Shoulder pain

Why does my shoulder hurt?

Why is the shoulder so prone to becoming painful? The answer comes down to the shoulder's unique structure, the constant demands placed on it, and various risk factors.

There are many possible causes of shoulder pain.

Bursitis. This condition occurs when fluid-filled sacs (bursae) in the shoulder become inflamed and painful.

Tendinitis. Inflammation of tendons in and around the shoulder can cause pain, difficulty holding an arm out to the front or side, and clicking, crunching, or catching when the arm is moved. Persistent wear and tear from repetitive motions like hitting a golf ball, swinging a tennis racket, or pulling heavy items off high shelves can lead to painful tendinitis.

Osteoarthritis. This is the most common type of arthritis and the shoulder is a common place for it to develop. The typical features of osteoarthritis include pain, stiffness, and loss of motion.

Shoulder impingement. Pain can result when tendons do not have enough space to move properly.

Dislocation. The same anatomical design that gives the shoulder its flexibility also makes it subject to dislocation. The shallowness of the shoulder socket allows the ball of the upper arm bone to easily pop out of the socket. Trauma is the most common cause, but dislocation can happen when repetitive movements stretch out the shoulder ligaments to the point where they can no longer support the shoulder joint.

Frozen shoulder. This occurs when inflammation and scar tissue invade the shoulder joint, causing stiffness, aching pain, and markedly restricted motion.

Rotator cuff injury. This condition results from a gradual or sudden tear in the group of muscles and tendons that surround the shoulder joint and help to hold it in place (see "What is a rotator cuff injury?" below).

Shoulder sprain. A shoulder sprain is usually the result of injury to the acromioclavicular (AC) joint that sits at the top of the shoulder, where the collarbone (clavicle) meets the bony projection atop the shoulder blade. When severe, this injury is also called a shoulder separation.

Other problems. Other problems that can lead to shoulder pain include neck pain (often caused by strained trapezius muscles that support the neck, upper back, and shoulder blades) and pinched nerves.

What is a rotator cuff injury?

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, holding it in place and allowing its wide range of motion. Rotator cuff tears are the most common rotator cuff injury and can occur in several ways.

Age is a leading risk factor. Over time, the rotator cuff naturally weakens to the point that the tissue tears easily. Another cause is repetitive arm motions - for example, having a job that involves overhead movements or lifting heavy objects, or playing sports like baseball or tennis. Injuring your shoulder - from falling on an outstretched arm, for example - can cause a tear. Rotator cuff tears also run in families.

Signs and symptoms of a rotator cuff injury include:

• aching or pain in the shoulder
• pain when you lift your arm
• difficulty sleeping on the affected side
• sudden weakness in the arm
• reduced movement in the arm, usually because of pain and weakness.

Most rotator cuff injuries are treated with conservative measures such as rest, ice, over-the-counter pain relievers, physical therapy, and activity modification. A corticosteroid injection into the shoulder can help reduce inflammation and ease pain. Still, doctors recommend limiting the number of injections to no more than three or four a year. Too many shots can weaken the rotator cuff tendon.

Surgical repair of the rotator cuff or shoulder joint replacement may be recommended for more severe tears that don't readily heal.

Separated or dislocated shoulder?

The same anatomical design that gives the shoulder its flexibility also subjects it to injuries like dislocations and separations.

Dislocated shoulder

A shoulder dislocation occurs when the ball of the upper arm bone pops out of the shallow socket. (When the ball slips only partly out of its socket, it's called a subluxation.)

Dislocation can occur in various ways. Repetitive movements - for example, swimming, tennis, and volleyball - can stretch the shoulder ligaments to the point where they can no longer support the shoulder joint. Alternatively, a traumatic injury, such as a powerful hit to the shoulder or a fall, can rip the head of the upper arm bone out of the socket. Some people are prone to dislocations due to looser-than-normal joints.

Symptoms of shoulder dislocation include:

• intense pain
• inability to move the shoulder joint
• shoulder that appears deformed or out of alignment
• swelling
• bruising
• numbness, weakness, or tingling near the injury.

A dislocated shoulder joint is often easily fixed with a closed reduction procedure, in which gentle traction allows the shoulder muscles to relax to the point where the ball slips back into place. An experienced coach or trainer can sometimes perform a closed reduction. Ideally, a doctor should perform the procedure because some methods can be painful. Performing this procedure incorrectly could further damage the shoulder and contribute to future instability.

