Overcoming shoulder pain

The shoulder joint is the body's most flexible and complex joint. Three bones, nearly a dozen different muscles, and many ligaments and tendons work together to move the arm in just about any direction. "Most people will experience shoulder pain at some point in their lives," says Patrick Wilson, a certified orthopedic manual therapist at Harvard-affiliated Brigham and Women's Rehabilitation Services. "The pain can come on gradually or abruptly, ranging from mild to excruciating."

The most common causes of shoulder pain are bursitis, rotator cuff problems, frozen shoulder, and osteoarthritis. They can occur for various reasons, such as overuse, injury, and age-related wear and tear. You should seek medical care if shoulder pain lasts longer than a week, suddenly increases, or comes with swelling, redness, or warmth. Your doctor may be able to make a likely diagnosis based on your symptoms and a shoulder exam, or you may need imaging such as MRI.

Here's a look at the common causes of shoulder pain and how they are treated.

Bursitis

Bursae are fluid-filled sacs in and around the shoulder that provide padding and reduce friction between the bones and tendons. Bursitis happens when one or more of the bursae become inflamed, often as a result of repetitive or intense joint movement, but it may occur without any predisposing factors. Symptoms include

• pain on the outside of your shoulder that may radiate down your arm
• increased pain when you move the shoulder or lie on it.

Initial treatment begins with reducing inflammation and swelling by resting the shoulder, applying ice or heat to the joint, and taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen. For severe or persistent pain, your doctor may recommend a corticosteroid shot. Physical therapy can help maintain joint mobility. On rare occasions, and only if all other measures fail, you might have surgery to remove the inflamed bursa and give the rotator cuff more room.

Rotator cuff problems

The rotator cuff is a group of muscles and tendons that stabilize the shoulder and help move your arm in a circular motion. Signs of a rotator cuff issue are shoulder pain or stiffness on the outside of the upper arm when you lift your arm above your head or reach behind your back. Most problems fall into two categories: impingement and tears.

Rotator cuff impingement. This happens when there is irritation, inflammation (tendonitis), or compression of the tendons in the shoulder. An impingement can be caused by an injury or wear and tear from daily life.

Rotator cuff tears. A tear causes pain and weakness. A tear can be partial, where only part of the tendon is separated from the bone it is attached to, or a full tear, where the tendon becomes completely separated. It often occurs from an injury — for instance, if you fall on your shoulder, lift a heavy object above your shoulders, overextend your arm, or have the arm aggressively pulled.

Treatments for impingement and minor tears include corticosteroid injections into the shoulder, anti-inflammatory meds, and physical therapy to stretch and strengthen the shoulder muscles and tendons. Many times, these can ease the pain. Rotator cuff tears don't heal on their own, and it may take up to a year for the condition to improve. Severe tears may need surgery to repair the damage.

Frozen shoulder

Also known as adhesive capsulitis, frozen shoulder is caused by a thickening and stiffening of the tissues around the shoulder joint. It more commonly occurs in people ages 40 to 60.

A frozen shoulder can develop after a rotator cuff impingement or tear, or even with a minor injury. But why some people go on to develop a frozen shoulder is unclear. One theory is that in many cases, people with shoulder pain instinctively hesitate to move their arm, increasing stiffness. Over time, this makes it difficult to move the shoulder, and thus the shoulder becomes "frozen."

Physical therapy is almost always recommended. Other interventions include NSAIDs and corticosteroid injections. With treatment, the stiffness and pain usually improve. Still, it can take several months or even a year to fully resolve. If treatments don't help, you can have surgery to remove the excess tissue around the shoulder joint.

Osteoarthritis

Osteoarthritis develops when cartilage cushions between the bones in the shoulder erode, causing the bones to rub against one another. There are numerous treatments for osteoarthritis, including rest, modifications to activities, anti-inflammatory drugs, corticosteroid injections, and sometimes surgery to replace the joint.

Image: © fstop123/Getty Images