Degenerative changes are common in people over 40 years of age. MRI is useful in diagnosing more severe disorders such as abscesses, tumors, and subluxations. Treatment is directed at early mobilization unless there is a serious underlying disorder. Collars should be used only during work activities and not at night. Patients with persistent radicular symptoms should have more complete workups.
Patients often complain of night pain and inability to lie on the affected shoulder.
Shoulder pain must be differentiate from pain associated with radiculopathy. With the latter, pain tends to be less at night and is often relieved by a collar. This includes rotator cuff disease. This may result from repeated impingement of the cuff under the acromium. In older patients tears of the cuff may be partial or complete and associated with chronic and severe pain.