Shoulder pain has been an important cause of out-patient visits in elderly age group. Most common casues of which are namely:
- Rotator cuff pathology (Muscle swelling/ tear)
- Frozen Shoulder
- Trauma or Injury
- Soft tissue swelling (Fibrofasciitis)
- Neck pain (trapezitis)
- Cardiac conditions
Most patients have following compliants:
- Restricted range of movements
- Unable to sleep
- Loss of Grip
- Numbness in affected side
- Neck, Elbow and Hand pain
The treatment of these completely depend on the clinical history and chronicity of problem. Radiological investigations also support the clinical diagnosis and help plan treatment. Most patients do well with conservative treatment which includes:
- Ice Packs
- Anti-Inflammatory medicines
Some patients have to be administered Steroid/Local anaesthetic/Normal Saline to augment the conservative treatment. There is a subset of patients which donot get better with conservative treatment and are considered candidates for surgery.
The Indications on clinical examination and history which indicate investigation of candidates usually have these points in common:
- Disease process not improving with conservative treatment (Usually 6 weeks)
- Worsening of disease or symptoms despite treatment (Usually>3 weeks)
- New symptomatolgy along with presenting complaints
- Restricted Range and not able to perform activities of daily living
- Dependence for personal hygiene maintenence
- Inability to Lift/resist falling of the arm (Drop Arm Test)
- Persisting numbness in localised area – ?Cervical Radiculopathy (Nerve impingement)
- Intractable pain with Injury/fall/fever.
These patients should be investigated for the underlying pathology with help of Radiological (Xrays, MRI, CT scans, Ultrasound) and/or Hematological investigations (Routine Blood investigations) to rule out surgically treatable cause of pain.
Rotator cuff pathology and frozen shoulder remain two most common diagnosis & have excellent functional and objective outcomes with both conservative and surgical treatment. Usual time of recovery is from 3weeks to 3 months depending on diagnosis and its severity.
Post Operative radiographs showing arthroscopic double row rotator cuff repair surgery.