By PP James Lam, Rotary Club of HK Northwest

Recently one of my Rotarian friends asked me whether he should see a heart specialist for his shoulder pain. He learnt from a TV programme that shoulder pain might be caused by heart problem. I re-assured him that the vast majority of the shoulder pain would be due to a shoulder origin. Only a small proportion would be due to cardiac origin.

With the abovementioned experience, may I take this opportunity to answer two simple questions.

“When should you seek help from an Orthopaedic Surgeon?”

“What causes your shoulder pain?”

Orthopaedics is translated into Chinese as “Bone Specialist” (骨科). In fact, this translation only relates to part of the spectrum of our practice. Orthopaedics is the medical specialty that focuses on injuries and diseases of your body’s musculoskeletal system. This complex system includes your bones, joints, ligaments, tendons, muscles, and nerves that allows you to move, work and stay active. We take care of patients of all ages, from newborns with congenital foot deformity, to athletes requiring arthroscopic surgery in order to return them to high level sporting activities, to older people with arthritis needing joint replacement. Of course, we also take care of anybody with a broken bone and torn ligament.

Our job nature includes:

  • Diagnosis of your musculoskeletal injury or disorder
  • Treatment with medication, exercise or surgery
  • Rehabilitation by recommending exercises or physiotherapy to restore movement, strength and function to pre-injury stage
  • Prevention in providing information to prevent injury or slow down disease progression (like what I am doing now)

Orthopaedic Surgeons perform numerous types of surgeries, including arthroscopy (treat problems inside a joint using small key-hole incisions and a minimally invasive approach), internal fixation (fixing broken pieces of bone using metal implants), joint replacement (when an arthritic or damaged joint is removed and replaced with an artificial joint) and soft tissue repair (mending of soft tissue, such as torn tendons, ligaments, nerve and blood vessels).

As for the second question, “What are the more common causes of shoulder pain?”

In fact, what most people call “the shoulder” is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm — from scratching your back to throwing a ball. Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The head of humerus fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A combination of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are called the rotator cuff. They cover the head of your upper arm bone and attach it to your shoulder blade.

The shoulder can move around freely in different planes. However, mobility has its price. It may lead to increasing problems with instability or impingement of the soft tissue or bony structures in your shoulder, resulting in pain. You may feel pain only when you move your shoulder, or all of the time. Many daily activities, such as combing your hair or getting dressed, may become difficult. The pain may be temporary or it may continue and require medical diagnosis and treatment.

Most shoulder problems fall into four major categories:

  • Tendon inflammation (bursitis or tendinitis) or tendon tear (which will propagate with time) or adhesive capsulitis (frozen or stiff shoulder)
  • Instability (dislocation or the joint going out of place)
  • Fracture (broken bone with severe pain, swelling, and bruising around the shoulder)
  • Arthritis

Other much less common causes of shoulder pain are tumours, infection, and nerve-related problems.

In the case of an injury of the shoulder causing intense pain, you should seek medical care as soon as possible. In the initial visit to the Orthopaedic Surgeon, he would try to arrive at a clinical diagnosis through careful clinical assessment. Though good medical history and physical examination could pinpoint the diagnosis quite accurately, X-rays and Magnetic resonance imaging (MRI) are often required for the confirmation.

In terms of treatment, 80-90 percent of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise, and anti-inflammatory medication. Surgery may be required to resolve some shoulder problems, if the non-surgical methods are not helpful. Certain types of shoulder problems, such as recurrent dislocations and some rotator cuff tears, may not benefit from exercise alone. In these cases, surgery may be recommended fairly early. Surgery usually can involve arthroscopy (minimally invasive) to remove scar tissue or repair torn tissues. Occasionally traditional open procedures for larger reconstructions or shoulder replacement may still be required.

Prevention is always better than cure. Having good posture while handling heavy weight (like luggage) and regular exercise to keep your fitness are the best bet to lower the chances to get a painful shoulder. Avoid repetitive movement using the shoulder in your daily activities. Never overdo.

May I wish everyone a healthy and fruitful Rotary Year “Engage Rotary Change Lives”!