Shoulder pain is the third most common musculoskeletal complaint after knee and back pain. Even simply raising an arm can trigger sharp pain, and nighttime shoulder pain frequently wakes patients from sleep. Shoulder pain should not be casually dismissed as frozen shoulder. There is a significant chance it could be a rotator cuff tear, in which the shoulder tendons are torn.
"The shoulder joint is the only joint in the body that can move 360 degrees, which means it is used heavily and equally vulnerable to damage," said Dr. Yeo Woo-jin, director of Barun Sesang Hospital and a leading specialist in shoulder disorders. "Shoulder conditions are also degenerative diseases. As people age, blood circulation to the tendons decreases, and the more the shoulder is used, the more damage accumulates."
In an episode of Seoul Economic TV's "Now, the Best Doctors" airing at 9 p.m. on the 4th, Dr. Yeo Woo-jin, an orthopedic surgeon at Barun Sesang Hospital, appears to explain the causes, major conditions, treatments, and prevention methods for shoulder pain.
◇ Three Major Shoulder Conditions: Rotator Cuff Tear, Frozen Shoulder, Calcific Tendinitis
Many people assume all shoulder pain is frozen shoulder, but rotator cuff injuries are actually far more common. "Statistically, 60 to 70 percent of shoulder pain patients who visit hospitals have rotator cuff tendon injuries," Dr. Yeo said. "Frozen shoulder is closer to a symptom than an actual disease name."
The three major shoulder conditions are frozen shoulder, rotator cuff tear, and calcific tendinitis. Frozen shoulder is a condition in which repeated inflammation in the joint capsule surrounding the shoulder causes it to thicken, shrink, and stiffen. In this case, patients cannot raise their arm on their own, and even with someone else's help, the arm cannot be lifted beyond a certain angle. In contrast, rotator cuff tears generally maintain a certain range of motion, but are characterized by pain and loss of strength at specific angles.
Frozen shoulder is commonly believed to heal on its own over time, but Dr. Yeo stressed that such assumptions should not be made. Over the long term, 10 to 20 percent of cases can result in permanently reduced range of motion. Therefore, if the shoulder is progressively stiffening and pain is worsening, patients should seek active treatment at a hospital. Stretching can help, but it is difficult for patients to perform correctly on their own when pain is severe, he explained. When patients visit the hospital, doctors use a technique called closed manipulation, in which the stiffened joint capsule is forcefully torn by hand, followed by rehabilitation therapy to aid recovery.
Calcific tendinitis is a condition in which calcium deposits form inside the tendon. It typically causes no symptoms, but excruciating pain can develop when the calcium begins to dissolve and swell. The pain is characteristically severe enough to send patients to the emergency room. The exact cause remains unclear, but researchers believe it is related to a phenomenon in which damaged tendon cells are replaced by cells that produce calcium deposits during the regeneration process. Some patients show a constitutional tendency to develop calcium deposits in other parts of the body as well.
Rotator cuff tears are mostly caused by degenerative changes associated with aging. "In people over 70, even without symptoms, more than half show some degree of tearing when examined," Dr. Yeo said. In other words, it is a type of change similar to wrinkles that comes with age. However, if damaged tendons are continuously overused through work or exercise, pain can develop and progress to actual tears. Falls in which the arm is braced, traffic accidents, and sports injuries can also cause tears, but overall, degenerative tears are more common.
◇ Treatment Varies by Degree of Tendon Tear
