1. Neck Pain
A. Radiating pain beyond forearm – Cervical radiculopathy
Intro: Cervical radiculopathy is a condition involving irritation of the nerve roots coming out of the cervical spine (neck).
Symptoms: Numbness, tingling, and/or sharp burning pain radiating down either arm. There may be associated weakness as well.
Treatment: Warm compress, physical therapy, and medication. If unresolved, an epidural steroid injection or even surgery may be occasionally needed to treat this condition. It is advised to seek medical attention for evaluation of this condition as soon as possible.
B. No radiating pain – Neck muscle spasm/cervical spine disease
Intro: Neck muscle spasm is a common cause of neck pain that may be brought on by neck muscle weakness, neck muscle strain, or an underlying cervical spine condition such as arthritis. Improper posture with cellphone or computer use may exacerbate this condition.
Symptoms: Tightness and pain on motion of the neck.
Treatment: Warm compress, physical therapy, and medication. If underlying spine condition is involved an epidural steroid injection or even surgery may be occasionally done. It is advised to seek medical attention for evaluation.
2. Acromioclavicular joint disorder
Intro: The acromioclavicular joint is a joint on top of the shoulder where the collarbone meets the shoulder blade. Pain in this joint may be a result of overuse, old age, or a history of past injury.
Symptoms: Brought on by pressing onto the joint, or by raising the arm above the shoulder.
Treatment: Ice, physical therapy, and medication. If unresolved, a steroid joint injection may provide relief, or surgery in rare unresolved cases. It is advised to seek medical attention as soon as possible if an injury is involved.
3. Shoulder pain
A. <18 years old – Multidirectional Instability
Intro: Multidirectional instability is a condition of the shoulder joint that typically occurs in younger individuals. It involves laxity of the shoulder joint in multiple directions.
Symptoms: Discomfort moving the shoulder or feeling of instability. This condition is brought on by overuse and commonly occurs in athletes.
Treatment: Physical therapy to strengthen the muscle groups around the joint.
B. <18-year-old baseball player – Little league shoulder
Intro: Little league shoulder is a condition of the shoulder joint among young baseball players, especially pitchers and catchers. It is often due to stress on the growth plate of the arm bone (humerus) while pitching, resulting in widening of the growth plate.
Symptoms: Discomfort moving the shoulder and pain.
Treatment: Cessation of throwing and physical therapy, followed by a throwing program before returning to play. If suspected, it is advised stop throwing and to seek medical attention for evaluation as soon as possible.
C. <60-year-old with limited range of motion – Frozen shoulder (adhesive capsulitis)
Intro: Adhesive capsulitis, also known as frozen shoulder, is a condition of the shoulder that involves thickening and stiffness of the joint capsule. It most commonly occurs in individuals around 40-60 years of age, with diabetes and thyroid disorders being a risk factor.
Symptoms: Decreased motion of the shoulder along with pain, especially when sleeping on the side. Frozen shoulder may resolve on its own but may take six months to over a year. Not moving the shoulder will likely worsen the condition.
Treatment: Physical therapy and medication. An steroid into the joint may help with this condition as well. For persistent conditions, manipulation under anesthesia or surgical release of the capsule may be done.
D. >60-year-old with limited range of motion – Shoulder osteoarthritis
Intro: Osteoarthritis of the shoulder is a degenerative joint disorder that may manifest the elderly naturally or in individuals with prior shoulder injury.
Symptoms: Pain and decreased motion of the shoulder.
Treatment: Physical therapy and medications. A steroid injection into the joint may provide relief as well. When nonoperative modalities fail, shoulder replacement surgery may be considered.
E. Anterior shoulder pain – Proximal biceps tendonitis
Intro: Tendonitis of the proximal biceps tendon involves inflammation of the tendon of long head of biceps muscle. This condition is caused by repetitive motion (overhead especially) or overuse. There may be degeneration of the tendon (tendinosis) as well.
Symptoms: Tenderness over front of shoulder and pain on certain motions.
Treatment: Physical therapy and medications. A steroid injection near the tendon may help provide relief. Regenerative treatment such as plasma rich platelet (PRP) injection, which promotes healing of the tendon, is another treatment modality for this condition. Surgeries such as arthroscopic tenodesis (repairing tendon) or tenotomy (cutting tendon) may be considered in refractory cases.
F. None of the above – Shoulder (subacromial) impingement
Intro: Shoulder/subacromial impingement is a common cause of shoulder which results from compression of rotator cuff tendons as it passes underneath the bony tip of the outer edge of the shoulder blade (acromion). This condition causes pain due to irritation of the rotator cuff tendons and the subacromial bursa, a synovial cavity between the acromion and tendons.
Symptoms: Pain on overhead activities and sleeping on the side.
Treatment: Physical therapy and medications. A steroid injection into the subacromial space may provide relief. Plasma rich platelet (PRP) injection, which promotes healing of the tendon, is another treatment modality for this condition. In rare unresolving cases, subacromial decompression surgery can be done, which widens the space where the tendons pass through.