The Top 10 Causes of Shoulder Pain — and How to Fix it
Strong shoulders provide support for your body - but what if yours are in pain? (Photo: Courtesy of Yamada Taro / Getty Images)
Your shoulder is one of the busiest intersections in your body: three bones form one main joint cushioned by cartilage and held in place with cords of muscles, ligaments, and tendons. When everything works as one, you have the mobility and stability to lift, throw, flex, and reach. Injure one of these separate parts, however, and you can be sidelined with searing pain, not to mention a severely compromised range of motion, says Guillem Gonzalez-Lomas, M.D., sports medicine physician at NYU Langone Medical Center in New York City. Get insight into why your shoulder hurts, plus how to end the pain and regain your mobility, with this cheat sheet of 10 common shoulder injuries.
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Shoulder Tendonitis
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Anyone who extends his arms in repetitive movements — from baseball pitchers to house painters, or anyone who lifts regularly at the gym — is prone to this injury, an inflammation of the shoulder tendons due to overuse, says physical therapist Kosta Kokolis, cofounder of Bodhizone Physical Therapy in New York City. The rotator cuff, the bundle of muscles and tendons connecting your arm to your shoulder blade, is most prone to tendonitis. You’ll know it’s the rotator cuff if the top of your shoulder hurts. Tendonitis can also strike the bicep tendon, which makes the front or side of your shoulder ache. Either way, you won’t able to raise your arms or reach behind you. Ice, rest, and anti-inflammatory pain meds are a first line of defense. If things don’t improve in a few weeks, see your doctor, who may want to give you steroid injections or perform surgery.
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Shoulder Bursitis
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Shoulder bursitis often goes hand and hand with tendonitis. It’s an inflammation of the shoulder bursa, a sac of lubricating fluid that protects the rotator cuff. Like tendonitis, it’s caused by repeatedly extending your arms overhead, says Lawrence Gulotta, M.D., an orthopedic surgeon at the Hospital for Special Surgery in New York City. The pain, which you’ll usually feel when you try to reach your arms high, can start off mild and gradually get worse, or it can feel excruciating early on. If anti-inflammatory pain meds and resting your shoulder don’t help, your doctor may give you steroid shots or refer you to physical therapy to rebuild your range of motion.
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Shoulder Osteoarthritis
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Osteoarthritis happens when the cartilage between the bones in the shoulder thins out, says Dr. Gonzalez-Lomas. As you move the affected joint, you feel pain and may even hear a clicking sound — that’s the bones rubbing together without their usual protective cushion. Osteoarthritis can happen in younger guys, particularly after a previous shoulder injury. But it often doesn’t strike until your forties or fifties, leaving you with a progressively more painful joint and increasingly limited mobility. An X-ray or MRI lets a doctor diagnose it, and anti-inflammatory pain pills, rest, and range of motion exercises can ease it. Your doctor may also want you to try physical therapy, and in severe cases, a joint replacement is an option.
Shoulder Dislocation
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A shoulder dislocation is a traumatic injury: The ball at the end of your upper arm slides out of the cup-like socket of your shoulder blade. “Sometimes you can hear the pop, and you might see the bulge of the ball in the front of the shoulder,” says Kokolis. If that doesn’t clue you in, your suddenly limp arm, plus severe pain and swelling at your shoulder, are pretty good tipoffs. Unless you want to risk even more shoulder damage, don’t let a trainer or gym buddy convince you that he can pop it back in. Instead, splint or sling your arm so it remains steady in its current position and head to the emergency room. There, a doctor will maneuver it back into place, or call in a surgeon if the dislocation is severe enough.
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Frozen Shoulder
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If you’ve hurt your shoulder within the last six months, there’s potential for this secondary condition. When you stop using your shoulder to give the original injury time to heal, the capsule containing the bones, ligaments, and tendons of your shoulder thickens and develops adhesions, eventually freezing in place, says Kokolis. One big clue: you’ll feel the pain at night, even when you’re lying still. If you think you have frozen shoulder, see your doctor, who will advise you on stretches and exercises to reduce the stiffness. “Massage also helps, and if it’s severe, a doctor may manipulate the joint during surgery to increase mobility,” says Kokolis.
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Labral Tear
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The labrum is a thin cuff of rubbery cartilage attached to the shoulder socket. It helps keep the ball of the upper arm in place. “During activities that involve reaching overhead repeatedly — lifting weights, playing tennis, or throwing a football — the labrum can suddenly tear, causing a lot of pain,” says Dr. Gulotta. A labral tear can also happen slowly over time, generally in guys over age 40. Symptoms include a decrease in shoulder strength and an inability to lift objects. Treatment involves rest and anti-inflammatory meds, and if that doesn’t help, cortisone injections and physical therapy. In rare cases, surgery may be required to repair the labrum.
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Rotator Cuff Tear
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The muscles and tendons that make up your rotator cuff allow your shoulder joint to, well, rotate. Tear it, and these tissues will pull away from the bone, making it difficult, but not necessarily impossible, to use your shoulder. “You’ll feel pain and weakness when you try to raise or lower your arm,” says Dr. Gulotta. “I see this overuse injury in people who do activities like CrossFit, and sacrifice form to keep going and then injure themselves.” To properly diagnose it, you need to see your doctor for an X-ray or MRI. Like other shoulder injuries, healing starts with resting the shoulder, icing it down, and handling pain with anti-inflammatory meds. But if it doesn’t get better, surgery may be the next step.
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Broken Collarbone
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The collarbone, or clavicle, connects your breastbone to your shoulder blades. Falling or getting hit are the most common ways the bone breaks — or rather snaps, often with a cracking sound. The area will immediately swell up and hurt horribly, and you’ll have difficulty raising and lowering your arms, says Dr. Gulotta. You might also notice a bulge against the skin, or your shoulder might look like it’s sagging. After a doctor confirms the break, you’ll wear a sling to keep it supported as it heals, which can take up to 12 weeks.
Shoulder Impingement
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Shoulder impingement happens when the rotator cuff gets pinched between the two bones, rubbing or impinging on the cuff’s muscles and tendons. “It’s an overuse injury that’s common in weight lifting, often occurring when you try to bring weight back down,” says Kokolis. Symptoms include pain when you try to reach your arms behind you or lift them overhead. Shoulder impingement can lead to rotator cuff tendonitis or shoulder bursitis, and it takes an M.D. to diagnose it properly, before these conditions set in and make things worse. Anti-inflammatory pain meds and physical therapy can fix the impingement.
Separated Shoulder
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Often confused with a dislocated shoulder, this injury concerns ligaments. After a hard fall or strike to the shoulder, the ligaments holding the shoulder blade and collarbone in place tear and sometimes totally detach from the joint. You’ll feel intense pain and see swelling and bruising at the top of your shoulder, and the now-unanchored collarbone might even jut out like a bulge under the skin. Also called an AC separation (after the acromioclavicular joint, the official name of the intersection where your shoulder blade and clavicle meet), this injury needs to be diagnosed by an M.D. They’ll take X-rays to rule out a fracture. A combination of rest, anti-inflammatory pain meds, and stretching or strengthening exercises should help a separated shoulder heal within six weeks.
By Esther Crain
