What is your orthopaedic surgeon thinking when you tell them that you have shoulder pain?
Surgeons are trained to think very systematically and pragmatically. Their first intent is to make the correct diagnosis. This involves determining why you have shoulder pain. Possible sources are: 1. Neck pain - a degenerative or acutely injured neck can damage the nerve supply to the skin and shoulder joint. This causes a burning pain, worse with neck movement, and less so with shoulder movement. 2. Shoulder - Rotator Cuff - the most likely source of shoulder pain is from your rotator cuff tendons. If they become inflamed, the bursa overlying thickens up to try and protect it (resulting in bursitis). The tendons grate over a spur, and eventually a hole forms. This can be painful at any stage of the process. 3. Shoulder - labrum - Labral tears are less painful, usually there is a click, when the shoulder is being used. This may cause a sharp pain. Severe labral tears result in shoulder dislocations which can be unpredictable. Once a surgeon has locked in a diagnosis, they are then thinking about treatment options. A surgeon should exhaust all non-surgical treatments prior to considering surgery. Non-surgical options include: 1. Anti-inflammatories. In some patients, once the swelling settles, the pain doesn't come back and this should be trialled for 1-2 weeks. 2. Steroids - likewise, a steroid injection can settle pain effectively, but should not be used more than 3 times in a single site. 3. Physiotherapy - good posture and correct strengthening programmes are vital at all stages of your treatment. Surgery - your surgeon will plan your bespoke surgery.