Shoulder Surgery: Diagnostic Aids

Shoulder surgery is not something to be taken lightly. When it comes to intrusive surgeries of this kind, most primary care practitioners realise that it is essential to approach initial treatment very conservatively. The shoulder is the joint where adequate steroid injection techniques can be most helpful- more than any other structure in the body.

The diagnosis of the cause of shoulder pain can be greatly simplified by taking into account certain fundamental principles. For example, the age and gender of the person complaining of discomfort provides a very important guideline. Some types of shoulder pain and disorders occur with high frequency in certain age groups and gender combinations. Listed below you’ll find a series of commonly occurring shoulder maladies as well as the groups it generally tends to affect. Used in conjunction with pain location, these parameters can be quite useful in making a diagnosis after a clinical examination.

Commonly occurring shoulder maladies:
1. Thoracic Outlet Syndrome (young females aged 14 to 20)
2. Shoulder instability due to previous dislocations (young athlectic males aged 14 to 21 participating in sport). In this instance there is often a previous injury where the shoulder was dislocated the first time.
3. Shoulder instability or Os-acromiale (young physically active males and females aged 18 to 30 years old)
4. Rotator Cuff Impingement Syndrome (males and females 40 years and older)
5. Frozen shoulder (females 45 to 55 years old)
6. Calcific Tendonitis (females and males 40 to 60 years old)
7. Acromio-clavicular joint pain (active sporting males between the ages of 35 to 55 who complain of pain on top of the shoulder)
8. Rotator Cuff Tears (males and females 50 years and older)
9. Osteoarthritis of the shoulder (males and females aged 60 years and older)

The above information relates conditions that commonly occur in certain gender and age groups which tend to request shoulder reconstruction surgeries. Further factors that may help in making a diagnosis includes both the nature and localisation of the pain.

Localisation of the pain:
1. Pain on top of the shoulder may be caused by AC joint problems.
2. Pain in the shoulder and outside of the upper arm could be following the pattern of Rotator Cuff problems that include rotator cuff impingement, tendonitis, calcific tendonitis and rotator cuff tearing.
3. Pain at the back of the shoulder usually indicates arthritis.
4. Pain in the neck and upper part of the shoulder may be caused by a referred problem from the neck.
5. Pain in the neck or shoulder that radiates down the arm and into the hand could be linked to neurological complications like thoracic outlet syndrome or disc problems in the neck.
6. Night pain occurs with most shoulder problems. Shoulder instability does not commonly affect sleep but most other conditions do when a person lies down at night. The reason is that any inflammation that might be present is worse when the position of the shoulder is lower due to the pressure effect of gravity.
7. Constant or intermittent pain: Most mechanical reasons for pain (e.g. rotator cuff tears) mostly cause discomfort only with certain movements e.g. lifting the arm. On the contrary, certain conditions cause constant pain unrelated to movement – these would indicate nerve conditions like thoracic outlet syndrome.

Nature of the pain:
Acute “blinding” pain usually occurs when calcium is absorbed by a person who suffers from calcific tendonitis. Other conditions may cause intermittent pain depending on the position of their arm and the activity being performed. If the pain is constant and runs from the neck down to the shoulder and hand, it is most likely from a nerve problem in the neck or thoracic outlet. If the pain is more mechanical and occurs during movement only it would suggest a damaged structure in the shoulder.

As previously stated, shoulder reconstruction is something that has to be considered very carefully. With the use of these diagnostic guidelines primary care physicians will be able to make a more accurate diagnoses and research the most effective treatment available. Invasive shoulder surgery can offer great relief for patients suffering from debilitating pain but non-invasive treatment should always be considered first.

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