Shoulder Pain

If you do experience shoulder pain, it can be difficult to figure out the cause. Often it is not the should itself that is actually the source of the pain, like when it comes from the neck which then radiates to your shoulder.  

In general, if you are experiencing a lot of pain or know you injured yourself, it's best to be evaluated right away to have your shoulder condition diagnosed. 

But if you have general, mild or moderate shoulder pain or stiffness, try adjusting your activities, taking acetaminophen or an over-the-counter nonsteroidal anti-inflammatory drug, and performing mild stretches to see if the pain improves on its own. However, if the pain is getting worse or doesn't go away after a few weeks… a trip to one of the NYC Pain MD centers is in order.  

What causes shoulder pain?

Your rotator cuff is a group of muscles and tendons that help tether your shoulder to the socket and allow you to move it in a circular motion. Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). 

The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade. 

It is estimated that several million people visit a doctor each year for shoulder and rotator cuff–related issues. Most problems with the rotator cuff fall into these categories:  

Most shoulder problems fall into four major categories: 

• Tendon inflammation (bursitis or tendonitis) or tendon tear 
• Instability 
• Arthritis 
• Fracture (broken bone) 

Other much less common causes of shoulder pain are tumors, infection, and nerve-related problems. 

Generally, our doctors suspect a rotator cuff problem if you have pain or stiffness in your shoulder when you lift your arm above your head to brush your hair or when you reach behind your back. You won't be able to do a lot of things you want to do, such as put dishes in an upper cabinet, play tennis, or do garden pruning.  Even more involved, would be a Rotator cuff impingement.  

What are the different types of shoulder pain?

Rotator cuff tears. A tear in the rotator cuff will produce pain that is similar to an impingement but has one additional differentiating feature. If the pain is associated with weakness, it is likely caused by a tear, and if you just have pain, it may only be a rotator cuff impingement, sprain, or inflammation. 

A tear can be partial, whereby only part of the tendon is ripped away from the bone it is attached to. Or there can be a full tear, causing the tendon to completely separate from the bone. Although younger people can have rotator cuff tears, they become more common as people age, possibly because the interface between the tendon and the bone weakens and becomes more susceptible to injury. The prevalence rises with each decade of life. 

Compared with impingement, a tear is more likely to be caused by an injury. Common causes include falling on the ice, getting pulled by a dog on a leash, or tripping and landing on your shoulder. In other cases, problems crop up seemingly without cause. You might suddenly notice pain when lifting something over your head. 

If you suspect a tear or are experiencing sudden pain from an injury-immediate evaluation is warranted. 

Calcific tendinitis. With calcific tendinitis, calcium deposits get embedded within the rotator cuff tendons. While it's unclear exactly what causes these deposits to form, some experts believe they may result from a healing process in the ligament gone awry. The condition can cause severe pain that often starts in the morning. It's more common in middle-aged and older adults and those who have diabetes. 

Treatment is aimed at relieving pain and preserving the range of motion of the shoulder. Options include anti-inflammatory medications, corticosteroid injections, and physical therapy. If the pain is severe or persistent, your doctor may suggest surgery to remove the deposits. 

Adhesive capsulitis. Commonly referred to as Frozen Shoulder, adhesive capsulitis is caused by a thickening and stiffening of the tissues around the shoulder joint. It typically develops in people ages 40 to 60. Frozen shoulder is more common in women than in men and in people with certain medical conditions, such as diabetes, high cholesterol, or thyroid disorders. 

A frozen shoulder can occur after a rotator cuff impingement, a tendon tear, or even a minor injury. But why some people go on to develop a frozen shoulder is not clear. Someone with shoulder pain may hesitate to move the arm as a result of those problems, which then leads to additional pain and stiffness. As a result, it may become virtually impossible to move the shoulder for weeks or months.  

Osteoarthritis. Often thought to be mostly in the knees or hips, shoulders are NOT immune to this type of arthritis and it is not uncommon. However, similar to those other joints, this condition develops when cartilage cushions between the bones in the shoulder erode as your protective synovial fluid “dries up” exposing your shoulder to rubbing and grinding. 

General Tendonitis: A tendon is a cord that connects muscle to bone. Most tendinitis is a result of inflammation in the tendon. 

Generally, tendonitis is one of two types: 

• Acute. Excessive ball throwing or other overhead activities during work or sport can lead to acute tendinitis. 
• Chronic. Degenerative diseases like arthritis or repetitive wear and tear due to age, can lead to chronic tendinitis. 

