Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Kenneth Trauner

Kenneth Trauner, MD

Orthopedics

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Oakland Medical Center
Appt/Advice: 510-752-1155

See all office information »

subContentURL_nobackslash = resources/dc/condition

firstActiveTabUrlFragment = resources/dc/conditionlist

subContentURL_nobackslash = resources/dc/condition

JSP2Include = /mdo/presentation/conditions/condition.jsp?nocache=true

Overview

The shoulder is the meeting place of 3 bones: the shoulder blade (scapula), arm bone (humerus), and collar bone (clavicle). The main shoulder joint (glenohumeral joint) is a ball-and-socket joint that is formed by the rounded shape at the top of the arm bone fitting into a cup-shaped socket (glenoid) in the shoulder blade. It is your most moveable joint, allowing you to raise, twist, and bend your arm forward, to the side, and behind. This flexibility, however, makes your shoulder vulnerable to injury and overuse wear and tear. 

Most of the time, problems are caused by muscles, tendons, and ligaments, rather than bones. Tendinitis and/or tears of the tendon(s), such as the rotator cuff and the biceps tendon, are some of the most common shoulder problems. Many people with shoulder pain have problems with several structures in their shoulder. For example, people with bursitis or tendinitis may also have rotator cuff and labrum (cartilage) tears.

Types

Rotator cuff injury or tear

The rotator cuff is the main structure that moves and stabilizes the shoulder. It is made up of 4 muscles and 4 associated tendons that attach the muscles to the bones. They form a cuff over the ball-and-socket joint of the shoulder.  

Rotator cuff problems can be mild or severe. Your rotator cuff can become inflamed, frayed, or come completely away from the bone. Most rotator cuff injuries involve the supraspinatus tendon, which is located at the top of your shoulder. This tendon can get pinched between the ball of the upper arm and part of the shoulder blade called the acromion when you raise your arm up or out to the side. This pinching of the rotator cuff is known as impingement.

Impingement typically causes inflammation of the rotator cuff tendons, so the resulting injury is often called tendinitis. It also causes irritation of the bursa, a sac of tissue between the bone and the tendon, so it is also referred to as bursitis. In reality, impingement, rotator cuff tendinitis, and bursitis are all different ways to describe the same problem.

Shoulder cartilage tear (glenoid labrum tear)

The ball at the top of the upper arm bone rests in a socket in the shoulder blade called the glenoid. The glenoid is lined with a ring of cartilage and fibrous tissue called the labrum. The labrum surrounds the ball of the upper arm bone and keeps it inside the glenoid.

The labrum can tear in a number of ways. A small tear may affect only the rim of the labrum. However, a more severe tear at the top of the labrum can also affect the biceps tendon and even cause it to detach completely.   

Labrum tears can result from a shoulder dislocation or from wear and tear on the joint over time. 

Biceps tendinitis

A number of tendons attach muscles to the bones to stabilize and support the main shoulder joint. The biceps tendon connects the biceps muscle to the shoulder blade. When this tendon becomes inflamed, it is called biceps tendinitis.

Symptoms

Rotator cuff injury or tear

The rotator cuff can tear a little, or it can come completely away from the bone. As a result, symptoms can vary. You may feel mild pain and weakness or serious pain that restricts your movement. In many cases, however, people can have rotator cuff injuries with no symptoms at all. 

When a rotator cuff problem does cause symptoms, they include the following:

  • Disruption in your sleep caused by pain, especially if you lie on the affected shoulder
  • Pain in the front of your shoulder and down the side of the arm
  • Weakness in your arm
  • Difficulty raising your arm
  • Pain when reaching or throwing overhead
  • Pain, even though the shoulder moves normally

This last symptom is important because it differentiates rotator cuff problems from other common shoulder injuries. Unlike patients with other shoulder problems, patients with rotator cuff injuries are still able to move their arms through a full range of motion. In some cases, the arm may be so weak that they cannot do this by themselves. However, a doctor can lift the arm and move it up and down and around. With other shoulder injuries, such as a frozen shoulder, range of motion is severely restricted and it is impossible to make the arm move.

Shoulder cartilage tear (glenoid labrum tear)

A cartilage tear can cause a number of symptoms that include:

  • Pain when you raise your arm over your head. 
  • Catching of the joint. You may notice a clicking or popping sensation when you move your arm in certain ways.
  • Pain at night.
  • Loss of strength and range of motion.
  • Instability of the joint.

Biceps tendinitis

The symptoms of biceps tendinitis can vary and include the following:

  • Pain in the upper arm.
  • A pop or snapping sound when you move your arm or shoulder.
  • Difficulty turning the arm palm up or palm down.
  • Bulge in the upper arm above the elbow. This is called a "Popeye" deformity and occurs only if there is a complete tear.

