Shoulder pain is common. It is the symptom of many diagnoses in the shoulder, and results from irritation of several anatomic structures in the shoulder making the exact diagnosis and treatment of shoulder pain a challenge for practitioners.
Diagnosis in the Shoulder
The main pain generators in the shoulder are the subacromial bursa and rotator cuff, the long head of biceps tendon, the acromioclavicular joint and the glenohumeral joint including the labrum and joint capsule. Less common causes of pain include nerve entrapments and neuritis as well as myofascial or muscle pain. Experience with the diagnosis of shoulder issues and a detailed exam is the first step to determining the cause of shoulder dysfunction.
Imaging of the Shoulder
Many people know about the detailed information that a shoulder MRI can provide about the inner workings of the shoulder joint. However, there are several ways to investigate shoulder issues, and each diagnosis demands a different approach to diagnosis.
The options for imaging include:
These can be of the shoulder, humerus or can focus on the acromioclavicular joint (AC joint).
The soft tissue of the shoulder can be seen using ultrasound imaging. The rotator cuff, biceps tendon and AC joint can all be seen using this modality. Also, examinations can be performed dynamically, or while patients move their shoulder, to provide additional information.
These cross-sectional scans provide detailed information about the bony structure of the shoulder. The images can be used to create 3D models of the shoulder joint to help with surgical planning in cases of glenohumeral arthritis and instability repairs where bone loss is a concern. It is often difficult to see details of the rotator cuff on CT scans.
For the imaging of the rotator cuff a standard MRI provides significant details. MRI is particularly useful to assess the rotator cuff muscles in cases of rotator cuff tears where there is atrophy of the muscle bellies.
MRI Arthrogram (MRA)
In this more invasive test gadolinium dye is injected into the glenohumeral joint by a doctor before an MRI. This highlights the capsule of the shoulder joint and help to better visualize the labrum. These exams are most useful in cases of instability or SLAP tears of the long head of the biceps.
Shoulder surgery addresses four main issues that can decrease shoulder function: pain, weakness, instability/dislocations and stiffness or lack of movement. The majority of shoulder surgery can be accomplished arthroscopically, which involves using small incisions to place a camera and specially designed tools into the shoulder joint in order to correct problems. Here is a link to some further information on arthroscopic shoulder surgery.
For some diagnoses, open shoulder surgery is required including in some cases of long head of biceps tendonitis, pectoralis major tears, shoulder instability with bone loss or failure of previous arthroscopic stabilization and conventional shoulder replacements for arthritis.
Many shoulder surgeries are performed using nerve blocks to limit pain. In addition, the majority of patients also have general anaesthesia during the procedure. This limits the discomfort that patients experience while they are having shoulder surgery and facilitates repairs by relaxing muscles and allowing appropriate positioning of the arm.