I see a lot of shoulder pain and injuries in my office from a wide variety of causes. Our shoulders have the most movement than any other joint. Most joints move a couple directions or multiple directions a little. Shoulders are the only ones that can go around in a circle. The hip is similar, but doesn’t have nearly the same range of motion. This makes the shoulder very complicated, easy to injure, difficult to diagnose, and therefore difficult to treat well. Diagnosis of shoulder injuries or pain is the most important aspect, as it is in most things, but often needs to be more specific in the shoulder. If someone has low back pain that doesn’t seem to have any cause besides mechanical strain, you can do a number of different therapies that will all help. In the shoulder, if you’re not super specific about what you’re treating, it’s very difficult to get better. A proper assessment involves a comprehensive history to determine where the pain might be coming from, orthopedic tests, neurologic tests, movement/functional evaluation, palpation (feeling around), and possibly imaging.
If you’ve had a shoulder injury, x-rays are often necessary to rule out dislocation or fracture. Most shoulder injuries, however, involve the rotator cuff. This can’t be seen with x-ray and needs to be looked at another way. Mostly, MRI has been used to look at the rotator cuff, but through modern technology and advancement in ultrasound, the rotator cuff can easily be seen. This is sometimes even better than MRI to see the injured tendons, and can be done quickly in the office. The benefit of ultrasound imaging of the rotator cuff is that you are seeing a live picture and can even evaluate movement to see if there are any tears. It also provides a tremendous benefit through the ability to easily do follow-up images to evaluate progress. Ultrasound is quick and more cost effective than MRI for rotator cuff injuries. That’s why I trained in musculoskeletal ultrasound and now provide it in my office for diagnostic purposes.