Following an injury a couple of years ago I suffered, and continue to suffer from intense shoulder pain. Painkillers don't seem to help and it is making my life extremely uncomfortable. It is particularly painful when I move my arm away from my body which makes washing and dressing very difficult. It is also affecting my sleep as it is too painful to lie on. My GP thinks I may have 'rotator cuff disease' and has referred me to see a specialist. What kind of tests and treatment should I expect?
Mr Balachandran Venkateswaran, Consultant Orthopaedic Surgeon:
Shoulder pain is a diagnostic conundrum full of pitfalls. Your description fits most commonly with what we call rotator cuff tendonitis or in severe cases rotator cuff tear. With certain positions of the arm the inflamed bursa and the cuff tendon can become pinched and painful.
Rotator Cuff Disease
The rotator cuff is one of the most important tendon complexes (of four tendons) that helps with the movement and stability of the shoulder joint. It is prone to degeneration and tendonosis (a process of tendon wear and weakening) which can cause pain and may even rupture.
An inflamed rotator cuff (of the tendon and the bursa) is one of the most common problems seen in clinic. Tears of the rotator cuff can be symptomatic or asymptomatic, with the most common location being in the tendon on the top of the shoulder.
The pain is felt usually in the upper part of the arm and quite often radiates to the elbow. The pain feels like a dull ache with most activities and can be sharp in certain positions of the arm. You may not be able to reach your back pocket, fasten your bra strap, and comb your hair and, in severe cases are not able to do any overhead activities. In addition there is weakness with cuff tears which can be subtle in the small and medium tears.
There are various tests and examination techniques which help the surgeon with a diagnosis. An X-ray, ultrasound and/or MRI scan of the affected shoulder helps identify certain pathologies which help towards a diagnosis.
50% of patients get better without needing an operation. This is done by avoiding activity, having physiotherapy, non steroidal inflammatory drugs and subacromial injection of steroids. These measures should be tried for six months before considering surgery. The operation for tendonitis involves a procedure called arthroscopic (key hole) subacromial decompression. This is where the space under the acromion bone is increased so that the tendon is no longer pinched. In cuff tears, both open and key hole treatments can have good results. The advantage of key hole surgery is that it is minimally invasive and other procedures can be done simultaneously. Between 80 and 95% of patients who have this surgery are satisfied with the results. (For more patient information: www.spirehealthcare.com and www.shouldersurgery.org.uk)