Many physicians find shoulder pain difficult to diagnose and treat, according to a review article from the Cleveland Clinic. But prompt diagnosis is important, since there are multiple conditions that can cause shoulder pain, and some of them are likely to get worse without treatment. Inflammatory conditions, including arthritis and capsulitis, are treated differently from other conditions such as rotator cuff tear. You can be prepared to help your doctor make the correct diagnosis if you review your own history before your appointment. Here are some of the questions to expect:
When did the pain start? Inflammatory conditions tend to start gradually, while traumatic injuries cause pain immediately. However, a patient with arthritis or capsulitis may notice an increase in pain following an obvious injury, and fail to report the complete history.
Which activities aggravate the pain, and which positions help relieve it? Details are important. The reference article lists four common diagnoses and 12 less-common conditions that should be considered. You may want to consider keeping a journal of what you're doing and how your shoulder feels for a few days before you see the doctor.
Where does it hurt? Again, be very specific. Does the pain radiate to the neck, shoulder blade, elbow, or fingers? Is it worse in front or back?
In addition to reviewing your history, be prepared for a physical examination that includes some pain. The review article reports that a diagnostic injection of lidocaine (a local anesthetic) may be helpful in reducing pain for the exam, so that the doctor can evaluate range of motion and strength more accurately. However, one study in the literature showed that the needle was correctly placed only 37 percent of the time. If your pain is severe, you may want to ask your doctor about oral pain killers before the physical exam. X-rays or magnetic resonance imaging may also be part of the diagnostic tests.
Treatment depends on the diagnosis, and may include physical therapy, activity modification, pain medication, corticosteroid injection, and surgery. The corticosteroid injections are difficult to administer: one study quoted in the review article found that the needle was accurately placed only 70 percent of the time.
Surgery is required only in select cases. Early physical therapy is recommended for most of the common shoulder pain conditions.
Reference:
Codsi MJ, “The painful shoulder: When to inject and when to refer”, Cleveland Clinic Journal of Medicine 2007 July; 74(7): 473-87.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.