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Shoulder pain

Pain - shoulder

Shoulder pain is any pain in or around the shoulder joint.

Test Your Shoulder Pain Knowledge

The shoulder is the most movable joint in the human body.
A. True
B. False
The correct answer is true. Tendons are a type of tissue that connect muscle to bone. A group of four tendons in the shoulder, called the rotator cuff, give the shoulder a wide range of motion.
Rotator cuff problems are the most common cause of shoulder pain.
A. True
B. False
The correct answer is true. 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. Arthritis and bone spurs can also cause shoulder pain.
Which of the following can cause rotator cuff problems?
A. Keeping your arm in the same position for a long time, such as doing computer work
B. Sleeping on the same arm each night
C. Playing sports that use your arm in an overhead motion such as tennis, baseball, swimming, and lifting weights
D. Working with your arm overhead (such as painting and carpentry)
E. Falling on your arm while it is stretched out
F. All of the above
The correct answer is all of the above. Poor posture over many years and normal wear and tear related to age may also lead to rotator cuff problems. Sometimes self-care can treat shoulder pain. If you injure your shoulder from a sudden fall, talk with your doctor.
Symptoms of rotator cuff problems include:
A. Pain when lifting your arm overhead or to the side
B. Pain in the front of the shoulder
C. Pain when lying on your shoulder
D. Weakness and loss of motion of your shoulder
E. All of the above
The correct answer is all of the above. Your shoulder can feel stiff when you try to lift with your arm or move your shoulder. It may become harder to place your arm behind your back. Most people with rotator cuff tendon tears have pain at night. If you notice that shoulder pain makes you want to avoid using your arm, call your doctor.
If you have shoulder pain from rotator cuff problems, self-care involves using:
A. Heat
B. Ice
C. Acetaminophen (Tylenol)
D. Ibuprofen (Motrin) or Naproxen (Aleve)
E. B and D
F. All of the above
The correct answer is B and D. Ice and ibuprofen or naproxen help reduce pain and swelling. Acetaminophen treats pain, but won't reduce swelling. Apply ice packs 20 minutes at a time, 3 - 4 times a day. Avoid activities that cause pain. Call your doctor if symptoms don't get better. A steroid injection in your shoulder may help.
Changing your posture can help relieve shoulder pain.
A. True
B. False
The correct answer is true. Your posture during the day and night can help relieve some of your shoulder pain. Sleep on your back or the side that is not painful. Putting pillows under your shoulder may help. When sitting, keep your shoulders back, place a rolled towel or pillow behind your lower back, and keep your feet flat on the floor or on a low stool.
Other ways to ease the strain on your shoulder include:
A. Avoid carrying a backpack or purse over just one shoulder.
B. Lift and carry objects close to your body. Try not to lift heavy loads away from your body.
C. When reaching for something with your arm, point your thumb up.
D. Wear a sling.
E. All of the above.
F. A, B, and C
The correct answer is A, B, and C. Consider making some changes around your home so it is easier for you to take care of yourself. Store everyday items you use in places you can reach easily. Keep things with you that you use a lot, like your phone.
Physical therapy can help treat shoulder pain.
A. True
B. False
The correct answer is true. Your doctor may refer you to a physical therapist (PT) to treat shoulder pain. After testing and examining you, your PT will know which muscles are too weak or too tight. You will then start a program to stretch out your muscles and make them stronger.
If you have a rotator cuff tear, you will need surgery.
A. True
B. False
The correct answer is false. Rest and exercise may help someone with a partial rotator cuff tear who does not normally put a lot of demand on the shoulder. You may need surgery to repair the tendon if the rotator cuff has a complete tear, or if the symptoms continue after trying other types of treatment.
Sudden shoulder pain can be a sign of a heart attack.
A. True
B. False
The correct answer is true. 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.

Considerations

The shoulder is the most movable joint in the human body. A group of four muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion.

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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.

Causes

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

Rotator cuff tendinitis

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keep it stable. ...

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Shoulder pain may also be caused by:

Arthritis in the shoulder joint
Bone spurs in the shoulder area
Bursitis, which is inflammation of a fluid-filled sac (bursa) that normally protects the joint and helps it move smoothly
Bursitis
Bursitis is the swelling and irritation of a bursa. A bursa is a fluid-filled sac that acts as a cushion between muscles, tendons, and bones....
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Broken shoulder bone
Dislocation of the shoulder
Shoulder separation
Frozen shoulder, which occurs when the muscles, tendons, and ligaments inside the shoulder become stiff, making movement difficult and painful
Frozen shoulder
Frozen shoulder is a condition in which the shoulder is painful and loses motion because of inflammation.
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Overuse or injury of nearby tendons, such as the bicep muscles of the arms
Nerve injury that leads to abnormal shoulder movement
Tears of the rotator cuff tendons
Poor shoulder posture and mechanics

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. There is usually pain at rest and no worsening of 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 to 4 times a day for 2 to 3 days. Wrap the ice in cloth. Do not put ice directly on the skin because this can result in frostbite.
Rest your shoulder for the next few days.
Slowly return to your regular activities. A physical therapist can help you do this safely.
Taking ibuprofen or acetaminophen (such as Tylenol) may help reduce inflammation and pain.

