Condition: Shoulder tendon and muscle injuries can occur in any of the four muscle-tendon groups that surround the shoulder.
Background: Two common types are rotator cuff tears (RCTs) and long head of biceps tendon (LHB) tears. These tears typically occur traumatically, through falls, overhead sports, direct force or penetration. However, they can also develop non-traumatically through aging, wear and tear over time, or long-term changes from a previous injury. Another type is a pectoralis major (PM) tear. This occurs in the tendon that attaches the chest muscle to the upper arm bone and is typically associated with indirect trauma, like excessive weightlifting.
Risk Factors: People aged 40 or older are commonly at increased risk. Athletes or people with jobs that require repeated overhead motion are more at risk (i.e. pitchers and swimmers), and pre-existing injury also increases risk.
History and Symptoms: The primary symptoms include pain and weakening in the shoulder.
Physical Exam: The physician will examine the area for muscle tone, bruising or deformity, as well as range of motion and strength. They will also check for symmetry, and examine the opposite shoulder as well as the neck, to rule out any neck or spine issues. Special physical exam maneuvers specifically directed towards the rotator cuff and biceps tendon will be performed.
Diagnostic Process: History and physical examination findings including special testing will be considered and if needed, may be compared to imaging of the shoulder (i.e. x-ray, ultrasound, MRI)
Rehab Management: Physical medicine and rehabilitation (PM&R) physicians well equipped to manage shoulder and muscle injuries due to expertise in neuromuscular anatomy and physiology. PM&R physicians develop rehabilitation strategies to increase range of motion, stabilize and strengthen the shoulder joint, reduce pain, and restore function. These plans are carried out by physical therapists and also include lifestyle modifications. PM&R physicians are able to prescribe the necessary medications to reduce pain and inflammation. If these measures don’t help, rehabilitation physicians maintain technical expertise to perform many types of injections to reduce pain and inflammation. The PM&R physician is uniquely positioned to address each of these factors to accurately diagnose and treat shoulder pain while restoring, function to each person’s everyday life.
Other Resources for Patients and Families: The National Institutes of Health offers resources on shoulder problems in several languages and can mail print copies to patients and families.