After a reduction, the affected arm will remain in a sling for several weeks to allow the shoulder to recover. Ice the affected shoulder three or four times a day to treat soreness. Once the pain and swelling subside, a physical therapist can show you exercises to strengthen the shoulder muscles and rebuild your range of motion.

Separated shoulder

A separated shoulder, also known as a severe shoulder sprain, is an injury to the acromioclavicular (AC) joint.

The AC joint sits at the top of the shoulder, where the collarbone (clavicle) meets the bony projection (the acromion) atop the shoulder blade. The acromioclavicular ligament and coracoclavicular ligaments hold the collarbone to the shoulder blade and stabilize the shoulder.

A shoulder separation typically results from a relatively hard blow to the shoulder, such as what you might sustain in a car accident or playing contact sports like football. A hard enough hit can stretch or tear the ligaments, causing the bones of the AC joint to separate.

Symptoms of a separated shoulder include:

• pain in the shoulder
• weakness in the shoulder or arm
• bruising
• swelling
• limited movement in that arm
• a bump at the top of the shoulder
• a feeling like the shoulder joint is unstable.

With ice, rest, nonsteroidal anti-inflammatory drugs, and physical therapy, most people improve from a separated shoulder within a few weeks. However, it can take six weeks or longer to fully return to sports and other activities that rely heavily on the shoulder. If pain persists despite more conservative treatments, surgery is an option.

What are the best ways to relieve shoulder pain?

While the best treatments for shoulder pain depend in part on its cause, certain treatments are commonly recommended for different shoulder conditions.

Doctors usually recommend conservative measures first, like activity modification, rest, ice or heat, nonsteroidal anti-inflammatory drugs, and physical therapy exercises. These interventions will relieve pain and help you recover movement without needing to resort to more invasive therapies.

Other treatments include:

Rest. One of the best treatments for shoulder pain is rest, which gives the shoulder time to heal and prevents re-injury. Depending on what caused your pain, rest can mean taking a break from any activities that contributed to your injury. Avoid heavy lifting, reaching above shoulder height, and moving into positions that worsen the pain. If you work in a job that requires overhead motions or heavy lifting, you might need to take time off or request a change in responsibilities. Athletes need to stay on the bench until healing is complete. Your doctor might recommend keeping the affected shoulder still by putting it in a sling or other shoulder immobilizer.

Ice and heat. Immediately after an injury, ice helps reduce inflammation and numbs the pain. For the first 24 to 48 hours after the injury, use an ice pack or cold compress on the affected shoulder for 15 to 20 minutes every three to four hours. You can use something as simple as a package of frozen peas as a makeshift ice pack. Whatever you use, do not place the pack directly on the skin, as this can lead to frostbite. Instead, wrap it in a towel or cloth. Once the swelling has subsided, switch to heat. A heating pad eases stiff muscles and joints and it increases blood flow to the area.

Physical therapy. A cornerstone of shoulder pain treatment, the goal of physical therapy is to help you regain strength and movement in the affected shoulder so that activities such as reaching for items on a high shelf or putting on your shirt become easier to do without pain.

A general physical therapy program includes a range of exercises - some that you do with the therapist, others that you do on your own at home - to strengthen and improve mobility in the muscles that support your shoulder joint. You will likely use a combination of light weights, exercise bands, and weight-bearing exercises (such as push-ups or planks), depending on your strength, ability, and stage of recovery. Your therapist might also use other treatments such as ice, heat, or manual therapy.

Expect to visit your therapist at least once a week for four to six weeks before you see major improvements in shoulder pain and function. If your symptoms have not improved substantially in about six weeks, you may need to see an orthopedic specialist to discuss other treatment options.

How can I strengthen my shoulder?

Following a minor shoulder injury, exercises and stretches are important for your rehabilitation. These movements help strengthen the muscles that support your shoulder and help prevent future injuries.

If your pain is caused by specific issues like a frozen shoulder, shoulder impingement, tendinitis, or a dislocated shoulder, you need an individualized exercise plan designed by a physical therapist to improve strength and mobility.

Regular home stretching and strengthening exercises also can help those with arthritis manage pain and stiffness and improve the shoulder's range of motion, to help with everyday movements like reaching overhead and carrying heavy objects.

There are many exercises and stretches that can help manage pain and improve shoulder strength. Most use light weights, resistance bands, and one's own body weight. Stretches can be performed with body movements alone or by using aids like a wall or doorway for support.

No matter the source of your shoulder pain, it's often a good idea to check with your doctor or physical therapist before beginning shoulder exercises or stretches. This ensures you can do what you need for your pain and perform the movements correctly.