Shoulder pain can occur suddenly with an injury, such as a fall on the shoulder. However, many people develop shoulder pain without any injury (non-traumatic shoulder pain). There are several common causes of non-traumatic shoulder pain, and the risk for these problems increases with age. The most common causes are tendonitis, rotator cuff tear, bursitis, arthritis and frozen shoulder.
What is tendonitis?
A tendon is a cord that connects a muscle to bone. There are two major tendons in the shoulder, the rotator cuff and the biceps tendon. Either can become inflamed and painful (called tendonitis) from overuse or from repetitive wear and tear due to age.
What is a rotator cuff tear?
The rotator cuff is a large tendon in the shoulder whose main function is to stabilize the shoulder during movement. Degenerative changes in the tendon can occur due to the wear and tear of everyday use. With advancing age, splitting and tearing can occur. The size of tears can range from small to large. If the tear is massive, the tendon will completely split into two pieces.
What is bursitis?
Bursae are thin, fluid-filled sacs located in many joints throughout the body including the shoulder. They function as a cushion between a bone and a nearby tendon. With overuse the bursa in the shoulder can become inflamed and swollen (called bursitis) causing pain with movement and sometimes even at rest. Bursitis often occurs together with rotator cuff tendonitis.
What is shoulder arthritis?
Shoulder pain can be due to arthritis. There are different types of arthritis, but the most common to affect the shoulder is osteoarthritis (OA), also known as “wear and tear” arthritis. The cause of OA symptoms is the wearing down of the cartilage in the joint. Cartilage normally functions as a cushion between the bones. OA usually begins in middle age and gradually worsens over time.
What is frozen shoulder?
In frozen shoulder, the tissue around the joint (called the capsule) becomes thick and tight. It is as if the capsule becomes “shrink-wrapped” around the shoulder causing pain and stiffness. Over time, the shoulder becomes very hard to move. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men. The cause is not known.
What are the symptoms of these shoulder disorders?
Common to all of them is pain in the shoulder. For some patients the pain may come and go with daily activities, but for others the pain can be constant. Shoulder pain during the night is common. Many patients also complain of pain in the upper arm (called referred pain). Some describe the discomfort as dull, aching or throbbing. Joint stiffness can limit the normal range of motion causing difficulties with activities such as combing one’s hair or getting dressed.
How is the cause of shoulder pain diagnosed?
The cause of the pain can usually be determined based on the patient’s description of their symptoms, an examination of the shoulder, and imaging tests including x-ray, ultrasound and MRI. Lab tests are only occasionally necessary to help make a diagnose.
How is shoulder pain treated?
Treatment can vary depending on the cause of the pain. The common disorders usually require some combination of medication, physical therapy, and shoulder injection. Most patients can be treated and managed over time without surgery. However, there are situations when it is appropriate to consider seeing an orthopedic surgeon with expertise in the surgical treatment of shoulder disorders.
Points to remember:
- Non-traumatic shoulder pain is common with advancing age.
- The most common causes of shoulder pain are tendonitis, rotator cuff tear, bursitis, arthritis and frozen shoulder.
- Most of the time these disorders are treatable without surgery.
*For persistent joint pain that is interfering with your daily activities, see a rheumatologist to make the correct diagnosis and begin the proper treatment.