Healing Shoulder Pain: A troubleshooting guide for common shoulder problems

Up to 70% of people will experience shoulder pain at some point in their lives. Shoulder pain can be particularly vexing, because it makes it hard to sleep. But why is the shoulder so troublesome? The answer comes down to the shoulder’s unique structure, the constant demands we place on it throughout the day, and a variety of risk factors. This report will serve as your guide through shoulder repair and recovery and help you communicate more effectively with your doctor as you move through the process.

Healing Shoulder Pain: A troubleshooting guide for common shoulder problems Cover

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How many times have you used your shoulders today? Think about it. Every time you reach for a cup on a high shelf, wave to a friend, raise your coffee mug to take a drink, throw a ball, or swing a golf club, you rely on the complex, interconnected network of bones, muscles, tendons, and ligaments that make up this joint. You can execute more than a thousand different motions thanks to the shoulder’s superior mobility.

Yet the anatomical design that makes this joint so versatile also becomes its greatest vulnerability. The shoulder can move in so many directions because it is a shallow ball-and-socket joint, in which the “ball” (the top of the upper arm bone) is larger than the socket it fits into. This puts the shoulder at risk for instability, making it the most commonly dislocated joint in the body. Its unique anatomy also makes it susceptible to sprains and separations, as well as a variety of overuse injuries. Some of the factors that predispose the shoulders to injury are inherited anatomical differences, while others are behavioral, including poor conditioning that can lead to fatigue and poor form while working or participating in sports.

Whether you have an acute (short-term) injury such as a ligament tear from playing sports or doing repetitive actions at work, or you are experiencing chronic (long-term) shoulder pain from arthritis, this report will guide you through the process of diagnosing the source of your pain and mobility loss and finding the most appropriate treatment. The following pages also offer advice on how to find a qualified, experienced physician to address your pain. And you will learn which tests your doctor will use to pinpoint the source of your discomfort. The numerous treatments covered in this report run the gamut from conservative measures like rest and over-the-counter pain relievers—an approach your doctor will likely start with—to the latest, state-of-the-art surgical procedures for repairing and replacing a damaged shoulder joint. Finally, you will learn tips to strengthen and protect your joint to avoid reinjuring it in the future.

Over my 30 years as a practicing orthopedic surgeon, I have treated thousands of people for virtually every condition that affects the shoulder joint. I have seen firsthand how the proper interventions can restore mobility, relieve pain, and return my patients to their previous level of function. I hope this report will serve as your guide through shoulder repair and recovery and help you communicate more effectively with your doctor as you move through the process.

Prepared by Harvard Health Publishing in consultation with Jon J.P. Warner, MD, Chief, Shoulder Service, Massachusetts General Hospital Professor of Orthopaedic Surgery, Harvard Medical School Director, Boston Shoulder Institute. (2019)

  • Why do we get shoulder pain?
  • The anatomy of the shoulder
  • Common shoulder problems
    • Bursitis
    • Tendinitis
    • Rotator cuff injury
    • Biceps tendon tears
    • Shoulder joint instability and dislocation
    • Arthritis and problems that can cause arthritis
    • Frozen shoulder (adhesive capsulitis)
    • Separated shoulder (shoulder sprain)
    • Fractures (broken bones)
  • Poor posture and shoulder pain:
  • What’s the connection?
  • Diagnosing shoulder pain.
    • Which doctor should you see?
    • Medical history and exam
    • Blood tests
    • Imaging tests
    • Electrical studies
    • Creating your treatment plan
  • Conservative (nonsurgical) treatments
    • Rest and activity modification
    • Ice and heat
    • Physical therapy
  • SPECIAL SECTION: Exercises to prevent and relieve shoulder pain
  • Drug treatments
    • Anti-inflammatories and pain relievers
    • Corticosteroid injections
    • DMARDs for rheumatoid arthritis
    • Platelet-rich plasma injection.
  • Surgery
    • Arthroscopy
    • Open surgery
    • Possible complications
    • Post-surgery rehabilitation
    • Preventing future shoulder problems
  • Resources
  • Glossary

Risk factors for developing shoulder pain

A number of factors increase your likelihood of developing shoulder pain, including age, gender, and genes. Even being overweight or smoking can play a role. Some of these factors fall within your control, while others are beyond it.

