial clavicular) joint pain • Impingement or “bursitis” • Rotator Cuff Tear • Intra articular pain “inside the joint” • Arthritis • Cartilage injury • Loose bodies mattmitchellmd.com

4. Extra-articular • Impingement or bursitis • Inflammation of bursa or “sac” in subacromial space • Symptoms • Crepitus which patients call “popping” “crunching” in shoulder • Pain with overhead activity • Pain localized on apex of shoulder mattmitchellmd.com

5. Anatomy AC joint Clavicle Acromion Bursa: Location of “Bursitis” Rotator Cuff Underneath Bursa Humerus mattmitchellmd.com

6. Treatment of Impingement • Physical Therapy • Regain range of motion • Start strengthening • Injections • Caution in young people • Toxic to cartilage • Limit injections to 3 or less • Surgery • Arthroscopic decompression • Shave piece of bone and remove inflamed bursa mattmitchellmd.com

7. Results of Treatment • Most patients get better with physical therapy and modifications to activity in 6 months • Surgery has good results when people have had a favorable response to injections mattmitchellmd.com

8. AC or Acromio-clavicular Pain • Pain located in the joint that connects the acromion and clavicle • Symptoms • Pain located in the mid clavicle or “collar bone” area • Sometimes occurs in weight lifters • Can also exist with impingment or “bursitis” mattmitchellmd.com

9. Anatomy AC joint: location of AC pain Clavicle Acromion Bursa: Location of “Bursitis” Rotator Cuff Underneath Bursa Humerus mattmitchellmd.com

10. AC Pain Treatment • Physical Therapy • Regain range of motion • Start strengthening • Injections • Caution in young people • Toxic to cartilage • Limit injections to 3 or less • Surgery • Arthroscopic decompression • Shave part of joint out mattmitchellmd.com

11. Results of Treatment • Physical therapy can be beneficial if “bursitis” or impingement is also present • Injections can give very good relief of pain • Surgery has high predictive success if injections temporarily relieve pain mattmitchellmd.com

12. Rotator Cuff Tear • Tear of the small muscles around the shoulder • Symptoms • Pain with overhead activity • Weakness • Pain on apex of shoulder • More common in people over 40 years old mattmitchellmd.com

13. Anatomy Rotator Cuff Muscle “Covers” the Shoulder Like a Cuff mattmitchellmd.com

14. Treatment • Treatment depends on symptoms and age of patient • Young patients with tears should probably have early repair even if symptoms are not severe • Middle age patients 40-60 years old should be trialed with non-operative treatment but • enlargement of tear and arthritis is a possibility • Older patients with large tears can be treated with injections and non-operative treatment mattmitchellmd.com

15. Results of Treament • Very large tears are difficult to treat • In older patients pain is reliably relieved but strength may not be improved with surgery • In younger patients some improvement in strength may be possible with surgery mattmitchellmd.com

16. Intra-articular Pain • Cartilage Injury • Labrum (surrounds the articular cartilage) • Arthritis (articular cartilage) • Symptoms • Dislocations • Throwing pain • Loss of strength mattmitchellmd.com

17. Intra-articular Pain Arthritis: articular cartilage Superior Labral Tears: throwing pain Inferior Labral Tears: instability and dislocation mattmitchellmd.com

18. Treatment • Physical Therapy • Range of motion • Strengthening • Injections • Used to help with diagnosis • Surgery • Arthroscopic repair of labral injury • Tighten capsule if necessary mattmitchellmd.com

19. Results • Arthroscopic repair of labral injuries • Good results with accurate diagnosis • Arthroscopic treatment of dislocation • It has results equal to open repair but these reports are early • There may be a role for early repair in young active people mattmitchellmd.com

20. Summary • Shoulder pain has intra-articular and extra-articular causes • Burisitis or impingement is most common extra-articular cause • The main initial treatment is physical therapy and activity modification • Surgery has good results in most cases Back to Patient Information mattmitchellmd.com