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Shoulder Pain Overview

Shoulder pain should not be ignored. Early treatment can prevent further injury and chronic shoulder problems.

This site provides information on the more common causes of shoulder pain and symptoms, treatment and prevention.

Always seek a proper diagnosis from a qualified physician. Please do not attempt self-diagnosis.

See a doctor immediately if the shoulder is hot or swollen, if there is severe pain, it there is numbness, if fever is present, or if the arm cannot be lifted straight out to the side.
Pain in the shoulder may be referred from other areas of the body, e.g. disc problems the neck.

 

 

The Shoulder Joint

The structure of the shoulder joint allows more range of motion than any other joint in the body.

The shoulder actually has several joints that work together to allow a wide range of motion. Most injuries occur at the “main” shoulder joint, where the head of the upper arm meets the shoulder blade; the term “shoulder joint” refers to this joint. The other smaller shoulder joints are referred to by their specific names. See shoulder anatomy.

The head of the upper arm bone sits on a very small and shallow socket in the shoulder blade. This allows for the shoulder’s wide range of motion but makes it susceptible to injury. Because there is little bony stability, the shoulder relies greatly on connective tissue (e.g. ligaments, tendons, muscles) to hold the bones of the joint together and to stabilize the joint.

Causes of Shoulder Pain

The Most Common Cause of shoulder joint pain is rotator cuff tendonitis – injury and inflammation of the tendons (rotator cuff tendons) that envelope the shoulder joint. The most common cause of rotator cuff tendonitis is overuse of the shoulder, though the rotator cuff tendons may be injured suddenly as a result of a fall or accident.

Muscle strain is common in the muscles that run over the shoulders to the neck . It is often the result of holding the shoulders in a raised position for long periods of time. The muscles between the shoulder blades are often strained from slouching from long periods of time. Muscle strain varies in severity. See muscle strain and posture.

Jump down to Shoulder Injuries and Conditions.

Other painful shoulder conditions, such as frozen shoulder, may occur for no apparent reason. (The risk of frozen shoulder increases when the shoulder is not used enough after a painful injury). The cause of calcium deposits in the shoulder, which may trigger episodes of acute inflammation of the tendons, is also unclear. Arthritis sometimes occurs in a previously injured shoulder joint.

Risk Factors

WEAK ROTATOR CUFF MUSCLES

Weak or fatigued rotator cuff muscles can lead to soft tissue injury. If the muscles that stabilize the shoulder joint (mainly the rotator cuff muscles) are weak or fatigued, the muscles fail to fully stabilize the joint. If the head of the upper arm bone is not kept in place in its socket, abnormal force is placed upon tissue surrounding the shoulder joint and can lead to injury. Shoulder tendonitis and bursitis are common.

OVERUSE

Shoulder pain is frequently caused by chronic overuse of the shoulder. The shoulder may become injured suddenly from a blow or fall, but gradual injury from chronic overuse of the shoulder is more common. Repetitive lifting, pushing, pulling, throwing, and especially overhead activities may lead to injury. Pain may be mild and intermittent in the beginning and worsen over time. Combining repetitive overhead activities with force increases the risk of injury further (e.g. stacking heavy objects on a high shelf).

Repetitive overhead activities can be particularly damaging. When the arm is raised overhead, the head of the upper arm bone migrates upward on the shoulder socket somewhat and rotator cuff tendons come into contact with the roof of the shoulder blade. Repeated contact and friction of the rotator cuff tendons often leads to irritation and inflammation of the tendons (tendonitis).

A strong rotator cuff helps keep the head of the upper arm bone from riding up excessively but some contact between the rotator cuff and bones in the joint still occurs with overhead activity. The bursa that lies under the roof of the shoulder blade may also be affected and become inflamed (bursitis). Shoulder bursitis often occurs along with shoulder tendonitis.

AGING

Aging is a major factor in rotator cuff injuries Tendons lose elasticity with aging and they become more susceptible to injury. Muscle mass also decreases with age. Both the rotator cuff muscles and tendons can be strengthened with resistance exercises. See Rotator Cuff Exercises.

