Shoulder Pain

Shoulder Pain - Diagnostics & Treatment Options

Shoulder pain

As a board-certified orthopedic surgeon, Dr. Joseph L. Finstein often sees patients who come in and say, “my shoulder hurts.” They’re often unsure of the cause, or have misdiagnosed themselves.

Either way, this begins a conversation which can lead to a number of different diagnoses, treatment plans and recovery paths. Every issue is different, and every patient is unique. Whatever you do, Dr. Finstein adds, address shoulder pain as early as possible.

Step One - Get an Evaluation for Shoulder Pain

“I’d encourage people with shoulder pain to come and be seen,” Dr. Finstein says, “because a lot of people think, ‘Oh, it’s just a sprain’ or something like that, and they may in fact have a full-thickness rotator-cuff tear. Or they think it’s a contusion, when in fact they have a displaced fracture that requires treatment. My advice is always to be seen early by a medical professional. Often, if we catch it early, these issues can be more easily treated.”

"My advice is always to be seen early by a medical professional. Often, if we catch it early, these issues can be more easily treated."
- Joseph L. Finstein, MD

Step Two - The Diagnostic Process

So, how would that visit go? In the following Q&A, Dr. Finstein walks potential patients through every step of what happens after you tell a health-care professional, “my shoulder hurts.”
Shoulder Pain Questions
What are some of the incorrect assumptions patients make about shoulder pain?
Shoulder Pain Answers
“I think most people think, ‘If I have pain in my shoulder, then it must have something to do with my rotator cuff.’ Certainly, a high percentage of shoulder issues can have something to do with the rotator cuff, but there are many other reasons for the pain.”
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What are the most common shoulder conditions?
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“I’d say subacromial bursitis; we certainly see our share of rotator cuff tears and labral tears – those are probably the most common. If I had to add something else, I’d say shoulder arthritis, whether it be humeral or AC (or acromioclavicular) joint. That would probably be next.”
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What is your diagnostic process?
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“When someone comes in with shoulder pain, we generally try to find out how long it has been bothering them. Where does it hurt? When did you first notice it? What were you doing during those periods of time? Is this their dominant arm? What types of activities bother them most? Those answers help us hone in, right away. Then we can examine them, once we know what we’re looking for. We’ll then use diagnostic tests in the office to narrow it down further to see if there is a spur or if they are having arthritic-type symptoms that we might be able to see on X-ray. Is this a traumatic thing, where they’ve a fracture of the shoulder? Or is this more an issue of calcium? With something like calcific tendonitis, calcium deposits build up in your muscles or tendons, which we can see quite readily with an X-ray.”
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How does a treatment plan ramp up? What are the variables?
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“Most of the time, unless I’m really suspicious of there being a tear of some kind whether it be labral or rotator cuff or some obvious fracture that would require operative intervention right off the bat, we’ll do anti-inflammatories. Now, these days there can be a lot of complications: patients with gastric operations or patients with previous ulcers, and people on blood thinners. So, with shoulder pain we can’t always go straight to NSAIDS, but we’d like to if we can. We try to use a good bit of Tylenol, as well. Depending on what the pathology is, it might be a run of physical therapy. Sometimes, it might be an injection. It’s very pathologically dependent.”
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How effective long term are options like injections? Should that be considered more of a temporary fix to a longer-term problem?
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“It depends on what the problem is. Some people who have subacromial bursitis, which we see quite frequently, injections can be curative. We give them the injection, we give them the anti-inflammatory, then we send them to physical therapy and that can be the end of it. There are some patients who require a second injection. But in that instance, it’s not an attempt to dull the pain; it’s an attempt to remove the pain.”
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Is surgery considered a last resort?
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“If someone has a dislocated shoulder, then we’ll have to do a manipulation to get the shoulder back in. If they have a displaced, fractured shoulder then we would have to fix the fracture. If it’s a rotator-cuff tear, then we’d proceed immediately to surgery – unless it’s a partial tear, then they should proceed with non-operative treatments.  

With frozen shoulder (or adhesive capsulitis), we try to avoid surgery if we can. That’s where the injections can be very helpful. Anti-inflammatories can also be very helpful – and therapy can certainly help, as well. If patients are plateauing, or otherwise not making progress and having significant shoulder pain after trying all of the other alternatives, then surgery is a good option. It’s all pathologically dependent.”

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Are there negative consequences for avoiding early diagnostics?
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“If you’re talking about a time table of a few weeks, I don’t think there’s a downside – but if you are talking about a number of months or years, then there certainly can be. Using the example of a rotator cuff, if you have a traumatic tear, then those don’t usually do that well with therapy. Usually the atraumatic years, or degenerative-type tears, do very well with physical therapy and many times can avoid surgery.”
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What does follow-up care look like?
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“After the initial treatment, we’ll typically see them in four-to-six weeks to access their progress. Depending on how they are doing with that, we may order additional tests or additional therapy or additional medication. We’ll judge where they are at that point.”
 

Waiting Can Be a Mistake with Shoulder Pain

Does your shoulder hurt? Don’t wait, and don’t make the mistake of trying to figure out a diagnosis on your own. (As mentioned, it’s probably not a rotator cuff!) Call today to set up an appointment with Dr. Finstein and get on the road to recovery.
 

About the Doctor

Dr. Joseph L. Finstein, MD

Dr. Joseph L. Finstein, MD

Joseph L. Finstein, MD specializes in sports medicine, focusing on shoulder, elbow, hip, knee, foot, and ankle injuries. Dr. Finstein completed his Sports Medicine Fellowship at the Rothman Institute at Thomas Jefferson University  He is currently the team physician at De La Salle High School. Prior to joining Pontchartrain Orthopedics & Sports Medicine, Dr. Finstein assisted in the care of athletes from the Philadelphia Eagles, Flyers, Phillies, Soul and St. Joseph’s University.

 

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