Rotator cuff problems can be treated at home also.

Treated at home

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move in a coordinated and...

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If you have had shoulder pain before, use ice and ibuprofen after exercising.
Learn exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. A health care provider or physical therapist can recommend such exercises.
If you are recovering from tendinitis, continue to do range-of-motion exercises to avoid frozen shoulder.
Practice good posture to keep your shoulder muscles and tendons in their right positions.

When to Contact a Medical Professional

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

Heart attack

Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...

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Dizziness

Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...

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Sweating

Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...

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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 provider if you have:

Shoulder pain with a fever, swelling, or redness
Significant pain even with moving the shoulder with the arm or by someone else
Pain for more than 2 to 4 weeks, even after home treatment
Swelling of the shoulder
Red or blue color of the skin of the shoulder area

What to Expect at Your Office Visit

Your provider will perform a physical exam and closely look at your shoulder. You will be asked questions to help the provider understand your shoulder problem.

Blood or imaging tests, such as x-rays or MRI, may be ordered to help diagnose the problem.

MRI

A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...

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Your provider may recommend treatment for shoulder pain, including:

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

If you have a rotator cuff problem, your provider will likely suggest self-care measures and exercises.

Self-care measures

The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move in a coordinated and...

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Exercises

The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm in its joint and...

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Open References +

References

Gill TJ. Shoulder diagnosis and decision-making. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Martin SD, Thornhill TS. Shoulder pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 49.

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Shoulder joint dislocati...

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Shoulder joint dislocation - Animation

Force on a joint can cause a dislocation. The force pushes the bone out of the socket, which may damage surrounding ligaments, tendons, and nerves.

Rotator cuff problems

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Rotator cuff problems - Animation

Feeling pain in your shoulder when you lift your arm over your head may mean you have a have a problem with your rotator cuff. So, what causes rotator cuff problems? The rotator cuff is a group of muscles and tendons that attach to the bones of your shoulder joint. The group allows your shoulder to move and keeps it stable. Pain in your rotator cuff area usually means you have rotator cuff tendinitis, or inflammation of these tendons and inflammation of the bursa, smooth slippery sacs the tendons glide across; or a rotator cuff tear, when one the tendons is torn from overuse or injury. Rotator cuff tendinitis may be due to keeping your arm in the same position for long periods of time, such as doing computer work or hairstyling. Sleeping on the same arm each night can also cause this problem. You can also get tendinitis playing sports that require you to move your arm over your head repeatedly, such as in tennis, baseball especially pitching, swimming, and weight-lifting. Rotator cuff tears may happen if you fall on your arm while it is stretched out, or after a sudden, jerking motion when trying to lift something heavy. Chronic tears occur slowly over time, particularly in people who have chronic tendinitis. At some point, the tendon wears down and starts to tear. If you have tendinitis, you'll have pain when you lift your arm over your head, such as when you brush your hair and reach for objects on shelves. The pain may be mild at first, but over time you may have pain at rest or at night, especially when you lie on your shoulder. The pain of a sudden rotator cuff tear can be intense. Your shoulder may be weak, and you may hear a snapping sound when you move your shoulder. Chronic symptoms include a gradual worsening of pain, weakness, stiffness or loss of motion. Most people with rotator cuff tears have worse pain at night and when they wake up. To treat your rotator cuff problem, your doctor will check your shoulder for tenderness and lift your arm to see in which position you have pain. X-rays may show a bone spur, a bony projection. If your doctor thinks you have a tear, you may have an ultrasound or MRI. Treatment for rotator cuff tendinitis involves resting your shoulder and avoiding the activities that cause you pain. You can also try applying ice packs 20 minutes at a time, 3 or 4 times a day. Medicines like ibuprofen may help reduce swelling and inflammation. Eventually, you should start physical therapy to learn to stretch and strengthen the muscles of your shoulder. Surgery can remove inflamed tissue and part of the bone that lies over the rotator cuff, which may help relieve the pressure on your tendons. Someone with a partial rotator cuff tear can try rest and exercise, if they don't normally put a lot of demand on their shoulder. But if there's a complete tear, or if the symptoms don't improve with therapy, you may need surgery to repair the tendon. But with rest or exercise, symptoms of most shoulder problems often improve or go away, though it may take months.

