By Dr. Louis Catalano
Everyone has shoulder pain at some point in their life. Most often, it is caused by rotator cuff tendonitis or shoulder bursitis – maladies that cause pain with activities such as raising the arm overhead, reaching into a coat sleeve, or reaching into the backseat of a car. Often times these pains are sporadic, but not severe.
However, here are three serious issues that your pain could be hinting at:
1. Frozen shoulder or adhesive capsulitis.
This disorder can occur with mild trauma or no injury at all. It is more common in diabetics. Patients present with gradually worsening pain and loss of shoulder range of motion. The range of motion that is often lost is external rotation, or the ability to twist one’s shoulder away from the body with the shoulder at the side and the elbow at a 90-degree angle. The patient can also gradually loose the ability to reach overhead or behind one’s back. This problem should not be ignored because early treatment, including physical therapy and a steroid (cortisone) injection, can make recovery more easy and rapid. By avoiding treatment, the shoulder can become more “frozen”, and make a full recovery of range of motion difficult, if not impossible. Also, surgery may be needed if the shoulder becomes “too frozen”.
2. A pinched nerve in the neck.
These patients present with pain in the back of the shoulder, neck or both. They will also complain of numbness and tingling down the arm and into the hand. Constant numbness/tingling is worrisome. Any weakness of the shoulder, elbow, or hand is very concerning as well. The important point is that any symptoms in the arm/elbow/hand, whether numbness or tingling or weakness, must be evaluated immediately. A pinched nerve in the neck can possibly result in permanent numbness/tingling or weakness, so medical attention should be sought promptly.
Pain from a cancer lesion around the shoulder will be severe, constant, and tends to be worse at night. The pain will worsen, and never “go away”. Most patients will be ill, with unexplained weight loss or fevers/chills. I have seen a few patients who sustained a shoulder fracture caused by cancer, and this was the first manifestation of the cancer! Some cancer, like multiple myeloma, develops in bone. Other cancers often metastasize to bone and these include lung, prostate, colon, thyroid, and breast cancers. If a patient has a history of one of these cancers, and has severe, unrelenting shoulder pain, that patient should seek immediate medical attention.
Not all shoulder pain could lead to these, but if you have a decreased range of motion, frequent back pain or any of the above listed symptoms, it might be worth giving your doctor a call.
– Louis W. Catalano III, M.D. is an assistant clinical professor of orthopedic surgery at Icahn Mt. Sinai School of Medicine, residency director and attending surgeon in the Department of Orthopedic Surgery at St. Luke’s-Roosevelt Hospital and attending hand surgeon at the CV Starr Hand Surgery Center at Roosevelt Hospital. Dr. Catalano has had his publications appear in the Journal of the American Academy of Orthopedic Surgeons, Hand Clinics, Journal of Hand Surgery and other leading surgical publications. He is presently on NY Magazine’s “Best Doctors List” and takes care of many musicians, dancers and athletes in the New York area. Dr. Catalano currently resides in Pelham Manor with his wife and two children.