What causes shoulder pain?
The most mobile joint in your body is the shoulder. So why do we get shoulder pain? It is made up of bones held in place by muscles, tendons, and ligaments. They’re all designed to work together to allow the shoulder to move freely in many different directions.
This allows you to do everything from raising your arms over your head to throwing a ball and scratching your back. Unfortunately, this mobility comes at the expense of stability and that leaves the shoulder vulnerable to injury.
Factor in the wear and tear of everyday life and it’s easy to see why you’re shouldering so much pain.
You might want to consult your doctor for a formal diagnosis of your shoulder pain. That visit will include a physical exam, and possibly an X-ray, MRI, or ultrasound or we can do some simple assessments and see what we can find.
Read on to learn about some of the many reasons why your shoulder might hurt and how to find relief.
Rotator cuff tendonitis
Of all the reasons you can have shoulder pain, injury to your rotator cuff is the most common. A group of muscles and tendons that attach to the bones of the shoulder joint, the rotator cuff keeps the ball of your upper arm bone centered in your shoulder socket and also helps you raise and rotate your arm.
Doing the same motion over and over again can lead to inflammation of the rotator cuff tendons, also called tendonitis, which can cause shoulder pain. With tendonitis, shoulder pain and weakness are often mild at first and only noticeable when you move the joint; after a while, they can become more severe and occur all the time.
Rotator cuff tendonitis often gets better with a change in activities to avoid provoking pain so the tendon can heal.
Ice or heat to the shoulder and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can reduce pain as well. Seeing a soft tissue therapist for manual therapy and strengthening exercises to keep your muscles moving and to challenge weaker muscles will help.
Rotator cuff tears
It’s also possible to partially or completely tear a shoulder tendon, either from repetitive motion or from direct trauma, like a fall.
The pain of an acute tear, one that happens suddenly, can be excruciating. But shoulder pain, weakness, and stiffness of a chronic tear worsen slowly over time—so you often don’t notice when they begin.
Rest, ice or heat, and NSAIDs may help heal rotator cuff tears. But your doctor will likely suggest physiotherapy or soft tissue therapy to strengthen your shoulder muscles and improve the mechanics of the shoulder joint, as well as provide exercises to do at home.
Steroid injections, which give temporary pain relief so you can strengthen your muscles, or surgery may also be required.
This injury is exactly what it sounds like; severe stiffness and inability to move your shoulder the way you normally would, with varying levels of shoulder pain.
Medically known as adhesive capsulitis, frozen shoulder results when the connective tissue that lines your shoulder joint becomes thickened and inflamed. Precisely why this happens isn’t known, nor is the reason why middle-age women are especially prone to frozen shoulder.
There are other factors that can put you more at risk of the condition. For instance, up to 20% of people with diabetes develop frozen shoulder, and people with thyroid problems or Parkinson’s disease may also be vulnerable to this type of shoulder pain.
You don’t just wake up with frozen shoulder though. Doctors break the progression into three stages: “freezing,” “frozen,” and “thawing.” “Over time, you’ll notice a decrease in your range of motion and then all of a sudden it escalates, Most people get better without invasive treatment – eventually.
It usually takes about 18 months for a frozen shoulder to completely thaw. You can cut it down to a few months with soft tissue therapy, but it will still last a while.
Since some people wind up with a frozen shoulder on the opposite side as well, doctors often treat the good side too, just to keep it moving.
Got deep, achy soreness that feels hot and swollen? Chances are you have shoulder bursitis, inflammation of the bursa, a fluid-filled sac that provides a smooth surface for muscles and bones to glide over.
If you have two muscles aligned side by side and there isn’t something between them to reduce friction, they wouldn’t move. Normally these sacs, which are found in joints throughout the body, are filled with a small amount of fluid.
Sometimes, though, when you overdo it (say, by throwing a ball or lifting something over your head repeatedly), the body responds by bringing more fluid to the bursa—and the swelling that influx produces is what’s known as bursitis. A bursa is like a balloon that’s practically flat, and bursitis is the balloon being filled up with lots of water.
The pain from bursitis is typically on the outside of your shoulder and it’s made worse when using your arm above your head. Treatment is usually rest, ice and pain relief. Your doctor may recommend physical therapy such as soft tissue therapy to stretch or strengthen the shoulder muscles and increase range of motion.
You may also be offered cortisone injections to reduce inflammation but it’s worth trying to solve the problem without this first.
It’s not unusual to hear about pro athletes suffering tears to the labrum, a thin rim of soft cartilage that surrounds the edge of the shoulder socket and helps keep the shoulder stable yet mobile.
These tears are a common injury in regular folks too. Indeed, probably half of middle-age men and women have some sort of labral tear from years of using their arms.
Often you won’t even be aware you have one, since some tears are completely asymptomatic and cause no problems. Others can trigger shoulder pain, specifically when moving your arm in an overhead motion or across your chest—say, to scratch your left shoulder with your right arm.
There are several types of labral tears and treatment depends on the severity of the injury. For instance, if the labrum is still attached to the socket and just frayed, rest, NSAIDs, and physical therapy usually help relieve pain.
However, because these tears typically don’t completely heal, the problem can flare up again. If the labrum is fully detached, surgery is usually required.
You don’t even have to know what impingement means to know it’s something you don’t want to get—the word itself sounds like trouble.
Shoulder impingement often occurs after repeated overhead activity, like swimming. Shoulder tendons and bursa get impinged, or pinched, between the bones of the shoulder, which makes it painful to move your arm. Various positions, including overhead motion, reaching back, or lying on the affected side, may all worsen the symptoms.
Shoulder impingement can weaken the rotator cuff, so physical therapy is key to alleviating this pain and preventing further damage. Since one of the main jobs of the rotator cuff is to stabilise the joint, any weakness to it will lead to further impingement, creating an ever-vicious cycle.
Properly strengthening these muscles and balancing all the muscles and tissues that affect the position of the shoulder effectively can relieve the impingement.
By design, shoulders are unstable—it’s what allows them to move in so many ways. But the term “instability” is also a diagnosis that’s given when the shoulder hurts because the ball of the joint is too loose and is able to slide around too much in the socket.
Chronic strain and worsened instability can occur when an already loose shoulder is overused, especially if the use is repeatedly challenging the ligaments that help hold the shoulder in the socket.
We see this a lot in the throwing athlete, swimmer, golf or volleyball player—someone who uses their shoulder a lot through its full range of motion. Instability is a likely cause of shoulder pain in younger people, especially if it comes on with certain sports, because wear-and-tear conditions like rotator cuff tears and arthritis tend to occur with age.
Rest, heat or ice, and NSAIDs can help control pain and swelling. But the key fix for instability is treatment and exercise to strengthen the muscles that assist in keeping the ball of the joint in the socket. This will improve stability of the shoulder and allow your joint to move more smoothly.
How to prevent shoulder pain
The best way to manage shoulder pain is to avoid it in the first place. As computer and cell phone use continues to climb, posture problems follow, and they dramatically increase the risk of shoulder injuries. To help keep tech-related shoulder pain at bay, raise your mobile device to eye level rather than tilting your chin down to scroll and text, and be sure to place your computer monitor at eye level.
Another factor in shoulder pain: Many people only exercise the muscles they see in the mirror, and this can create an imbalance that pulls the shoulder and other structures forward, contributing to injury. It’s crucial to balance this out by strengthening the muscles of the back and maintaining flexibility all around.
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