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A Practical Guide to Common Shoulder Pains and Issues

There’s no shortage of shoulder pain going around. In fact, in 2006, an astonishing 7.5 million people went to the doctor complaining of shoulder issues, according to OrthoInfo.

It’s no wonder, since the shoulder is an essential part of everyday life no matter what you do. While athletes rely on their shoulders extensively, individuals with semi-active hobbies such as cooking or gardening also depend on healthy shoulders. This is why shoulder experts such as Dr. Robert Rolf—a board-certified orthopaedic surgeon with a specialty in sports medicine—are in such high demand at Beacon Orthopaedics and Sports Medicine. Without healthy shoulders, completing even just simple tasks can be a real struggle.

The shoulder is the only part of the human body that allows full 360º motion, although the hips come close. This extreme mobility requires a complex system of bones, cartilage, muscles, and tendons to seamlessly work together. And, similar to machines, the more moving parts there are, the easier it is for something to go wrong.

This article provides a practical guide to common shoulder pains and issues with treatment information provided by Dr. Rolf.

Pinching When You Raise Your Arm

What Does This Pain Mean?

If you feel a pinching sensation when you lift your arm above shoulder level, it’s likely that you have a shoulder impingement. When you raise your shoulder, the space between the acromion (shoulder blade) and rotator cuff becomes narrow. It’s possible for the acromion to rub against the tendons and bursae of the rotator cuff, causing pain. This rubbing or pinching is also called “impinging,” hence the name.

What Causes an Impingement?

Shoulder impingement has two main causes:
1. Pinching that results from swelling of the nearby muscles or bursae
2. Bone growths/spurs that press on the tendons

In either case, the decreased amount of space in the shoulder joint increases the likelihood that tendons will get pinched. Swimmers and over-head athletes (baseball, softball, tennis) are especially at risk for impingement because of how frequently they perform overhead motions.

What Are Your Treatment Options?

In some cases, the fix for impingement is simply to stop overworking the shoulder. If rest isn’t enough to reduce swelling, anti-inflammatory injections can be administered to the afflicted shoulder.
If nonsurgical treatments don’t relieve pain, surgery may be considered. Depending on the cause of the impingement, the surgeon will go into the shoulder and either removed the inflamed part of the bursa, remove part of the acromion (in a process called anterior acromioplasty) or shave off any bone spurs.

Inability to Move Your Shoulder Without Pain/Stiffness

What Does This Pain Mean?

These symptoms strongly suggest a condition known as frozen shoulder, which is also called adhesive capsulitis. Frozen shoulder is a long-term condition where the capsule of connective tissue that encloses your shoulder joint becomes stiff and tight. This makes it difficult to move your shoulder without extreme stiffness or pain. The condition can sometimes last for years.

What Causes Frozen Shoulder?

There is no conclusive answer to what causes connective tissue around the shoulder to grow tight and stiff; however, diabetes and reduced shoulder movements for long periods of time (like when recovering from an injury) have been shown to greatly increase the risk of developing frozen shoulder.

What Are Your Treatment Options?

Though surgical treatments for frozen shoulder exist, nonsurgical treatments are much more common (and often extremely effective). A combination of anti-inflammatory medicine and physical therapy often completely restore the shoulder back to a healthy state.

If nonsurgical treatment does not help, surgery can be performed that will cut, tear, and stretch the stiff shoulder tissue. These methods often relieve stiffness and pain once recovery is complete.

Pain and Tenderness when Your Shoulder is Touched

What Does This Pain Mean?

This pain suggests bursitis, which is inflammation of a bursa, a tiny fluid-filled sac that reduces friction between moving parts of the body. There are several bursae in the shoulder, but the one most commonly responsible for shoulder bursitis is located just below the acromion and is called the subacromial bursa.

What Causes Bursitis?

There are three main causes of bursitis. In order from most to least common, causes are, sudden trauma, overuse, and infection.
Sudden trauma, such as falling and landing on one’s shoulder, is by far the most common cause of shoulder bursitis. The trauma causes the bursa to swell with blood, which puts pressure on other parts of the shoulder and makes it tender to the touch.

If overuse is the culprit, bursitis often accompanies impingement or tendonitis of the surrounding area. Overuse is most common in people who frequently move with their arms over their head. This covers most athletes, but also includes many manual laborers such as painters or construction workers.

Infections are uncommon but can still cause bursitis. Infection is most common in those with a weak immune system, such as those with AIDS or cancer.

What Are Your Treatment Options?

The most effective treatment for shoulder bursitis depends on the cause, but rest and anti-inflammatory medicine are effective treatments. If necessary, corticosteroids can be injected into the shoulder to decrease swelling, or a surgeon can drain excess fluid from the bursa.
Physical therapy is less common for bursitis than other shoulder conditions, but it still helps speed along recovery in certain patients.

Pain and Weakness after Lying on the Affected Shoulder

What Does This Pain Mean?

This pain points toward a rotator cuff tear. A rotator cuff tear is when one or more tendons in the rotator cuff tear. There are two kinds of rotator cuff tears: full and partial thickness.

To visualize the differences between the two types of tears, it’s easiest to imagine a taut rubber band. A full-thickness tear is like a taut rubber band that has been cut. It no longer has any tension in it, and it cannot hold two things together any longer. A partial-thickness tear is like a taut rubber band that has a rip. It is still taut, but more pressure is on the part of the rubber band that is still attached, and it is more likely to rip in the future.

What Causes Rotator Cuff Tears?

Just as there are two types of rotator cuff tears, there are two main causes of rotator cuff tears: acute injury and degradation.

To keep with the rubber band metaphor, an acute injury is when too much force is put on a rubber band and it snaps. A degenerative injury is when a rubber band that has been pulled taut for a long time becomes more and more brittle until it eventually wears out.

In either case, repeated overhead activities put one at greater risk for a rotator cuff tear.

What Are Your Treatment Options?

Roughly 80% of rotator cuff tears respond well to nonsurgical treatment, according to OrthoInfo. This treatment often involves rest, activity modification (such as avoiding the motion that caused the injury), strength exercises paired with physical therapy, and steroid injections if needed.

However, nonsurgical treatments don’t actually repair the torn tendon, which is a problem since rotator cuff tendons heal very slowly. In some cases, surgery is the better option.

In rotator cuff surgery, the doctor reattaches the torn tendon to the head of the humerus.

When It’s Time to See the Doctor

Ideally, you should see an orthopaedist as soon as you suspect you have a shoulder injury; however, once your shoulder pain begins to affect your everyday life, it’s imperative that you see a physician.

These guidelines above are an excellent way to self-diagnose any shoulder issues you might have. However, this is not a substitute for professional medical advice. If you experience any of the aforementioned symptoms, it’s unlikely that your condition will improve until you consult a specialist.

Schedule an appointment with Dr. Rolf at Beacon Orthopaedics and Sports Medicine for a professional evaluation of your shoulder. Dr. Rolf has had world-class training in complex shoulder reconstructive processes and can help you feel better, faster.