Shoulder Pain Causes and Non-Drug, Non-Surgical Treatment

What most people call the shoulder are really several joints that combine with tendons and muscles to allow a wide range of motion to the arm - from scratching your back to throwing the perfect pitch. The joint includes four tendons that hold muscle to bone. Together these four "rotator cuff" tendons stabilize the upper arm bone to the shoulder socket and allow wide movement in the shoulder.

Shoulder pain is an extremely common complaint, and there are many common causes of the problem.  Most shoulder problems involve the soft tissues -- muscles, ligaments, and tendons -- and pinched nerves in the neck.  But it is important to get an accurate diagnosis of the cause of your symptoms so you get the right treatment.

Common Causes of Shoulder Pain

Rotator Cuff Tendonitis

The most common cause of shoulder pain is a problem with the tendons that attach your shoulder muscles (rotator cuff muscles) to the bone of your upper arm. More than 6 in 10 people who have shoulder pain also have problems with their tendons.

Four tendons called rotator cuff tendons hold your shoulder joint in place. Your shoulder is the most flexible joint in your body. But its wide range of movement also means that it is easy to injure. Pain can occur if your rotator cuff tendons get damaged or swollen, or if there are changes in the bone around them.

Most tendonitis is the result of a wearing process that takes place over a period of years, much like the wearing process on the sole of a shoe.  Generally tendonitis is one of several types:

• Acute tendonitis following overuse from activities such as excessive ball throwing and other sports or work related activities.
• Chronic tendonitis resulting from degenerative disease or repetitive wear and tear due to age.
• The splitting and tearing of tendons that may result from acute injury or degenerative changes in the tendons due to advancing age.

Rotator cuff injuries are among the most common of these disorders. The rotator cuff is the arrangement of muscles and their tendons, which provides shoulder motion and stability.

Bursitis

Sometimes excessive use of the shoulder leads to inflammation and swelling of a bursa, a condition known as bursitis. Bursas are fluid filled sacs located around the joint that lessen the friction caused by movement of the shoulder to protect the joint. Bursitis often occurs along with rotator cuff tendonitis. Sometimes the many tissues in the shoulder become inflamed and painful, limiting the use of the shoulder. As a result, the joint may stiffen and create a condition called frozen shoulder. Fortunately, with appropriate care, this condition will resolve.

Pinched Nerves from Injury or Instability

Sometimes the bones in one of the shoulder joints move (or in an injury, are forced) out of their normal position. This condition, instability, can result in dislocation of one of the joints in the shoulder. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. When you lift your arm over your head, the shoulder may feel as if it is slipping out of place or an uncomfortable, unusual feeling that some people refer to as having a "dead" arm.

Arthritis

Shoulder pain can also result from arthritis. There are many types of arthritis, but generally it involves inflammation of the joint, causing swelling, pain, and stiffness. Arthritis in the shoulder is often related to sports or work injuries.

Frozen Shoulder

Also called adhesive capsuliitis, this is a common condition that leads to stiffness of the joint. Stretching is an important aspect for treatment.

Shoulder Instability

Instability is a problem that causes a loose joint.  Instability can be caused by a traumatic injury or may develop slowly over time.

Shoulder Dislocation

A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.

When Should You Get Treatment?

Often people will avoid shoulder movements to try to lessen the pain from these conditions. This sometimes leads to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion. In the case of an acute injury, if the pain is intense, you should get treatment as soon as possible. If the pain is less severe, it may be safe to wait a few days to see if time will alleviate the problem.