Shoulder Pain

Introduction
Common Causes
Home Care
What can I do to help the pain?
What exercises should I do?
Will I need surgery?

Shoulder pain involves any pain in or around the shoulder joint. The shoulder is the most mobile joint in the human body. The joint includes four tendons. The purpose of a tendon is to hold muscle to bone. Together, these four "rotator cuff" tendons stabilize the upper arm bone to the shoulder socket and allow a wide range of motion in the shoulder. Any swelling, inflammation, tearing, or bony changes around these tendons causes pain when a person tries to move the arm above the head, behind the back, or straight out in front.

A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) of the rotator cuff (the part of the shoulder that helps circular motion). Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder). You might have soreness after activities such as painting, lifting or playing a sport, which require you to lift your arms. Or you may not remember any specific injury.

The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.

The tendons pass underneath a rigid bony arch in the shoulder. The most common cause of shoulder pain is when the tendons become trapped under this arch. The compressed tendons become inflamed or damaged, a condition called rotator cuff tendinitis. This can occur from general wear and tear as you get older, an activity that requires constant shoulder use like baseball pitching, or an injury.

• Arthritis in the joints about the shoulder (gradual narrowing of the joints and loss of protective cartilage).
• Bursitis (inflammation of a fluid-filled sac, or bursa, that lies between tendon and skin or between tendon and bone). Normally a bursa protects the joint and helps make movement more fluid.
• Fractures of the shoulder bones.
• Frozen shoulder syndrome occurs when you don't move your shoulder because of pain or injury. The muscles or connective structures stiffen up inside the shoulder and make any motion painful and difficult.
• Inflammation of nearby tendons, such as those connected to the bicep muscles of your arms, from overuse or injury.
• Dislocation of your shoulder, which is when the ball-shaped head of your arm comes out of the socket.

When you first feel shoulder pain, apply ice for up to 15 minutes, then leave it off for 15 minutes. Repeat this cycle for several hours. Wrap the ice in a cloth, DO NOT apply ice directly to the skin. Then, continue to ice 3 to 4 times a day for 2 to 3 days.

Rest the shoulder from strenuous activity for the next few days. When the pain and swelling have subsided, gradually begin to strengthen the shoulder muscles. Perform light weight lifting, using a full range of motion. Consider seeing a physical therapist for help doing this safely.

• You have fever, swelling, or redness.
• You are unable to use the joint.
• Your pain lasts more than 1-2 weeks despite self-care measures.

Treatment should help your pain and help you restore your shoulder to normal function. Pain relief strategies include active rest (you can and should move your shoulder, but you shouldn't do strenuous activities like lifting heavy objects or playing tennis). Application of ice, taking nonsteroidal anti-inflammatory medicine such as ibuprofen (two brand names: Advil, Motrin) or naproxen (brand name: Aleve) and, occasionally, an injection of anti-inflammatory steroids can also help.

Normal function can be restored with special exercises. The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. These range-of-motion exercises are followed by resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.

The following exercises may help you. Check with your doctor to see if you should do other exercises, too.

Range of motion. Stand up and lean over so you're facing the floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles, and then draw bigger ones. Repeat these exercises 5 to 10 times during the day. If you have pain, stop. You can try again later.
Rotator cuff strengthening. Use a piece of rubber tubing for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With your hand that is closest to the door, bend your arm at a 90° angle and grab the loop of the tubing. Pull the band across your tummy. At first, do one set of 10 exercises. Try to increase the number of sets as your shoulder pain lessens. These exercises should be done every day.
Upper extremity strengthening. As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your left arm at your side. With a weight in your left hand and your forearm across your tummy, raise your forearm. Keep your elbow near your side.

Sometimes an injury that lasts a long time will cause the tendon to tear. This type of injury may need surgery. A tear of the rotator cuff is suspected when the pain goes on in spite of a good rehabilitation program or when there is weakness in certain motions of the arm.