Joseph Yao, M.D.

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Shoulder pain, Part I: tendonitis, bursitis

Shoulder pain is common and has numerous causes including arthritis, rotator cuff tears, a pinched nerve in the neck and cancer. Bursitis and tendonitis are the most frequent causes of shoulder pain. The rotator cuff consists of four muscles that go from the chest to the upper arm bone (humerus). They stabilize and move the shoulder joint. A piece of tissue called tendon attaches each rotator cuff muscle to the upper humerus. A sack (bursa) is located just above the top part of the rotator cuff.
     Inflammation to the tendon (tendonitis) and bursa (bursitis) causes pain. Pain is made worse with shoulder motion, especially when the arm is placed overhead. Raising the arm presses the humeral head up into the undersurface of the acromion (the bony roof of the shoulder), pinching the bursa and rotator cuff between the two structures. This is called impingement syndrome. Lying on the involved shoulder is often painful. Lifting objects can be difficult. It is natural for a person to avoid moving the painful shoulder, and this can result in stiffness called frozen shoulder.
     Shoulder tendonitis and bursitis often occur together and may be caused by overexertion or repetitive activities, especially when the arm is used above shoulder level. Truck drivers can develop shoulder tendonitis and bursitis by throwing ropes or chains while securing their loads onto trailers. Using their arms to help them climb in and out of their trucks can also cause these problems.
     Treatment includes avoiding use of the arm forcefully or above shoulder level. Lying on one’s side in bed or sleeping with the arm above shoulder level should be avoided. Other measures include oral nonsteroidal anti-inflammatory medications, steroid injections into the bursa, gentle motion exercises, local heat/ice and physical therapy. Simple tools such as a broomstick or an overhead rope-and-pulley can permit the uninjured arm to help move the injured arm and prevent the development of stiffness.
     Approximately 95 percent of shoulder impingement-related tendonitis/bursitis will heal within six months. Those with persistent pain may benefit from subacromial decompression (shaving bone from the undersurface of the acromion to reduce pinching of the bursa and rotator cuff). This is usually done using a lighted telescope device (arthroscope) inserted into the shoulder through small puncture wounds. Maximum improvement will be reached within six months following surgery.
     An MRI scan can accurately diagnose tears to the rotator cuff. IT can also provide information about whether the tear is partial or complete, in addition to the location and size of the tear.
     Dr. Joseph Yao has undertaken extensive subspecialty training in joint replacement after completing an orthopedic surgery residency. Dr. Yao has been in private practice orthopedic surgery since 1987, and he has treated many truck drivers for joint and nerve ailments.