The most commonly affected tendons in the shoulder are the four rotator cuff tendons and one of the biceps tendons. The rotator cuff is made up of four small muscles and their tendons that cover the head of your upper arm bone and keep it in the shoulder socket. Your rotator cuff helps provide shoulder motion and stability. 

Bursitis: Bursae are small, fluid-filled sacs that are located in joints throughout the body, including the shoulder. They act as cushions between bones and the overlying soft tissues and help reduce friction between the gliding muscles and the bone. 

Sometimes, excessive use of the shoulder leads to inflammation and swelling of the bursa between the rotator cuff and part of the shoulder blade known as the acromion. The result is a condition known as subacromial bursitis. 

Bursitis often occurs in association with rotator cuff tendinitis. The many tissues in the shoulder can become inflamed and painful. Many daily activities, such as combing your hair or getting dressed, may become difficult. 

Instability: Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse. 

Shoulder dislocations can be partial, with the ball of the upper arm coming just partially out of the socket. This is called a subluxation. A complete dislocation means the ball comes all the way out of the socket. 

Once the ligaments, tendons, and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. Repeated episodes of subluxations or dislocations lead to an increased risk of developing arthritis in the joint. 

What YOU should do if your shoulders are painful, stiff or aching and impairing your everyday activities? 

If you’re an active individual and have noted progressive aching and immobility in the shoulders over time…you Are NOT alone! 

We get shoulder pain sufferers calling by the dozens every week. 

Here’s your answer: There are many reasons why the shoulder keeps hurting, and there are many minimally invasive, safe treatments that can help. Patients differ case to case and any recommended treatment is dependent on your particular issues. Proper professional assessment by pain specialists can help direct you to the best solution 

Here's What NYC Pain MD Doctors Can Do:  

Stem Cells & Regenerative Medicine 

Regenerative medicine is a conservative treatment option and might not be the final answer for all patients with degenerative hip injuries. However, many are successful long term and help our patients improve their quality of life, avoid the pain, downtime, disability, and most importantly risk that is associated with a major surgery like total hip replacement surgery. patients are encouraged to start a hip osteoarthritis diet with regular hip rehabilitation to help re-strengthen the hip joints back to proper function.  

1. Shoulder stem cell treatments offer a viable alternative and are very safe to try even for severe cases. Stem cell therapies using cells from your own body can also be repeated only if necessary after 6-12 months to achieve optimal results for people with active lifestyles. For patients with severe hip damage, stem cell treatment alone might not be sufficient and require additional interventions.  Stem cells may be accessed from your own bone marrow or body fat but in some cases, may come from derived Placental Cells. Again - each case requires specific methods. 

1. Platelet Rich Plasma: Often used in conjunction with stem cells (they act like “fertilizer” before “seeding”) can be very helpful in the regenerative process and is accessed from our own blood then concentrating the platelets up to 8-10 x normal for good results 
2. A2M: developed by an injured doctor himself, A2M used a special protocol to isolate anti-inflammatory proteins to bind inflammatory chemicals that eat away at your own cartilage tissue and promote inflammation and arthritis. 

Image-Guided Viscosupplementation 

As is often done to arthritic knees, NYC Pain MD offers this treatment for mildly to modestly arthritic shoulders.  Damaged hips often occur due to a “drying out’ process.  But, utilizing precisely placing natural lubricating “gel” back into the shoulder over several weeks . . . the rubbing, grinding, and inflammation that this causes can often be reduced offering improved mobility, decreased inflammation and lessened pain.   Theoretically, this could slow the degenerative process and lengthen the life of the previously unhealthy hip joint. 

Advanced Anti-Inflammatory Infiltration 

New and advanced anti-inflammatory injectables (pharmaceuticals) are now available most notably “Zilretta” which is formatted in “microbubbles’ and offers more extensive longer lasting pain relief compared to old-fashioned steroids. 

Soft Wave Tissue Regeneration Therapy 

Medical Scientists, Engineers, and Pain specialists have come up with an uber-advanced application using intensive, painless, and non-invasive acoustic sound waves that offer not only deep relief of inflammation and pain but also stimulate the release of your own ‘resident’ stem cells.  Within a short course of 10 – 15 minute procedures, Soft Wave Technology, often called ShockWave because of the buzzing sound it makes, can offer dramatic results in many cases.  Most say they get 20-50% relief …. After just one single treatment.   Of course, each case differs so results do vary from case to case. 

Call the nearest NYC Pain MD office today to schedule joint pain treatment, or book your appointment online.