Shoulder Pain
Marc Darrow, M.D., J.D.

Tendonitis in the shoulder is often from an Inflammation as a result of the wearing process that takes place over a period of time. It can also occur from an unusual, awkward movement or fall.

Sometimes, excessive use or injury of the shoulder leads to inflammation and swelling of a bursa, a condition known as bursitis. Bursas are fluid filled sacs located around the body and joints. They lessen the friction caused by movement of a joint. Bursitis often occurs in association with rotator cuff tendonitis. Symptoms of shoulder bursitis include mild to severe pain, limiting the use of the shoulder.

In extreme cases the joint stiffens into adhesive capsulitis, a painful stiffness and immobility often described as "frozen shoulder."

Shoulder impingement syndrome involves one or a combination of problems: inflammation and/or swelling of the bursa located just over the rotator cuff, inflammation of the rotator cuff tendons (tendonitis), or calcium deposits in tendons—called calcific tendonitis, (caused by wear and tear or injury).

The main problem is usually that the acromium or a bone spur puts pressure on the supraspinatus tendon. This type of injury usually occurs as a result of wear and tear and typically in athletes whose sport requires repetitive overhead movements such as serving in tennis, swimming, strength training or weight lifting, and golfing.

This injury is also seen frequently in baseball pitchers and basketball players, where a great deal of overhead arm motion is required.

The symptoms include pain from the shoulder to the elbow, especially when the arm is raised above the head, reduced arm strength and range of motion without pain.

Because inflammation is present, a patient will usually be told to immobilize the area to prevent further irritation and inflammation, and be prescribed anti-inflammatory medication and perhaps a cortisone injection.

A Proper Diagnosis
A proper diagnosis of shoulder pain is essential to determine the root cause of the problem and the proper method of treatment because many shoulder conditions are caused by specific activities, such as over use caused by excessive workouts, a detailed medical history is an invaluable tool.

A physical examination should also include screening for physical abnormalities—swelling, deformity, muscle weakness, and tender areas—and observing the range of shoulder motion—how far and in which directions the arm can be moved.

Although x-rays may be helpful in defining problems, more elusive ones may require computerized tomography (CT scan), which provides a more detailed view of the bones. Electrodiagnostic studies such as the electromyogram (EMG) and a nerve conduction study can indicate whether pain or weakness in the area is coming from a pinched nerve in the neck, or a peripheral nerve injury away from the neck, or down the arm. Magnetic Resonance Imaging (MRI) and ultrasound are other safe and effective diagnostic tools, providing images of the soft tissues without using radiation. An arthrogram is an x-ray, CT or MRI in which dye is injected into the joint for added contrast. However studies have shown that the advanced technologies commonly used to diagnosis injuries are grievously insufficient to show where the pain is coming from.

This is when a Prolotherapy doctor and his ability to reproduce pain by touching is invaluable. If you can put your finger on the exact spot that is causing the pain, then there is a high probability that you are a candidate for shoulder Prolotherapy since most shoulder problems involve the soft tissues—muscles, ligaments, and tendons—rather than the bones. These soft tissue injuries are precisely the kinds of injury that respond so effectively to Prolotherapy.