We’ve all had to have a health exam that seems worse than the original injury or pain. A shoulder x-ray can seem that way, in part due to the instability of the joint and once injured, it can be very painful to move to be examined. Some of the many causes include strains, dislocations, separations, tendonitis, bursitis, torn rotator cuffs, frozen shoulder, fractures and arthritis. In 2003, 13.7 million people in the United States sought treatment for shoulder problems, due in part, to the fact that the ball at the end of the bone of the upper arm is larger than the shoulder socket that holds it and so relies on the surrounding muscles and tendons to hold it in place. Over time, as a function of aging, tendons become weaker and degenerate, which lead to complete tears of muscles and tendons. These tears are surprisingly common and may not lead to significant pain or disability.
Arthritis which can affect any joint in the body, can also affect the shoulder. The amount of arthritis can range from mild to severe. At its worst stage, when pain limits even the most simplest tasks, joint replacement may be considered. Although making the exam easier to complete, great care should be taken with any replaced joint when having any x-ray so no damage is done to weakened surrounding tissue or to mechanical parts.
Frozen shoulder, which results from a lack of synovial fluid in the joint capsule and adhesions in the shoulder joint, leaves the shoulder joint so stiff and tight that it is nearly impossible to carry out even simple movements like raising the arm. Rheumatic disease, shoulder surgery, diabetes, stroke, lung disease and heart disease and being female all predispose one to having frozen shoulder problems. There are many exercises that can be done to keep your shoulders limber that are easy and mild enough anyone to do them a little every day and should be investigated if you have any risk factors. Consulting a physician or physical therapist is always recommended.
So the next time you are going to have a shoulder x-ray or any x-ray which may require that your arms are to be raised and you have shoulder problems, remember, given the large number of shoulder afflictions that can be present, some of which you may not be aware of, you may be limited in how much you can cooperate. Go slowly and stretch those fragile tendons and ligaments carefully before you arrive if you are able or ask your x-ray technician to move your joints slowly for you if you are not able. Do not be afraid to request that a different view be attempted if you are not able to move into the requested position. Some x-rays can be taken standing rather than in a sitting or laying position if that change would allow greater flexibility or comfort. Although not routine, each body part has alternate views to attain the necessary information for the Radiologist.
Requesting padding on vulnerable bony or painful joints to allow you to remain still in the event that you are in an awkward or uncomfortable position will in the end benefit both you and the technologist. There are radiolucent pads available in every department for such use that will not affect the outcome of the picture. If it is easier for you to remain still, the pictures will be clearer or not need to be repeated thus reducing the amount of radiation exposure.
And for those young and still agile a little prevention can go a long way towards a future without limited range of motion. There are many sources with information on how to protect and strengthen your shoulders for the remaining years to come.
 Questions and Answers about Shoulder Problems by National Institute of Arthritis + Musculoskeletal + Skin Diseases also at www.niams.nih.gov
 Shoulder pain in Older Patients: Interpreting clinical findings by Allison Tobola, MD, Kyle Cassas, MD., Franklin Sease, MD.