Prevention of Shoulder Pain

Overuse shoulder injuries often can be prevented.

Strengthen the rotator cuff. Weak rotator cuff muscles may be unable to adequately stabilize the shoulder joint. Building up strength of the rotator cuff through exercise helps to stabilize the shoulder joint to prevent abnormal pressure on the soft tissues surrounding the joint. The muscles that control the shoulder blade also play a role in stabilizing the shoulder joint.

Avoid repetitive overhead activities. If you are involved in activities that involve repetitive overhead movements, take frequent breaks. Fatigued rotator cuff muscles lose the ability to keep the shoulder stabilized.

Avoid doing too much too soon. If you are going to engage in any overhead activity you haven’t done for a long time, such as getting back into playing tennis, endurance must be built up slowly. Exercises to strengthen the muscles you will be using in an activity reduce the chance of injury.

Warm up before engaging in sports such as swimming, tennis or throwing sports that require overhead movement.

Proper form for your sport should be learned and practiced to prevent injury.

Maintain proper posture. Muscles over the shoulders become strained from holding the shoulders in a raised position for long periods of time. Muscles in the upper back, between the shoulder blades, become strained as a result of slouching. See Muscle Strain and Posture.

Treatment of Shoulder Pain

Prevent major problems by treating minor problems early. If a minor injury is not given a chance to heal before it is subjected to the same activity, pain and inflammation may become chronic.

Treatment of shoulder pain depends on the cause – seek a proper diagnosis from a qualified physician. Most shoulder injuries heal with conservative treatment. Healing takes time. The time it takes to recover depends upon several factors, e.g. the severity of injury, the type of injury, how quickly one heals, how early one begins treatment.

Typical treatment of shoulder pain (for most conditions) involves a combination of rest (not complete rest), exercise, anti-inflammatory medication, applying cold or heat to the shoulder joint and, in some cases, an injection of steroids into the shoulder joint.

Doing activities that aggravate shoulder pain often cause further damage, delay healing, and may lead to long-term problems. However, not using the shoulder at all weakens the shoulder and leaves it more vulnerable to injury. Immobilizing the shoulder may also lead to frozen shoulder. Stretching exercises help prevent this condition.

Strengthening exercises for the muscles that support the shoulder, particularly the rotator cuff (the muscles and tendons that dynamically stabilize the main shoulder joint) are a major part of treatment for most shoulder injuries, but strength training before adequate healing has taken place may cause further pain and injury. A physician or physical therapist can determine when the shoulder is ready for strengthening exercises. Exercises can prevent injury from recurring.

Massage therapy is also used to treat many soft tissue injuries. From muscle strain to tendonitis to frozen shoulder, massage therapy increases circulation, speeds healing, improves range of motion and relieves pain.

Most shoulder pain improves with conservative treatment; however, surgery may occasionally be required (depending upon the type of and severity of the injury). Surgery may be performed to tighten loose ligaments, repair a torn tendon, remove a calcium deposit, trim a damaged tendon, etc. when conservative treatment doesn’t adequately resolve symptoms.

Shoulder Injuries / Conditions

Rotator Cuff Injury

Rotator Cuff Injury is the most common cause of shoulder pain. Rotator cuff injuries include rotator cuff tendonitisrotator cuff tears, and shoulder impingement syndrome.

The rotator cuff is a group of four muscles and their tendons, which envelope the main shoulder joint and stabilize the shoulder joint (keeps the head of the upper arm bone centered on its socket) while in motion. The stability of the shoulder joint depends largely upon the strength of the rotator cuff muscles. Activity that overloads or fatigues the rotator cuff muscles often leads to injury.

Rotator Cuff Tendonitis

Rotator cuff tendonitis (also called shoulder tendonitis) is the most common rotator cuff injury. Tendonitis is an inflammation of a tendon.

Rotator cuff tendonitis is often caused by chronic overuse of the shoulder and occurs gradually. Though the rotator cuff tendonitis can come on suddenly, most cases occur over weeks or months from overuse. The symptoms are often intermittent in the beginning and gradually get worse. Pain and weakness, especially when raising the arm overhead are the main symptoms.

