We rely on our shoulders to help us with so many daily tasks: reaching overhead to open a cabinet, lifting a heavy box, playing a sport. We often take this for granted—until we experience shoulder pain.
“The shoulder is the most flexible joint in the body. But that flexibility makes it more unstable and susceptible to injury,” says Stephanie Muh, M.D., an orthopedic surgeon at Henry Ford Health. “The good news is that many shoulder conditions can be diagnosed with a clinical exam and treated without surgery.”
How Your Shoulder Joint Works
Your shoulder is a “ball and socket” joint made up of the upper arm bone (humerus) and the shoulder blade (scapula). The round end (ball) of the humerus fits into the socket in the scapula.
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Muscles, tendons and ligaments surround the joint. The ligaments connect the bones to your shoulder, while the tendons connect the joint to your surrounding muscles.
“The shoulder is unique because it lacks bony structure and relies on the soft tissue surrounding it for mobility. Most injuries and damage occur from wear and tear on the soft tissue,” says Dr. Muh.
What Are The Most Common Shoulder Conditions?
The three most common shoulder conditions are tendonitis, arthritis and rotator cuff tears.
Shoulder tendonitis (shoulder impingement)
Shoulder tendonitis is the most common cause of shoulder pain and immobility. It is caused by repetitive arm motions while working or participating in sports. A sudden abnormal movement, such as improperly lifting weights, can also cause tendonitis.
The tendons in the shoulder become irritated and damaged, causing inflammation and swelling. When the joint moves, the swollen muscles rub together, causing pain and limiting the range of motion.
Shoulder tendonitis treatment
Treatment for shoulder tendonitis includes:
- Anti-inflammatory medications to reduce pain and swelling
- Cortisone injections directly into the affected tendons
- Physical therapy for affected muscles to restore range of motion and improve strength
- Surgery to remove inflamed soft tissue in people whose pain and mobility do not improve with other treatments
Arthritis
Arthritis (also called osteoarthritis or degenerative joint disease) is the second most common cause of shoulder pain and mobility problems, says Dr. Muh. It occurs when cartilage, the connective tissue that covers the bones in the shoulder joint, wears down.
Although arthritis can occur with wear and tear associated with aging, people of all ages can develop it. Other factors that increase arthritis risk include:
- Genetics
- Previous injuries or surgeries
- Repetitive stress on the joint from sports or job-related movements
- Other systemic diseases such as gout, psoriasis or rheumatoid arthritis
Arthritis can develop slowly. In the early stages, people may notice a dull ache and stiffness. As the condition progresses, shoulder and arm flexibility decreases as movements become more painful.
Arthritis treatment
While there is no cure for arthritis, treatment can help relieve symptoms. With mild arthritis, anti-inflammatory medications, cortisone shots and physical therapy can help restore shoulder function and flexibility.
Primary shoulder replacement surgery is an option for more advanced arthritis. The procedure replaces the arthritic joint with a metal ball and plastic socket.
Rotator cuff tear
The rotator cuff is a group of muscles connected through tendons to the top of the upper arm bone. As the shoulder joint moves, the tendons in the rotator cuff are constantly breaking down and rebuilding.
When the tendons break down faster than they can rebuild, tiny tears and inflammation occur, causing pain with movement.
Rotator cuff tears can result from:
- An injury or trauma
- Repetitive or abnormal overhead movements
- Aging
Rotator cuff tear treatment
“Treatment for rotator cuff tears depends on the severity of the injury, mobility of the joint and age of the patient,” says Dr. Muh. Older patients are often treated with anti-inflammatory medications, cortisone injections and physical therapy. After treatment, they can return to their daily activities pain-free.
Surgery followed by physical therapy is an option for younger people with a more severe rotator cuff tear. Procedures include:
- Rotator cuff repair: Orthopedic surgeons use minimally invasive techniques to move the muscle back over the bone so it can heal in place.
- Reverse shoulder replacement: This is a treatment option for people who have arthritis in addition to a more severe or complete rotator cuff tear. During this procedure, the surgeon reverses the ball and socket locations, attaching a metal ball to the shoulder bone and a plastic socket to the upper arm. This approach allows the shoulder to function without a rotator cuff.
When To See Your Doctor For Shoulder Pain
Dr. Muh recommends seeking medical care if you experience:
- An injury: If trauma causes shoulder damage, see your doctor immediately for proper treatment to avoid further damage.
- Ongoing shoulder pain and mobility problems: If pain and flexibility do not improve after taking anti-inflammatory medications and doing light exercise, your doctor can recommend a more formal program to relieve your symptoms.
“Sometimes shoulder pain is actually caused by neck or back problems. Your doctor can often make an accurate diagnosis after reviewing your medical history and doing a physical exam,” says Dr. Muh. “For more complex injuries, you may need imaging tests to pinpoint the source of pain.”
How To Prevent Shoulder Pain And Injuries
Dr. Muh recommends taking these steps to maintain your shoulder health:
- Pay attention to your body position: Use proper form as you do daily tasks. Avoid overreaching for that box in the closet. Instead, use a step stool or ladder.
- Keep your shoulders moving: An exercise program that includes strength training will keep your shoulder joints flexible and strong. Use proper form when lifting weights to avoid injuries to your shoulder or other joints. Remember to warm up before and cool down after workouts.
Reviewed by Stephanie Muh, M.D., an orthopedic surgeon at Henry Ford Health who sees patients at Henry Ford Medical Center - Royal Oak and Henry Ford West Bloomfield Hospital.