Diagnosis

We will conduct a full physical examination and ask you about the history of your shoulder problems. We are particularly interested in when and how your problems developed. We will also consider whether pain in the shoulder may be referred (or originate) from elsewhere in your body. For example:

  • Heart attacks or angina pectoris may cause left shoulder pain without associated movement.
  • Neck problems may irritate nerves that provide sensation to the shoulder.
  • Irritation of the diaphragm by an inflamed gallbladder, liver, or problem in the abdomen may cause shoulder pain.
Physical examination

During a physical examination, we will:

  • Look at your shoulder and compare it with your other shoulder.
  • Assess your ability to move your shoulder in various directions.
  • Touch your shoulder to assess any tenderness and/or swelling.
  • Check the strength of your shoulder muscles.
  • Check the stability of your shoulder joints.
Additional tests 
  • We may order an X-ray of your shoulder if we suspect that your symptoms are caused by a problem with the bones of the shoulder, such as arthritis, a fracture, or a tumor.
  • We may order an MRI (magnetic resonance image) if we believe that you have a rotator cuff injury or other serious problem.
  • We can often confirm a labrum tear only by looking inside your shoulder using an arthroscope. During shoulder arthroscopy, we insert a fiberoptic scope with a camera attached into a tiny incision in your shoulder. This allows us to examine the structures inside the joint. If we find a labrum tear, or other injury, we are often able to make repairs at the same time. 

Causes

Rotator cuff tear

Rotator cuff injuries can be caused by an accident or injury or, more commonly, from natural wear and tear. Wear and tear can cause damage very gradually over time or more quickly if you use your shoulder a lot.

A number of conditions can lead to a torn rotator cuff: 

  • An acute injury like a fall.
  • Overuse during sports activities or work requiring overhead reaching, lifting, and/or throwing.
  • Chronic wear and tear over time. For example, wear and tear can create bone spurs at the top of the shoulder blade as you get older. These can rub on the rotator cuff and eventually cause a partial or complete tear of the rotator cuff.

Shoulder cartilage (labrum) tear

The shoulder joint can be injured in ways similar to the rotator cuff. The following activities can injure the shoulder joint:

  • Repetitive forceful overhead movements.
  • Activities that involve high stress overhead movements. For example, athletes and weightlifters are more likely to experience a cartilage tear.
  • Shoulder dislocation. If your shoulder dislocates, it may tear the labrum.

Biceps tendinitis

The biceps tendon can be damaged by an injury, but most biceps tendinitis is caused by wear and tear damage that gradually weakens the tendon over time. Overuse, which means repeating the same shoulder movements frequently during swimming, tennis, or baseball, will make symptoms of tendinitis worse. Activities that increase your risk of developing biceps tendinitis include:

  • Falling on an outstretched arm
  • Lifting something too heavy
  • Pulling forcefully, for example, tugging on a lawn mower starter
  • Repeated overhead lifting
  • Sports like tennis and swimming
  • Smoking
  • Chronic or frequent use of steroid medications like prednisone or cortisone injections

Prevention

Many shoulder problems, particularly those caused by arthritis, are difficult to prevent. However, there are some steps you can take to avoid shoulder problems and to protect your shoulder joint if you already have problems:

  • Avoid lifting objects that are heavier than you are accustomed to lifting. 
  • Avoid performing repetitive overhead movements, such as weight lifting, for prolonged periods.
  • Avoid sudden jerking motions like pulling on a lawn mower starter. 
  • Remember to stretch and warm up prior to activities involving your shoulder. 
  • Quit smoking. We have many resources to help you quit. Smoking prevents optimal blood supply from reaching the tendons. This can increase your risk of tendon and muscle tears. 
  • Maintain good posture. This is particularly important if you have rotator cuff problems. Bad posture, such as slouching, can push the shoulder forward, making impingement worse. If you maintain good posture and stand up straight, this helps to open the shoulder up, creating more space between the ball of the upper arm bone and the acromion.

Treatment

Nonsurgical treatments

If your symptoms are mild and you can still use your shoulder, we will recommend that you try nonsurgical treatments first. These may include:

Rest. We will advise you to avoid lifting, reaching, and making overhead motions. Depending on the severity of your injury, you may need to restrict the way you move your arm for a number of weeks or months. We will monitor your progress to evaluate when you can resume your normal activities. 

Rehabilitative exercise. We can help you use exercise and other techniques to repair and strengthen the muscles in your shoulder and arm. This can help reduce inflammation and pain, enabling you to return to your normal activities.

Over-the-counter (OTC) pain medications. We may recommend OTC nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to reduce pain, inflammation, and muscle spasms, and to help you sleep. Follow these guidelines when using NSAIDs:

  • Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help manage your pain or discomfort. Even though you do not need a prescription for these NSAIDs, you should still be careful to consult the package so that you take the correct dosage. 
  • Also, please be aware that NSAIDs can interact with other medicines you may be taking and cause problems for people with various medical conditions. If you have a complex medical condition, if you are pregnant or trying to get pregnant, or if you have been taking NSAIDs and they do not relieve your symptoms, please let us know so that we can recommend an alternative.

