SHOULDER ARTHROSCOPY

Q: I have been bothered by shoulder and upper arm pain for months following a fall. My evaluation, including MRI has revealed no structural damage. What could be the problem? A:

It may have something to do with how the various structures that make up the shoulder are working together rather than any degree of true damage. The shoulder blade, or scapula, plays a critical role in the maintenance of normal shoulder function. The scapula contains the glenoid which is the socket of the shoulder joint so proper positioning and stability of the scapula will have implications on shoulder and arm movement. The scapula itself is designed to move and alterations in the appropriate motion of the scapula is termed scapular dyskinesis.

Scapular dyskinesis is an underappreciated source of ongoing shoulder difficulty for many patients. When the scapula does not rotate and retract properly as the arm is elevated it can lead to subacromial impingement and rotator cuff symptoms. The abnormal rotation, elevation and even resting posture of the scapula is common following surgery or significant trauma as the surrounding upper back muscles become deconditioned and stop moving the shoulder blade properly. Scapular dyskinesis can, however, be the result of even seemingly minor shoulder injuries. This can be a source of great frustration for patients as they struggle with upper arm and upper back symptoms of pain and crunching noise about the shoulder, termed crepitation. In most cases imaging tests such as MRI reveal minimal or no structural damage leaving patients confounded. Scapular dyskinesis in the absence of a more significant structural problem in the shoulder is treated with an appropriate physical therapy and rehabilitation program focused on strengthening the scapular stabilizer muscles. Improvement can take months and a patient, long term approach is often required. To learn more about common shoulder conditions visit ohioshouldercenter.com