Shoulder pain

Animation

Shoulder pain - Animation

Swelling, damage, or bone changes around the rotator cuff in your shoulder can cause pain that puts a kink in the activities of your life. Let's talk about shoulder pain. The rotator cuff is a group of muscles and tendons that attach to the bones of your shoulder joint. The group allows your shoulder to move and keep it stable. The most common cause of shoulder pain is when rotator cuff tendons become inflamed or trapped in your shoulder. This is called rotator cuff tendinitis, or irritation of these tendons and inflammation of the bursa, small slippery fluid filled sacs that the tendons glide over. A rotator cuff tear, when one of the tendons is torn from overuse or injury, can also cause intense shoulder pain. Other causes of shoulder pain can include arthritis, bone spurs - bony projections, a broken shoulder bone, frozen shoulder, when the muscles, tendons, and ligaments in your shoulder become stiff, and shoulder dislocation. Most of the time, you can take care of your shoulder pain at home. Try putting ice on your shoulder for 15 minutes, then leave it off for 15 minutes, three or four times a day for a few days. Make sure you wrap the ice in cloth, so it doesn't give you frostbite. Take ibuprofen to reduce pain and swelling. Slowly return to your regular activities once you start feeling less pain. Sudden shoulder pain can be a sign of a heart attack. Call Emergency Services if you have sudden pressure or crushing pain in your shoulder, especially if the pain starts in your chest, jaw, or neck. If you fall on your shoulder and feel sudden intense pain, you should see a doctor because you may have torn rotator cuff or dislocated your shoulder. If you have had shoulder pain before, try using ice and ibuprofen after exercising. Learn proper exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. Also, physical therapy can help. Make an appointment and talk about your options.

Normal rotator cuff

Presentation

<strong>Indications - Torn rotator cuff</strong><p>The role of the tendons is to hold the powerful shoulder muscles to the shoulder and arm bones. The tendons can be torn from overuse or injury.</p>

<strong>Procedure</strong><p>Either through an open incision or using small instruments through tiny incisions (arthroscopy), the tendon is repaired with sutures. If the tendon is separated from the bone, small rivets called suture anchors are used to attach the tendon back to the bone.</p>

<strong>Aftercare</strong><p>Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure is less predictable at returning strength to the shoulder. Recovery time often depends on the extent of the tear.</p>

Impingement syndrome - illustration

When tendons become trapped under the acromion, the rigid bony arch of the shoulder blade, it can cause shoulder pain called impingement syndrome. The tendons become compressed, damaged, and inflamed leading to rotator cuff tendonitis. This can occur from general wear and tear as you get older, or from an activity that requires constant use of the shoulder like baseball pitching, or from an injury.

Impingement syndrome

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Rotator cuff muscles - illustration

There are four muscle tendons that connect to the shoulder that make up the rotator cuff. Together these four tendons stabilize the upper arm bone to the shoulder socket and allow the wide range of motion in the shoulder.

Rotator cuff muscles

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Heart attack symptoms - illustration

Symptoms of a possible heart attack include chest pain and pain that radiates down the shoulder and arm. Some people (older adults, people with diabetes, and women) may have little or no chest pain. Or, they may experience unusual symptoms (shortness of breath, fatigue, weakness). Women are more likely than men to have symptoms of nausea, vomiting, back or jaw pain, and shortness of breath with chest pain.

Heart attack symptoms

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Bursitis of the shoulder - illustration

Bursae are fluid-filled cavities located at tissue sites where tendons or muscles pass over bony prominences near joints. Their function is to facilitate movement and reduce friction between moving parts. When a bursa becomes infected, traumatized, or injured it is referred to as bursitis.

Bursitis of the shoulder

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Shoulder separation - Se...

Presentation

<strong>Indications, part 1</strong><p>This type of ligament tear is considered a second-degree shoulder separation.</p>

<strong>Indications, part 2</strong><p>When the ligaments are disrupted in this fashion, the result is a third-degree shoulder separation.</p>

Shoulder joint dislocati...

Animation

Shoulder joint dislocation - Animation

Force on a joint can cause a dislocation. The force pushes the bone out of the socket, which may damage surrounding ligaments, tendons, and nerves.

Rotator cuff problems

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Rotator cuff problems - Animation

Shoulder pain

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Shoulder pain - Animation

Normal rotator cuff

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