Rotator cuff tendonitis is most common in people over the age of 40. Rotator cuff injuries are also common in swimmers, tennis players, house painters, and anyone involved in repetitive overhead movements. Click here for more info.

Rotator Cuff Tear

If rotator cuff tendonitis (inflammation of rotator cuff tendon) is not treated early and becomes chronic, the tendons become progressively weaker. It takes little force to tear a weakened tendon and it may occur during everyday activity. Aging also causes degenerative changes in the tendons and increases the risk of tears. Rotator cuff tears are uncommon in people under the age of forty. A torn rotator cuff in a young person is usually the result of a fall or accident. Click here for more info.

Shoulder Impingement Syndrome

There is a narrow space between bones in the shoulder joint (the roof of the shoulder blade and upper arm bone) that the rotator cuff tendons pass through. This space becomes narrower when the arm is raised overhead, causing compression of the rotator cuff tendons. Repetitive overhead activity may irritate the tendons and cause inflammation (tendonitis).

Rotator cuff tendonitis often occurs first and causes shoulder impingement syndrome. The inflamed tendons take up too much space and get squeezed between bones of the shoulder joint.

Bursitis

Bursitis is an inflammation of a bursa. A bursa is a sac containing a small amount of fluid located between moving parts of a joint to reduce friction. Like rotator cuff tendonitis, bursitis may be caused by overuse of the shoulder and may occur at the same time as tendonitis. Treatment is the same for both conditions. Click here for more info.

Muscle Strain

The muscles that run over the shoulder to the neck and the muscles between the shoulder blades are commonly strained. Muscles may be strained as a result of working hard and long to support the shoulders in awkward positions. Even a person who just “sits around” may suffer this type of overuse injury. Click here for more info.

Arthritis

Arthritis in the shoulder joint is not as common as arthritis in the knees, hips, spine, or hands but it can occur. A shoulder that develops osteoarthritis usually has been previously injured. People with rotator cuff tendonitis or shoulder bursitis may believe they have arthritis, as symptoms (pain and stiffness of the shoulder) are similar. Click here for more info.

Frozen Shoulder

Frozen shoulder sometimes occurs for no apparent reason. Frozen shoulder may occur when pain from an injured shoulder causes one to limit shoulder movement. As the shoulder heals, scar tissue and adhesions may cause surfaces within the shoulder joint to stick together and “freeze” the shoulder. It is much easier to prevent this condition than treat it. Though resting an injured shoulder is important, gentle stretching exercises that put the shoulder through its full range of motion are important in preventing frozen shoulder (also called adhesive capsulitis). Click here for more info.

Shoulder Dislocation

The shoulder is the most commonly dislocated joint in the body. The large head of the upper arm sits on a very small and shallow socket on the shoulder blade. Soft tissues, e.g. tendons, muscles, and ligaments, must hold the shoulder joint in place. A fall or severe blow to the shoulder may result in a dislocated shoulder. Often, a ligament is severely torn during a dislocation. The vast majority of shoulder dislocations are anterior dislocations – the head of the upper arm dislocates in front of the shoulder. Click here for more info.

Shoulder Separation

A shoulder separation involves the joint where the collarbone connects with the shoulder blade. Falling on an outstretched hand or a blow to the shoulder may cause the ligaments that hold the joint together to overstretch or tear and cause displacement of the collarbone. (Not all shoulder sprains are severe enough to cause displacement of the collarbone.) Click here for more info.

Calcific Tendonitis

Calcium deposits may form in the rotator cuff tendons of the shoulder. Though calcium deposits in the tendons do not always cause problems, these deposits may trigger acute attacks of pain and inflammation. Click here for more info.

Diagnosis of Shoulder Pain

Many shoulder conditions have similar symptoms and it may be difficult to diagnose the problem from symptoms alone. A physician, often an orthopedist, diagnoses the cause of shoulder pain by taking into consideration the patient’s symptoms and medical history, findings of a physical examination and sometimes diagnostic testing, such as x-rays, a CT scan, or an MRI.

The information on this website is for information purposes only, and is not intended to be used to diagnose or treat any medical condition.