Shoulder Pain

The shoulder is composed of 3 bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). It is one of the most vulnerable joints in your body because it can move in all directions.

The shoulder has three major joints:

• the acromioclavicular (AC joint) joins the scapula and the clavicle;

• the glenohumeral joint, a ball-and-socket type joint, joins the top of the humerus (ball) with the glenoid socket (a dish-shaped part of the outer edge of the scapula into which the ball fits);

• the scapulothoracic or ST joint joins the scapula to the rib cage.

The bones of the shoulder are held in place by muscles, tendons (which attach muscles to bone), and ligaments (which attach bones to each other).

The rotator cuff is a group of muscles and tendons that holds the ball of the humerus in the glenoid socket and provides strength to the joint. Two small sac-like structures called bursae cushion and protect the rotator cuff from the bony arch of the acromion (the part of the scapula that forms the highest point of the shoulder).

Causes

The shoulder can be easily injured because it can move in many directions, and because the ball of the humerus is larger than the socket that holds it.   Pain in the shoulder may be caused by overuse of, or injury to, the muscles, tendons and ligaments; injuries to the bones or changes and degeneration due to aging. .

Arthritis

Rheumatoid arthritis, osteoarthritis (degenerative joint disease), and posttraumatic arthritis can affect the AC and glenohumeral joints of the shoulder. Rheumatoid arthritis is an inflammatory condition of the joint lining. It affects multiple joints in the body. Osteoarthritis is a degenerative condition that affects the outer coverings of the bones where they form a joint. It is more common in the AC joint and usually affects people over the age of 50. Posttraumatic arthritis is due to an injury.  Symptoms vary but usually include include   shoulder pain in all shoulder movements that is made worse by activity and usually partially relieved with rest. Treatment can be resting the joint and taking nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen. When these measures do not work, surgery to replace all or part of the shoulder or to remove part of a bone can be done.

Tendinitis

Tendinitis can be caused by doing the same motion repeatedly. In younger people, tendons heal quickly, However, in older people the normal structural degeneration in tendons and the cumulative damage of previous episodes of tendonitis can lead to larger tears and degeneration in the muscles and tendons. Moving quickly   also can cause   inflame tendons, leading to tendinitis. Tendinitis causes pain, swelling, and stiffness. Pain from tendinitis may be constant, or you may feel pain only when you move a certain way.

Bursitis

Bursitis is caused by an inflamed bursa. Bursas are the small, fluid-filled sacs in and near the joints. They cushion and lubricate areas around both the joints and the tendons. Bursitis makes a soft, fluid-filled lump in the joint, which causes pain and swelling. The subacromial bursa located under the acromion, the highest part of the shoulder, is commonly affected.  A sudden increase in activity can cause bursitis. Acute bursitis often heals in 7 to 10 days with self-care. Call your doctor if you don't feel better in 10 days.

Dislocation of the Shoulder

A shoulder dislocation is when the bones of one of the joints are separated and the joint no longer functions.   Muscles, tendons and ligaments can be stretched and there may be bleeding into the joint. This can easily happen to the glenohumeral or the acromioclavicular joints by falling on an outstretched arm or onto the shoulder, or by violent twisting of the upper arm, or other trauma. The pain from a dislocation is made worse by moving the arm. A dislocated shoulder requires immediate medical attention.

Rotator Cuff Injury

Rotator cuff injury is damage to the tendons or muscles that form the rotator cuff. These injuries can come from a fall or a blow to the shoulder; often they are due to tendonitis or repetitive strain through overuse, such as throwing a softball, painting a ceiling, or swimming. Symptoms of rotator cuff injury include shoulder pain at night and when you raise or lower your arm between waist and shoulder. If your tendons are compressed, pain may be worst when the arm is raised with the palm down. Your arm or fingers also may tingle or feel numb. Often this can be treated by physical therapy. If the rotator cuff is torn, surgery may be necessary.

Referred Pain

Referred pain is a pain felt in the shoulder that is actually a symptom of injury or illness somewhere else in your body. If you feel sudden pain in your left arm, tightness in your chest, shortness of breath, or pain in your jaw with no known cause, it could be a sign of a heart attack. Call 911 immediately.

Self-Care Steps for Shoulder Pain

• Use the RICE method.

• Take a medication to reduce pain and inflammation.

• Be less active until you feel better.

• If there is no swelling, apply heat to the affected area before activity. Do not apply heat if there is swelling.

• Ice the painful area after activity.

• If your symptoms don't improve after 10 to 14 days, call your doctor.

• Follow any instructions for physical therapy.