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.
Shoulder pain is an extremely common complaint for which there are many causes. If you have shoulder pain, some common causes include:
• Muscle or tendon tears
• Bursitis/Rotator Cuff Tendonitis
• Rotator Cuff Tear
• Frozen Shoulder
• Calcific Tendonitis
• Shoulder Instability
• Shoulder Dislocation
• Shoulder Separation
• Labral Tear
• SLAP Lesion
• Biceps Tendon Rupture
Signs and Symptoms
Seeking Medical Advice
• Inability to carry objects or use the arm
Screening and Diagnosis
A complete physical examination includes inspection and palpation, assessment of range of motion and strength, and provocative shoulder testing for possible impingement syndrome and glenohumeral instability. The neck and the elbow should also be examined to exclude the possibility that the shoulder pain is referred from a pathologic condition in either of these regions. Referred or radicular pain from disc disease should be considered in patients who have shoulder pain that does not respond to conservative treatment. The patient should be questioned about neck pain and previous neck injury, and the examiner should note whether pain worsens with turning of the neck, which suggests disc disease. Pain that originates from the neck or radiates past the elbow is often associated with a neck disorder.
• X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
• MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.
• Myelography/CT scanning: Sometimes used as an alternative to MRI
• Electro diagnostic studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck and shoulder pain, arm pain, numbness and tingling.
• Rest: The first treatment for many common conditions that cause shoulder pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a frozen shoulder.
• Ice and Heat Application: Ice packs and heat pads are among the most commonly used treatments for shoulder pain. (See chart below)
• Stretching: Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain.
• Physical Therapy: Physical therapy is an important aspect of treatment of almost all shoulder conditions. Physical therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.
• Anti-Inflammatory Medication: Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with shoulder pain caused by problems such as arthritis, bursitis, and tendonitis.
• Cortisone injections: Cortisone is a powerful anti-inflammatory medication. Inflammation is a common problem in patients with shoulder pain, and is often used as a treatment.
• When to Use Ice: Use ice after an acute injury, such as an ankle sprain, or after activities that irritate a chronic injury, such as shin splints
• How to Use Ice: Apply ice treatments for no longer than 20 minutes at a time. Too much ice can do harm, even cause frostbite; there is no benefit to icing excessively.
• When to Use Heat: Use heat before activities that irritate chronic injuries such as muscle strains. Heat can help loosen tissues and relax injured areas.
• How to Use Heat: It is not necessary to apply a heat treatment for more than about 20 minutes at a time. Never apply heat while sleeping.
• Warm up, loosen up and stretch all the shoulder girdle muscles and tendons at least 15-30 minutes prior to undertaking any strenuous activity.
• Do not lift heavy weights at first. Start with lighter amounts that will not risk injury, and then work your way up.
• Overall, your shoulder is very prone to injury by lifting too much weight. It would be smart to not push yourself to the extreme when your shoulders are concerned, if possible.