Corticosteroid injections. If inflammation and pain affect your ability to move your shoulder and participate effectively in physical therapy, we may recommend a corticosteroid injection directly into the shoulder joint. A corticosteroid is a medication used to reduce inflammation and relieve pain. The injection also includes a local anesthetic medicine to provide pain relief.

Corticosteroid injections are usually used to treat acute inflammation. Multiple injections for chronic shoulder pain, using excessive amounts of corticosteroids, can increase the risk of developing osteoporosis, glaucoma, cataracts, avascular necrosis (bone tissue death due to an interruption in blood flow) of the hip or shoulder, and tendon degeneration. They can have other side effects as well. 

If you have diabetes, we ask that you watch your blood sugar levels closely, as corticosteroids can increase them. Contact your personal physician if your blood sugar level becomes very elevated. 

Surgical Treatment

We usually recommend that you try nonsurgical treatments before considering surgery. Surgery is a serious undertaking that can lead to complications including infection, bleeding, nerve damage, and loss of function. Recovery and rehabilitation can take many months.

We will discuss surgical treatment with you if nonsurgical approaches have not worked and you have a physically demanding job or lifestyle that requires strenuous shoulder motion. There are a number of different procedures, and we will discuss your options with you. Procedures include the following:

Shoulder arthroscopy

Shoulder arthroscopy allows us to use very small incisions to look inside your shoulder and repair damage that we find. The surgery usually takes between 1 and 2 hours, and you will be able to go home the same day. We use general anesthetic so that you are asleep during the surgery. You will still feel drowsy for several hours after the surgery, so you will need to arrange for someone to bring you to the hospital and drive you home.

The surgery involves the following steps:

  • Once you are asleep, we make a small incision in the back of your shoulder and inject saline solution into the joint so that we can see the structures inside your shoulder clearly. 
  • We then insert a fiberoptic scope with a camera attached into your shoulder. 
  • We use the scope to examine your shoulder and identify any debris or bone spurs that need to be cleaned up. We assess the extent of any tears to the rotator cuff or labrum.
  • We then make 2 or 3 small additional incisions into your shoulder and insert surgical instruments. We use the instruments to remove bone spurs, clean out inflammation, and remove any loose cartilage or other debris. 
Repairing a shoulder joint/labrum tear

How we repair the labrum tear will depend on the location of the tear and whether or not other structures are involved. For example, if you have a small tear on the rim of the labrum, we can usually just remove the torn tissue that is catching in the other structures in your shoulder and causing your symptoms. However, some tears can be large enough to make your shoulder unstable. For example, if the tear is at the top of the labrum, the tear can extend into the biceps tendon and even cause it to detach from the shoulder joint. This can cause the joint to become unstable. In that case, we will need to perform a more extensive surgery to repair the labrum and repair and reattach the tendon.

Rotator cuff repair

If we see an extensive tear to your rotator cuff when we look inside your shoulder, we may make one larger incision, rather than two small ones. In some cases, if the injury is old and the tendon has shrunk too far back, we may not be able to repair the tendon.

If the tendon is repairable, we will drill small anchors into the top of the arm bone. We use these anchors to reattach the tendon to the upper arm bone using sutures. The sutures stay in place long enough for the tendon to heal. Most sutures dissolve very slowly in the body and do not need to be removed.   

Shoulder replacement

If the torn areas of the rotator cuff have shrunk too far back to be reconnected again, we will consider other treatments to manage your symptoms, including corticosteroid shots and physical therapy to strengthen your shoulder. However, if these approaches don't work and you are in pain and losing function, we may recommend surgery to replace the shoulder completely. In the long term, replacing the shoulder may provide you with better function and pain relief. 

Additional References:

Lifestyle Changes and Management

If you have a shoulder cartilage or tendon injury, it is important that you adjust your activities to protect your joint. We recommend that you follow these guidelines:

  • When lifting heavy objects, hold them close to your body. 
  • Stick to lifting light weights in the gym and lift up only to the level of your shoulders. 
  • Swimming is an ideal exercise for all of your joints. However, we recommend that you avoid the front crawl and use sidestroke or breaststroke instead. 
  • Do not throw balls overhand or serve overhand when playing tennis. 
  • Do not do exercises that require you to push with your shoulder, for example, shoulder press and pushup exercises. 
  • Use good ergonomics. When you are working at a computer keep your shoulder blades down and back. Take regular breaks to move and stretch.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

We may ask you to come in 30 minutes before your appointment so that we can take X-rays of your shoulder. During your office visit, we will review any X-rays and discuss your medical and family history and I will examine your shoulder. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.

If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Prepare for Your Procedure
Videos

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

Content loading spinner