For many of us, shoulder pain is a regular part of life. In fact, research shows up to 70 percent of people deal with shoulder pain at some point. But while it is normal to have a little soreness now and then, pain that lingers may need treatment.
If you’re struggling with constant discomfort and reduced shoulder flexibility, you need answers.
“Shoulder pain is a very common complaint that we see in the patients who come to our clinic,” says Namdar Kazemi, MD, an orthopedic surgeon with The Christ Hospital Physicians-Orthopaedics & Sports Medicine. “It’s the second most common orthopedic ailment behind back pain.”
He says rotator cuff disease, frozen shoulder, and shoulder arthritis are the three most common causes of shoulder pain. Here, he offers some insights into these conditions and explains the most effective treatment options.
A bit about your shoulder
Your shoulder is a shallow ball-and-socket joint where your collarbone, upper arm bone and shoulder blade come together. There are 17 muscles that attach to the shoulder blade including the 4 rotator cuff tendons which are the workhorse of the shoulder. When that support structure is healthy and working well, your shoulder is pain-free and has full range of motion. But, Dr. Kazemi says pain appears if you have an injury or develop a condition that weakens your shoulder’s support network.
Rotator cuff disease
Your rotator cuff is arguably the most important tendon in your shoulder because it lets you move that joint in different directions. Unfortunately, it’s easy to develop a rotator cuff injury. In fact, according to the National Institutes of Health, more than 17 million Americans tear their rotator cuff every year, and injuries are more common with age. Some injuries affect part of your tendon (partial tears) and others impact all of it (full tears).
Causes and symptoms
Traumatic injuries—like shoulder dislocation, a fall or other accidents—can cause a rotator cuff tear. But most tears come from normal wear and tear on your shoulder.
Pain that runs from your shoulder to your elbow is the most common symptom, Dr. Kazemi says. The discomfort may wake you up at night.
Other possible symptoms include:
Clicking or popping sounds when you move your shoulder
Crepitus (a crackling, crunching or grinding sensation)
Limited range of motion
Stiffness
Weakness if you have a bigger tear
Treatments
Even though a rotator cuff tear is a rip in your tendon, it’s unlikely you’ll need surgery. Instead, providers recommend trying conservative treatments first for most tears. To help relieve your pain, they may suggest:
Physical therapy: Six to 12 weeks of exercises that focus on stretching and strengthening your shoulder muscles
Cortisone injections: Up to three steroid medication shots that reduce inflammation and pain to make physical therapy more comfortable
If conservative treatments don’t work—or you have a severe tear—minimally invasive surgery could be your best option. After surgery, most people start physical therapy within six weeks. Recovery time depends on your age, the size of your tear, muscle quality, smoking history and any additional health conditions. You may be able to return to heavy activities and lifting within six months, but a full recovery can take up to a year.
Frozen shoulder (adhesive capsulitis)
Frozen shoulder is also called “stiff shoulder.” It happens when the capsule around your shoulder joint becomes leathery and thick, Dr. Kazemi says. As a result, your shoulder gets stiff, and you lose range of motion.
Causes and symptoms
Frozen shoulder develops without a specific cause. Fortunately, Dr. Kazemi says it’s a problem that comes and goes on its own.
“It’s a self-limiting condition. If you don’t do anything about it, at some point, it will go away,” he says. “But it usually takes a long time.”
Frozen shoulder is four times more likely to affect people with diabetes or thyroid problems. But it can impact anyone. When it appears, your shoulder goes through three phases:
In addition to pain, you may also experience:
Treatments
Physical therapy is the hallmark treatment for frozen shoulder, Dr. Kazemi says.
“Physical therapy for frozen shoulder is a little bit ‘no pain, no gain,’” he says. “You bring your shoulder to a certain level and then stretch it more. Relieving frozen shoulder is all about stretching your muscles and tendons.”
In some instances, your doctor may recommend a steroid injection to reduce inflammation, relieve pain and make physical therapy easier. If your shoulder still doesn’t improve, your doctor may recommend surgery.
Shoulder arthritis
Arthritis develops when the bones in your shoulder joint rub together. This happens when you lose the cartilage that serves as a cushion between them.
Causes and symptoms
Normal wear and tear causes most shoulder arthritis, Dr. Kazemi says. However, there are other causes of arthritis, including inflammatory arthritis, like rheumatoid or psoriatic arthritis. There are other less common causes as well.
He says pain is the most common symptom of shoulder arthritis. There is usually shoulder stiffness along with crepitus as well.
Treatments
Dr. Kazemi says conservative treatments are the first-line options for shoulder arthritis. These methods include:
Activity modification (like lifting lighter weights for more repetitions at the gym)
Cortisone injections
Heating and icing your shoulder
Stretching
Taking anti-inflammatory medications
If conservative measures don’t work, you might need shoulder replacement surgery. Your doctor may recommend:
Anatomic replacement: For people who have shoulder arthritis and a healthy rotator cuff
Hemiarthroplasty: Surgery that replaces half of your shoulder joint with prosthetic materials
Reverse shoulder replacement: For people with shoulder arthritis and an injured rotator cuff or severe bone deformity
The Christ Hospital experience
If you’re experiencing shoulder pain, the orthopedic specialists at The Christ Hospital Joint & Spine Center use leading-edge diagnostic technology to identify what’s causing your discomfort. With several clinical sites located throughout the community, our experts offer nonsurgical and minimally invasive treatment options that can relieve your pain and improve your mobility.
To get answers and help you heal, schedule an appointment with Dr. Kazemi or another shoulder specialist with The Christ Hospital Physicians or call 513-221-5500.