What’s the cause of my shoulder pain?


What’s the cause of my shoulder pain?

Until you have shoulder pain, likely you forget how much you depend on healthy, pain free shoulders.  From blowing your hair dry, hanging a picture on a wall, lifting a heavy box, driving a vehicle or swinging a golf club, chronic shoulder pain can slow you down on performing some of life’s simplest and yet necessary tasks.

Understanding your shoulders

Our shoulders are the most flexible joint in the body allowing quite a bit of free movement. Shoulders are a complex arrangement of ligaments, tendons, and muscle keeping the bones in place creating a delicate balance of free movement, allowing the joint to flex, abduct, adduct, internally rotate, and externally rotate.  Sometimes we forgot just how important our shoulders are in that they give us the ability to reach overhead, to the side, across the body, behind the back, and everywhere in between. 

However, their incredible flexibility also makes them the most commonly injured joint as almost every one of us will experience some kind of shoulder issue during our lifetime.  This is because of the uniqueness and complexity of the shoulder that on the one hand, makes it the joint with the greatest range of motion, but on the other, the joint with the least stability.

Three common shoulder problems

If shoulder pain is affecting you and you are unsure why, here are three common reasons for making shoulders hurt that might be the cause:

1.  Impingement syndrome and rotator cuff disease

Impingement syndrome is a common shoulder condition seen in active adults, especially as they get older.  This condition is closely related to shoulder bursitis and rotator cuff tendinitis which may occur alone or in combination. 

In most parts of the body, the bones are surrounded by muscle. In the shoulder region, the muscle and tendons are surrounded by bones.  You can tell this by tapping the top of your shoulder and you can feel bone immediately under the skin. 

The rotator cuff is a set of muscles and tendons that connect the shoulder blade with the ball of the shoulder, to move the upper arm and stabilize the shoulder joint. Repetitive “impingement” by the rotator cuff can cause rotator cuff disease and pain.  Athletes such as tennis players or baseball pitchers and “weekend warriors” who do physical activity with repetitive arm movements are prone to this condition. The pain may be felt when reaching overhead or behind you such as when reaching for a car’s seat belt.  The pain is usually felt in the front and side of the shoulder and spreads down the upper arm to the upper arm bone. 

How is it treated? Treatment will depend on the individual case but generally a combination of physical therapy, oral anti-inflammatory medications or steroid injections into the area around the rotator cuff can help with the pain.  In some cases, treatment may require arthroscopic surgical repair or a “cleanup” of the rotator cuff.

2.  Arthritis

Arthritis is a degenerative condition in which cartilage in a joint wears away, leaving bone to rub against bone.  This causes pain and stiffness in the area affected.  If arthritis is found in the shoulder, it is known as osteoarthritis or arthritis from wear and tear.

The pain felt from arthritis in the shoulder may be noticed when you move your arm in any direction and with the discomfort felt in several places at the same time.  You may notice it is difficult to do repetitive motions due to pain and overall stiffness in the shoulder joint.  Many people describe the pain as a dull, aching feeling that often becomes worse with cold weather.

People most at risk for arthritis in the shoulder are the elderly, those with a previous shoulder surgery or trauma to the shoulder and anyone who has a family history of arthritis.

How is it treated? The best way to treat arthritis in the shoulder or anywhere in the body is to do a program of stretches to help keep it mobile.  Steroid injections are another option for those who are significantly affected by the pain and in extreme cases, a few people may require replacement of the shoulder joint.

3.  Frozen shoulder

Also known as adhesive capsulitis, frozen shoulder is a condition characterized by stiffness and pain in your shoulder joint.  Symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.  Frozen shoulder may happen if you are recovering from a medical condition or procedure that prevents you from moving your arm such as a stroke or a mastectomy.

Pain felt in a frozen shoulder can vary but usually it creates constant pain, both sharp and dull, even when resting. Movement tends to make the pain worse. The pain is often felt throughout the area of the shoulder along with stiffness.  This can prevent people with a frozen shoulder from lifting their arm higher than waist level or behind their back.  Women are more susceptible to developing frozen shoulder and people with diabetes, thyroid disease, or anyone age 40 and older, are also more at risk.

How is it treated?  Treatment will be individualized but usually involves using anti-inflammatory medication, pain medicines, physical therapy involving range-of-motion exercises and sometimes corticosteroids may be injected into the joint capsule.  Occasionally, a small percentage of cases may require arthroscopic surgery to loosen the joint capsule so it can move more freely.