Genes: Certain shoulder problems seem to run in families. Rotator cuff injuries are more likely to occur not only in siblings, but also in cousins and other more distant relatives. The tendency to injury may be due at least in part to inherited anatomical differences in the shoulder joint. It’s also possible that family members tend to share shoulder-straining experiences—for example, if they play the same sports or have the same physically demanding occupation.

Arthritis also has a genetic component. Inherited characteristics in the shape of the acromion (a bony projection on the end of the shoulder blade) and the glenoid cavity (the socket in the shoulder joint) can increase the likelihood of shoulder degeneration and damage.

Age: Your likelihood of developing osteoarthritis increases as you age. Years of playing tennis and golf or engaging in other repetitive activities can cause minor injuries that add up over time, eventually leading to a loss of the cartilage that cushions your shoulder joints. Osteoarthritis and soft tissue conditions, such as rotator cuff injury, shoulder impingement syndrome, and frozen shoulder, are the most common causes of shoulder pain in older adults.

Gender: Women are at higher risk for shoulder pain than men. Their smaller size, coupled with generally weaker muscles, leads to greater shoulder instability. In addition, after a woman spends years playing sports or engaging in repetitive motions at work, her shoulder joints begin to loosen, putting her at increased risk for dislocation. Hormones might play a role in gender-related shoulder differences. Relaxin, the hormone released during pregnancy to ease delivery, does so by relaxing ligaments throughout the body. For these reasons, women are more likely to suffer injuries when they play sports. However, because men participate in sports more over all, they account for a greater proportion of sportsrelated shoulder injuries.

Obesity: Extra weight puts added pressure on the joints, and the heavier you are, the more weight your joints have to bear. The knees and hips carry most of this force, but shoulders can be affected, too. Obesity might also contribute to shoulder pain by triggering the release of inflammatory substances. Inflammation activates pain receptors in the area, contributing to shoulder pain.

Other medical conditions: People with certain medical disorders are more likely to develop shoulder pain. These disorders include diabetes, multiple sclerosis, fibromyalgia, and inflammatory forms of arthritis, such as such as rheumatoid arthritis and psoriatic arthritis.

In diabetes, chronic high blood sugar leads to connective tissue damage and inflammation in the shoulders, as well as in other parts of the body. Frozen shoulder and rotator cuff injuries are particularly common in people with diabetes. Although researchers don’t know exactly why, it may have to do with impaired blood flow. Another possible culprit is the formation of damaging substances known as advanced glycation end products. These substances—which form when blood sugar is high, and sugar molecules attach abnormally to protein or fat—can make tendons stiff and weak.

Multiple sclerosis causes nerve damage, which leads to pain, weakness, and reduced function throughout the body, including the shoulders. Fibromyalgia is marked by muscle pain and tenderness at various sites, including the neck and shoulders. And inflammatory forms of arthritis produce inflammation in the joints.

Smoking: Along with the many other ill effects of cigarette smoking— among them cancer, heart disease, and lung disease— some studies have linked this harmful habit to shoulder pain, tendon injury, and an increased risk for rotator cuff tears. Smoking promotes inflammation, and it robs the blood of the oxygen needed to heal injuries in the shoulders and elsewhere in the body.

People who smoke tend to have larger rotator cuff tears, and they don’t improve as much after rotator cuff surgery as nonsmokers, according to a 2018 study in BMJ Open Sport & Exercise Medicine. Another study found that smokers didn’t heal well after rotator cuff repair. Nicotine—the active component in tobacco smoke—reduces blood flow to the rotator cuff, an area of the body that already has a limited blood supply. A steady flow of oxygen- and nutrient-rich blood is essential for maintaining a healthy rotator cuff, as well for promoting healing after surgery.

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