Shoulder pain

Alternative Names

Pain - shoulder

Considerations

The shoulder is the most mobile joint in the human body. A group of four tendons in the shoulder, called the rotator cuff, give the shoulder a wide range of motion.

Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or moving it forward or behind your back.

Common Causes

The most common cause of shoulder pain is when rotator cuff tendons become trapped under the bony area in the shoulder. The tendons become inflamed or damaged, a condition called rotator cuff tendinitis .

Shoulder pain may also be caused by:

• Arthritis in the shoulder joint
• Bone spurs in the shoulder area
• Bursitis , inflammation of a fluid-filled sac (bursa) that normally protects the joint and helps it move smoothly
• Broken shoulder bone
• Frozen shoulder, which occurs when the muscles, tendons, and ligaments inside the shoulder become stiff, making movement difficult and painful
• Overuse or injury of nearby tendons, such as the bicep muscles of your arms
• Dislocation of your shoulder

Sometimes, shoulder pain may be due to a problem in another area of the body, such as the neck or lungs. This is called "referred pain." People with this type of pain usually do not have pain when moving the shoulder.

Home Care

Here are some tips for helping shoulder pain get better:

• Put ice on the shoulder area for 15 minutes, then leave it off for 15 minutes. Do this 3 - 4 times a day for 2 - 3 days.
• Wrap the ice in cloth. Do not put ice directly on the skin because this can cause frostbite.
• Rest your shoulder for the next few days.
• Slowly return to your regular activities. A physical therapist can help you do this safely.
• Ibuprofen or acetaminophen (Tylenol) may help reduce inflammation and pain.

Call your health care provider if

Very sudden shoulder pain can sometimes be a sign of a heart attack . Call 911 if you have sudden pressure or crushing pain in your shoulder, especially if the pain runs from your chest, jaw, or neck, or occurs with shortness of breath, dizziness, or sweating.

Go to the hospital emergency room if you have just had a severe injury and your shoulder is very painful, swollen, bruised, or bleeding.

Call your health care provider if you have:

• Shoulder pain with a fever , swelling, or redness
• Problems moving the shoulder
• Pain for more than 1 - 2 weeks despite at-home treatment
• Swelling of the shoulder
• Red or blue coloring to the shoulder

What to expect at your health care provider's office

Your health care provider will perform a physical examination and closely look at your shoulder. You will be asked questions such as:

• Do you have pain in one or both shoulders?
• Does your pain move from the shoulder to other body areas?
• Where in your shoulder do you feel the pain? The front, side, or top?
• Do you have pain when you lift your arm up or away from your body?
• Did your pain start suddenly or slowly?

Your doctor may order blood or imaging tests.

Treatment for shoulder pain may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Injection of a powerful anti-inflammatory medicine called a corticosteroid
• Physical therapy
• Surgery if all other treatments do not work

Prevention

• If you have had shoulder pain before, use ice and ibuprofen after exercising.
• Learn proper exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. A doctor or physical therapist can help.
• If you are recovering from tendinitis, continue to perform range-of-motion exercises to avoid "frozen shoulder ."

References

Greiwe RM, Ahmad CS. Management of the throwing shoulder: cuff, labrum and internal impingement. Orthop Clin North Am. 2010;41:309-323.

Krabak BJ, Banks NL. Adhesive capsulitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 10.

DeLee JC, Drez D Jr, Miller MD, et al. Shoulder. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 17.