By Jeff Daniels EBS Medical Columnist
The shoulder is one of the most sensitive joints in the entire body. Its design, which enables us to do so much, like swing the arm in a complete circle, throw a ball, throw a frisbee and lift over our head, makes the shoulder joint very vulnerable to “wear and tear” injuries, which accumulate as we age. Because we use our arms throughout the day for multiple tasks, a painful shoulder often results in a visit to the medical clinic.
Direct trauma to the shoulder is very common here in Big Sky, especially in the skiing and snowboarding season, when we dispense more shoulder immobilizers than knee braces. Activities like mountain biking and horseback riding account for acute injuries in the summer, but everyday tasks without direct trauma like using a broom, swinging a hammer or pushing a lawnmower can result in weeks of shoulder pain.
Even if you’ve never had a problem with your shoulders and you’re over 40, odds are that there’s lots of pathology in the soft tissue that surrounds the bones of the shoulder. We know this from looking at MRIs of normal people. The tendons that make up the rotator cuff get frayed, and sometimes severed, without producing symptoms—at least initially. The labrum of the shoulder, a ring of firm tissue that surrounds the glenoid bone and forms a socket for the ball of the humerus, can tear in various places, which can lead to pain and instability. The tendons from the biceps muscle in the arm passes through the shoulder, and are vulnerable because the sheaths they pass through can be torn.
These abnormalities are not seen on a plain X-ray, but are diagnosed with an MRI. Aside from diagnosing fractures and dislocations, X-rays can help understand changes in the actual bones of the shoulder. Just like the hips, knees, and vertebrae of the spine, over time, arthritic changes in the bones will produce distinct changes easily seen on an X-ray.
One of the most common shoulder problems I treat is pain caused by the impingement of the structures of the shoulder on one another, often inducing inflammation and swelling inside the joint. It is commonly referred to as an impingement syndrome, and can occur following minor strain or trauma.
The diagnosis of an impingement syndrome is usually made from the nature of the shoulder symptoms and by examining the shoulder. A good shoulder exam will often tell as much as an MRI, which needs to be done with an injection of dye into the joint, a process known as an MR arthrogram. Testing for pathology of the rotator cuff tendons and muscles, for bicipital tendinitis, for labral tears, and for any neurological abnormality should be done when impingement is suspected.
If the tests for impingement are positive and all else is negative, I will usually recommend a steroid injection into the shoulder. This is done easily, safely and painlessly. In most patients, it will result in immediate relief of pain because most of the injection is local anesthetic. Within a few hours, the steroid kicks in and suppresses the inflammation inside the shoulder joint, resulting in several months of improvement, which may last much longer.
Don’t let shoulder pain stop you from enjoying the summer.
Dr. Jeff Daniels was the recipient of the 2015 Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 800 medical students and young doctors to train with the Medical Clinic of Big Sky.