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Shoulder pain

Definition

Alternative Names

Pain - shoulder

Considerations

The shoulder is the most mobile joint in the human body. The rotator cuff in the shoulder is made up of four tendons. These tendons give the shoulder a wide range of motion.

Any swelling, inflammation, tearing, or bony changes around these tendons causes pain when a person tries to move the arm above the head, behind the back, or straight out in front.

Causes

The tendons pass underneath a rigid bony arch in the shoulder. The most common cause of shoulder pain is when the tendons become trapped under this arch. The compressed tendons become inflamed or damaged, a condition called rotator cuff tendinitis. This can occur from:

• General wear and tear as you get older
• An activity that requires constant shoulder use, such as baseball pitching, or work activities in which you need to raise your shoulder
• An injury

Shoulder pain can also be due to:

• Arthritis in the joints around the shoulder (gradual narrowing of the joints and loss of protective cartilage).
• Bursitis (inflammation of a fluid-filled sac, or bursa, that lies between tendon and skin or between tendon and bone). Normally a bursa protects the joint and helps make movement more fluid.
• Fractures of the shoulder bones.
• Frozen shoulder syndrome occurs when the muscles, tendons, and ligaments stiffen up inside the shoulder and make any motion painful and difficult.
• Inflammation of nearby tendons, such as those connected to the bicep muscles of your arms, from overuse or injury.
• Dislocation of your shoulder, which is when the ball-shaped head of your arm comes out of the socket.

Home Care

When you first feel shoulder pain, apply ice for up to 15 minutes, then leave it off for 15 minutes. Repeat this cycle for several hours. Wrap the ice in a cloth. Do NOT apply ice directly to the skin. Then, continue to ice 3 to 4 times a day for 2 to 3 days.

Rest the shoulder from activity for the next few days. When the pain and swelling have subsided, gradually begin regular activity. Consider seeing a physical therapist for help doing this safely.

Ibuprofen or acetaminophen (Tylenol) may help reduce inflammation and pain.

When to Contact a Medical Professional

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

If you just had a severe blow or injury and your painful shoulder is swollen, badly bruised, or bleeding, get safely to an emergency room where they will check for a fracture or dislocation.

Contact your doctor if:

• You have fever, swelling, or redness.
• You are unable to use the joint.
• Your pain lasts more than 1 - 2 weeks despite self-care measures.
• Your arm turns red or bluish, or begins to swell.

What to Expect at Your Office Visit

Your health care provider will perform a physical examination, including a detailed examination of the shoulder, and ask questions such as:

• Does the pain affect one or both shoulders?
• Does your pain travel from the shoulder to other joints?
• Where in your shoulder do you feel the pain? The front, side, or top?
• Does the pain occur when you lift your arm overhead or away from your body?
• Did your pain start suddenly? Is it severe? Or, did it begin slowly and mildly and then get worse?

Diagnostic tests that may be performed vary depending on the results of your physical examination. Treatment may include the following:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• A corticosteroid injection
• Referral to a physical therapist and instructions on rehabilitation

Surgery is a last resort.

Prevention

• If you have had shoulder pain in the past, 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."
• In sports-related activities, learn proper techniques to prevent painful and expensive shoulder problems.

References

Miller RH, Dlabach JA. Shoulder and elbow injuries. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 44.

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.

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