Ask the Expert: Dr. Edward Craig, Shoulder Surgeon, Answers Your Questions on Shoulder Pain

by Dr. Edward Craig

Q1. What would cause sudden shoulder pain only in the front of the shoulders? Sometimes accompanied by redness and heat. Mostly occurring at nighttime.

Many problems in the shoulder cause pain in the front of the shoulder and most difficulties are made worse at night and can interfere with sleep. The problems can include rotator cuff tendinitis or tear, frozen shoulder, calcium deposits in the tendon and problems with the biceps tendon. You should speak with your physician to determine the cause of pain.

Q2. I play tennis every weekend for the past several years. My shoulder started to hurt after the last game. What can I do to treat the pain and prevent a rotator cuff tear? 

Before playing tennis, make certain you do a general body warm-up and stretch both arms in preparation for play. After tennis, ice the shoulder for 10-15 minutes. If pain persists, over the counter anti-inflammatory medications such as ibuprofen or Aleve can be helpful. The rotator cuff usually tears from a process of normal aging, wear and tear and sometimes overuse. Keeping the shoulder flexible with stretching range of motion exercises is important. There are also a number of rotator cuff strengthening exercises that can be done to maintain the tone and strength, and these are also helpful in preventing damage. It’s important to consult with your physician to determine the treatment.

Q3. My shoulder stiffens up and this sometimes makes movement painful. How would you treat the pain?

Most times, stiffness and restricted range of motion is the cause of pain in and of itself. The cause of the stiffness frequently is irritation of the tendons. If the problem is pain and stiffness (this has been called frozen shoulder and adhesive capsulitis), stretching exercises, ice and judicious use of anti-inflammatory medication usually restores flexibility and relieves pain. Working with a physical therapist is often helpful to achieve these goals. If the problem persists, evaluation of the shoulder by your doctor, with imaging studies such as x-ray or MRI may well be warranted. Consult with your physician and/or physical therapist.

Q4. I have shoulder arthritis. The pain is moderate. When would you recommend shoulder replacement for someone with this kind of condition?

The main indication for shoulder replacement is pain that interferes with quality of life and that is not relieved by non-operative means. Each person has his/her own definition of moderate pain and pain threshold, but in general, most people who have shoulder replacement do so because pain is severe—often interfering significantly with sleep, activities of daily living or recreation. There may be other treatment for moderate pain rather than joint replacement, such as mild stretching exercises, anti-inflammatory medication or injections into the joint of such medications as cortisone. Consult with your physician.

Q5. What’s the difference between a shoulder dislocation and separation?

The anatomy of the shoulder includes a ball (head of the humerus) that rests against the socket (glenoid fossa). The head of the humerus is held in the glenoid socket by soft tissues. On top of the shoulder is a bump where the collarbone (clavicle) meets the shoulder cap (acromion) to form a joint (acromioclavicular joint). The clavicle is held in place against the shoulder cap by a series of soft tissue ligaments.

Dr. Edward Craig, Shoulder Surgeon

With a shoulder dislocation, the main ball and socket of the joint is affected, and the ball moves out of the socket, partially or completely. When this occurs with trauma, most often the soft tissues which hold the ball in the socket are damaged, permitting the ball to go out of the socket, or dislocate.

A shoulder separation does not involve the main ball/socket, but involves the small joint (bump) on top of the shoulder where the collarbone meets the shoulder cap. When the ligaments holding the collarbone against the shoulder cap are damaged, the collarbone no longer is kept in place and “separates” from the shoulder cap. Thus a shoulder separation is not part of the main ball/socket joint, and is usually less painful and less serious than a dislocation.

Next week Dr. Brion Reichler, Neurologist, will answer your questions on gait and balance disorders. Write your questions on the wall or email socialmediacontact@hss.edu.