Shoulder Pain Management

Other Common Causes of Shoulder Pain

Acromioclavicular separation
Adhesive capsulitis (Frozen shoulder)
Avascular necrosis of the humeral head
Axillary-subclavian venous thrombosis
Brachial plexus injury
Calcific tendonitis
Charcot or neuropathic arthropathy
Gout
Neurologic injuries (C5-C6) caused by repetitive trauma
Peripheral nerve injury
Radiculopathy
Referred pain of cardiac, pulmonary or visceral origin
Septic shoulder
Soft tissue or bone tumor
Ganglion cyst of the shoulder
Symptomatic os acromiale

Acromioclavicular separation – A shoulder separation. Most shoulder separations are actually injuries to the acromioclavicular (AC) joint. The AC joint is the connection between the scapula (shoulder blade) and the clavicle (collarbone). Shoulder dislocations and AC joint separations are often mistaken for each other. But they are very different injuries.

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Adhesive capsulitis – Also known as Frozen shoulder, is an inflammatory condition that restricts motion in the shoulder. The capsule of a shoulder joint includes the ligaments that attach the shoulder bones to each other. When inflammation occurs within the capsule, the shoulder bones are unable to freely move within the joint.

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Avascular necrosis of the humeral head – Also known as osteonecrosis, aseptic (bone) necrosis and ischemic bone necrosis. A disease resulting from the temporary or permanent loss of blood supply to an area of bone. Without blood, the bone tissue dies and the bone collapses. If avascular necrosis involves the bones of a joint, it often leads to destruction of the joint articular surfaces.

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Axillary-subclavian venous thrombosis – Paget-Schroetter syndrome, or “effort” thrombosis of the axillary-subclavian vein, is an uncommon deep vein thrombosis usually caused by excessive upper limb activity. It may cause post-thrombotic syndrome, leading to significant disability if not treated appropriately.

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Brachial plexus injury – The brachial plexus is a network of nerves that conducts signals from the spine to the shoulder, arm and hand. Brachial plexus injuries are caused by damage to those nerves. Brachial plexus injuries can occur as a result of shoulder trauma, tumors or inflammation.

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Calcific tendonitis – A disorder characterized by deposits of hydroxyapatite (a crystalline calcium phosphate) in any tendon of the body, but most commonly in the tendons of the rotator cuff, causing pain and inflammation. The condition is related to and may cause frozen shoulder (adhesive capsulitis).

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Charcot or neuropathic arthropathy – A progressive destruction of bone and joints, which is usually caused by unrecognized injury and occurs in people who have peripheral neuropathy. Peripheral neuropathy is a disorder of nerves that results in the loss of protective sensation, which prevents an individual from detecting injury. Neuropathy may have many causes, but occurs most commonly in people with diabetes mellitus and in those who abuse alcohol.

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Gout – A crystal deposition disease hallmarked by elevated levels of uric acid (hyperuricemia) in the bloodstream. In this condition, crystals of monosodium urate (MSU), or uric acid, are deposited on the articular cartilage of joints, tendons and surrounding tissues. It is marked by transient painful attacks of acute arthritis initiated by crystallization of urates within and about the joints and eventually leads to chronic gouty arthritis and the deposition of masses of urates in joint and other sites, creating tophi. Gout results from a combination of prolonged elevation of uric acid and overall acidity in the bloodstream. In isolation, neither elevated uric acid nor acidity is sufficient to cause gout.

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Neurologic injuries (C5-C6) caused by repetitive trauma – Nerve damage to the cervical vertebrae (C5-C6). See also: Brachial plexus injury; Radiculopathy.

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Peripheral nerve injury – Describes damage to the peripheral nervous system, which transmits information from the brain and spinal cord to every other part of the body. More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development and prognosis. Impaired function and symptoms depend on the type of nerves – motor, sensory or autonomic – that are damaged. Some people may experience temporary numbness, tingling and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction.

Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are caused by systemic disease, trauma from external agents, or infections or autoimmune disorders affecting nerve tissue. Inherited forms of peripheral neuropathy are caused by inborn deviations in the genetic code or by new genetic mutations.

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Radiculopathy – Not a specific condition, but rather a description of a problem in which one or more nerves are affected and do not work properly. The emphasis is on the nerve root. This can result in pain, weakness, numbness or difficulty controlling specific muscles.

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Referred pain of cardiac, pulmonary or visceral origin – A term used to describe the phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury’s origin.

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Septic shoulder – An infection in the joint (synovial) fluid and joint tissues. The infection usually reaches the joints though the bloodstream, although some joints may become infected due to an injection, surgery or injury. Different bacteria and viruses can infect a joint and usually are associated with a person’s age. The following types of infectious organisms have been associated with septic arthritis:

• Staphylococci (common bacteria that often cause skin infections)
• Haemophilus influenzae (bacteria that can infect the larynx, trachea and bronchi)
• Gram-negative bacilli (a group of bacteria, including escherichia coli, or E. coli)
• Gonococci (bacteria that causes gonorrhea)
• Streptococci (a group of bacteria that can lead to a wide variety of diseases)

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Soft tissue or bone tumor – Bone and soft tissue tumors form in the body’s connective tissue, which includes bone, cartilage, blood and fat. Some, but not all, of these tumors are malignant or cancerous. Malignant tumors are often called sarcomas. Each sarcoma is named after the normal body tissue type it most resembles. Benign tumors tend to grow in one spot and rarely extend out from that spot to other areas of the body.

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Ganglion cyst of the shoulder – A bump or mass that forms under the skin. Most commonly, ganglions are seen on the wrist (usually the back side) and fingers, but they can also develop on the shoulder, elbow and knee. These form when tissues surrounding certain joints become inflamed and swell up with lubricating fluid. They can increase in size when the tissue is irritated and often can “disappear” spontaneously. These masses or cysts appear to grow sometimes, but they are not tumors or cancerous.

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Symptomatic os acromiale – Os acromiale, the joining of the acromion to the scapular spine by fibrocartilaginous tissue rather than bone, is an anatomic variant that has been reported in a small portion of the population worldwide. Os acromiale has been identified as a contributor to shoulder impingement symptoms and rotator cuff tears. Os acromiale is an uncommon cause of shoulder pain, with symptoms often resulting from an unstable meso-acromion. The associated pain may be due to impingement from the unfused fragment, a concomitant rotator cuff tear or gross motion at the os acromiale site.

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