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What to Do for Shoulder Pain

by Susan Randel  

Your shoulder is one of your body’s hardest-working joints. If you play sports such as tennis, golf, or softball—or even if you just regularly carry a heavy purse or tote bag, work in your garden, clean the house, paint a wall, rake leaves, or shovel snow—you use your shoulders.

Almost 1.2 million Americans visit the emergency room for shoulder pain each year, according to the CDC. But unless the pain is caused by an acute injury—a broken bone or a dislocated shoulder, for example—most shoulder pain is not an emergency and can be treated with rest, rehab, and patience. Here’s a look at the most common causes of shoulder pain, how to treat it, and what you can do to prevent shoulder problems.

Common causes of shoulder pain

The shoulder is your most mobile joint (actually three joints), moving up, down, forward, back, and twisting and turning in various ways. Its anatomy is as complex as its range of motion. There are three bones in the shoulder: the clavicle, or collarbone; the shoulder blade (scapula); and the humerus, the bone of the upper arm that fits into the other two. Because these bones do not fit together very tightly (not like, for example, the ball and socket hip joint), the shoulder is stabilized by an array of muscles, tendons, and ligaments.

The best known of these is the rotator cuff, composed of four muscle and their tendons. It provides mobility and strength as well as holding the arm bone in place. It is also the site of some of the most common causes of shoulder pain, such as tendonitis and bursitis, which occur when the tendons are overused and get trapped between the bones of the shoulder or the bursa (small fluid-filled sacs that cushion muscles, bones, and tendons) get inflamed, respectively. The rotator cuff tendons and muscles may also tear, limiting the range of motion of the shoulder. This can happen if you fall on your shoulder, or it can occur as a result of aging. A torn and unrepaired rotator cuff can cause weakness and pain.

Another common cause of shoulder pain is frozen shoulder (adhesive capsulitis), where the joint loses part of its range of motion. It isn’t clear what causes frozen shoulder, though it's likely that it stems from an autoimmune reaction of some kind. It can occur after an injury, but many people injure their shoulders and do not get frozen shoulder. Nor do you get frozen shoulder simply from not using your arm. The condition is most common after age 40 and disproportionately affects women; nobody knows why. Frozen shoulder also appears to be more common in people with diabetes, thyroid problems, and heart disease. About one-third of those who get one frozen shoulder will get the condition in the opposite shoulder at some point.

Like any other joint, the shoulder can be affected by arthritis—most commonly osteoarthritis, which occurs when the cartilage that cushions the joint wears down, causing the bones to rub together. Autoimmune diseases such as rheumatoid arthritis can cause painful swelling in the joint linings.

Finally, shoulder pain can stem from an acute injury such as a broken collarbone, dislocated shoulder (in which the arm bone is pulled out of place in the socket), or separated shoulder (in which the ligaments that connect the collarbone and shoulder blade get stretched or torn). These are usually caused by a fall or some other type of accident.

Remedies for shoulder pain

Some a shoulder injuries, such as a dislocation or fracture, require an immediate visit to the doctor or emergency room. Keep in mind that sudden sharp shoulder pain can be a sign of a heart attack, particularly if the pain runs from your jaw down your arm. This is a medical emergency. Call 911 and chew and swallow an aspirin tablet while you wait for help to arrive.

For pain that develops over time, the typical recommendation is rest, ice, and avoiding painful activities, along with over-the-counter pain relievers—such as acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve)—if needed. A sling to anchor the shoulder may help if movement is really painful. If pain persists or grows after a few days, you will need to visit your doctor, who may refer you to an orthopedist. Tests such as X-rays, ultrasound, or MRI may be done to determine the cause of the pain and the best course of treatment.

Physical therapy is often recommended for shoulder pain, whether it stems from a rotator cuff tear, frozen shoulder, or arthritis. A programof stretching and building muscleswill aid in healing while maintaining mobility of the joint. A physical therapist will teach you proper stretches and exercises to build up the shoulder muscles. Continuing your exercises at home after physical therapy ends will help prevent further problems.

If your shoulder doesn’t get better with physical therapy, your doctor may suggest a cortisone shot or possibly surgery, depending upon the problem. But surgery should be considered as a last resort. Of course, certain shoulder injuries can only be repaired via surgery, such as recurring shoulder dislocations, fully torn rotator cuffs, and some fractures. And very painful arthritis and limited motion may require shoulder replacement surgery.

Preventing shoulder pain

Exercises to strengthen the muscles of the arm, upper back, and shoulder are key to preventing shoulder pain, as well as promoting healing, as noted above. These three moves are a good place to start. You can also try the American Academy of Orthopedic Surgeons’ program of 13 exercises using small hand weights—1 to 5 pounds each, depending on your conditioning—and an elastic stretch band.

Also see Get Fit Without Getting Hurt.