Shoulder Pain: Causes, Treatments, and When to Seek Further Care

Shoulder pain

I would like to ask the doctor about my shoulder pain.
Currently, I am experiencing pain in the anterior side (around the biceps tendon area) and the supraspinatus region, as well as pain on the lateral side (which feels like radiating pain from the inside).
The pain worsens when I raise my arm.
About a month ago, I visited an orthopedic doctor who took X-rays and said there were no issues with the bones.
I then saw a rehabilitation specialist who performed an ultrasound examination and diagnosed me with bursitis and biceps tendonitis.
I underwent a series of treatments, including injections of dextrose solution, shockwave therapy, and corticosteroids.
After more than a month, I still have not improved.
The doctor noted that the ultrasound showed some improvement compared to the initial assessment, but I have not fully recovered.
I then consulted a traditional Chinese medicine practitioner who examined me and suggested that I might have a subluxation, possibly due to overuse of the shoulder (I frequently performed pull-ups about a year ago, and the current pain is also due to lifting heavy objects).
I mentioned to this practitioner that I had previously had X-rays taken, and he responded that subluxations cannot be detected on X-rays.
Is this statement correct? Should I seek further evaluation at a larger hospital for more detailed examinations? My left shoulder has been injured for three months now, and my right shoulder for two months, and I am unsure which specialist I should consult.
Thank you for your response, doctor.

Feiji, 20~29 year old female. Ask Date: 2021/07/06

Dr. Chen Yongxue reply Orthopedics

Hello, shoulder joint dislocation and subluxation can be diagnosed using X-rays.
In the case of tendonitis, injection therapy generally has a certain level of effectiveness.
It is often observed that when the tendon shows slight improvement, patients tend to resume activities that may harm the tendon (this does not necessarily involve heavy lifting or exertion; frequently, it is due to maintaining a posture for too long, such as using a computer or smartphone), leading to a recurrence of inflammation.
It is important to identify and address the underlying causes of the inflammation.
Please consult an orthopedic clinic for an examination.
Thank you.

Reply Date: 2021/07/06

More Info

Shoulder pain can be a complex issue, often stemming from various causes, including injuries, overuse, or underlying medical conditions. In your case, it seems that you've been experiencing persistent pain in the anterior and lateral aspects of your shoulder, particularly around the biceps tendon and supraspinatus muscle. This pain has been exacerbated when lifting your arm, and despite undergoing various treatments, including corticosteroid injections and physical therapy, you have not achieved the desired relief.

From your description, it appears that your shoulder pain may be related to several potential conditions, including bursitis, tendinitis, or even a rotator cuff injury. The fact that you have a history of performing pull-ups and lifting heavy objects suggests that overuse could be a contributing factor. Over time, repetitive stress on the shoulder can lead to inflammation of the tendons and bursae, resulting in pain and limited range of motion.

Your previous evaluations, including X-rays and ultrasound, indicated bursitis and inflammation of the biceps tendon. While these imaging studies are helpful, they may not always capture subtle injuries, such as partial tears of the rotator cuff or instability issues like subluxation. It is important to note that X-rays primarily show bone structures and may not reveal soft tissue injuries, which could explain why your traditional imaging did not identify any significant issues.

The claim made by the traditional Chinese medicine practitioner regarding "partial dislocation" (subluxation) not being visible on X-rays is partially correct. X-rays are not the best modality for diagnosing soft tissue injuries or subtle joint instability. An MRI (Magnetic Resonance Imaging) is often recommended for a more comprehensive evaluation of the soft tissues, including muscles, tendons, and ligaments. An MRI can help identify any tears in the rotator cuff, labral tears, or other soft tissue injuries that may not be visible on X-rays.

Given that your symptoms have persisted for several months and have not improved with conservative treatments, it would be prudent to seek further evaluation. A referral to an orthopedic specialist who focuses on shoulder injuries would be beneficial. They may recommend an MRI to assess the soft tissues more thoroughly and determine the most appropriate treatment plan.
In terms of treatment options, if imaging reveals significant soft tissue damage, surgical intervention may be considered, especially if conservative measures fail to provide relief. Physical therapy remains a cornerstone of treatment for shoulder injuries, focusing on strengthening the rotator cuff and improving shoulder mechanics. Additionally, modalities such as corticosteroid injections can help reduce inflammation and pain, allowing for more effective rehabilitation.

In summary, your ongoing shoulder pain warrants further investigation, particularly with an MRI to assess for any soft tissue injuries. Consulting with an orthopedic specialist will provide you with a clearer diagnosis and guide you toward the most effective treatment options. Remember, early intervention can often lead to better outcomes, so seeking care sooner rather than later is advisable.

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