Shoulder Pain

No matter if you’re unloading the dishwasher, cleaning out the garage, or playing catch with your son or daughter, shoulder pain can make even basic daily activities an uncomfortable experience.

From a general perspective, most shoulder problems fall into one of four general categories:

  • Arthritis

  • Fracture (broken bone)

  • Instability

  • Tendon inflammation and tears

Now, there are other potential causes of shoulder pain, although they tend to be less common. These include things like tumors and nerve-related conditions.

One of the common threads binding these various injuries and conditions is this simple fact – if you are experiencing pain in a shoulder, there’s a problem that needs to be addressed.

Depending on an array of factors, including the actual injury you’ve sustained, you might feel pain all the time, or only when you move your shoulder. Further, the pain could be temporary or it will continue and need to be diagnosed and treated by an orthopedic specialist.

Fortunately, you can find the care you need here at McDowell Orthopedics & Podiatry Group!

Shoulder Anatomy

Part of the reason shoulder pain develops is the fact that this is a very mobile joint. Actually, what most people refer to as the shoulder is several joints functioning as a single unit. These joints are made up of—and supported by—various bones, muscles, and tendons, and this provides the mobility we usually take for granted.

There are essentially three shoulder bones – the shoulder blade (scapula), collarbone (clavicle), and upper arm bone (humerus).

The shoulder blade has a rounded socket (the glenoid), and this is where the upper arm bone connects. It is kept centered in the shoulder socket by a combination of muscles and tendons called the rotator cuff. These tissues cover the head of the humerus and attach it to the shoulder blade.

If you are a sports fan, you’re likely familiar with the rotator cuff on account of how frequently it is injured during athletic events – and especially for baseball pitchers, football quarterbacks, and other athletes who use an overhand throwing motion.

A shoulder’s mobility is necessary for allowing us to use our hands and arms for so many different tasks, but it comes at a cost. With the joint being as mobile as it is, there is an increased risk of instability or soft tissue impingement. Issues like these can contribute to both chronic and acute (sudden) pain.

As we had mentioned earlier, the majority of shoulder problems stem from a handful of general root causes. Let’s take a look at these more closely so you can better understand what is happening and when it is time to contact us for an appointment.

Arthritis

Arthritis is a medical issue that affects numerous people in a variety of different ways, including being the source of shoulder pain.

There are actually quite a few different forms of arthritis, but they are all common in the fact they cause pain and swelling in joints. In the case of arthritis that causes shoulder pain, the most likely culprit is osteoarthritis.

Osteoarthritis is the kind of arthritis people will typically think about when they hear the word “arthritis.” This is the “wear and tear” variety that can develop as the human body ages. The protective joint linings break down over time and this eventually leads to bone-on-bone friction in an affected joint.

This arthritic condition can have a slow, lengthy onset – along with pain that increases in severity over time.

Since arthritic joints tend to hurt more with movement, many people respond by moving less. This can actually lead to a bigger problem, however. Reduced movement contributes to greater stiffness and tightness in an affected joint. In turn, this makes movement even more painful.

So, even though it may seem counterintuitive, one measure that can help with arthritis is a physical therapy program based on appropriate stretching and strengthening exercises.

Other forms of treatment will depend on the nature of the condition and are prescribed on a patient-by-patient basis, but may incorporate anti-inflammatory medication and a certain degree of rest. When conservative care isn’t sufficient, we may recommend joint replacement surgery.

Fractures

Beyond arthritis, another common cause of shoulder pain (along with swelling and bruising) is a fractured shoulder bone. This injury can affect any of the three shoulder bones we identified earlier: the clavicle, scapula, and humerus.

Typically, when younger patients fracture a shoulder bone, the root cause is an acute, trauma injury – such as one sustained in an auto accident or sporting injury. Older patients can also break a bone in an auto or sports injury, but there is also a greater likelihood the fracture was sustained during a fall to the ground.

The nature of treatment for a shoulder fracture really depends on the severity of the injury. Whereas the body will do the heavy lifting of mending the broken tissue, we will take appropriate measures to stabilize the broken parts so they heal correctly.

In a less-severe break, we may prescribe a basic sling to be worn for anywhere from a couple of weeks to a couple of months. With severe fractures, we might need to perform a surgical procedure.

Instability (Dislocations)

When the head of the upper arm bone—the humeral head—is forced out of the shoulder socket as the result of a sudden injury (or from overuse, as well), the resulting situation is one of shoulder instability.

This instability can cause dislocation of varying degrees. In a partial shoulder dislocation (subluxation), the ball of the upper arm bone comes only partially out of the socket. In a complete dislocation, the ball has come all the way out.

In either kind of dislocation, the shoulder’s muscles and connective tissues (tendons, ligaments) can either loosen or even tear. This can then lead to easier and more frequent dislocation in the future – along with unsteadiness, pain, and, after enough time lapses, arthritis.

For a dislocated shoulder, the initial step is to maneuver the arm bone back into place. It is best to have a trained medical specialist do this to make sure the bone is correctly and securely back into the shoulder socket. Following this, the odds are pretty decent a sling will be needed for at least a couple of weeks (while the injury heals).

If shoulder dislocations become a recurrent problem, surgical intervention might be recommended to address the issue.

Tendon Inflammation and Tears

Shoulder Pain

Overuse injuries from repetitive tasks are a leading cause for shoulder pain. In these cases, the pain is actually the result of either tendonitis (tendon inflammation) or bursitis (bursa inflammation).

A tendon is a connective tissue connecting muscle to bone. The best example of this is actually found down in the lower leg – the Achilles tendon (which connects the calf muscle to the heel bone).

A bursa is a small, fluid-filled sac that acts as a natural cushion and typically is located between tendons and bones. Bursae reduce friction, which allows the tendons and bones to glide more easily, especially in joints throughout the body – including shoulder joints.

Sometimes, bursa inflammation enables tendons to scrape against bone, and this results in either weakness or tearing of the respective tendons. Tendons scraping against bone is called impingement, which is important to know when we talk about shoulder pain.

Tendonitis

There are two general types of tendonitis:

  • Acute. This form is the result of excessive force placed on a tendon, such as when an athlete throws a ball very hard.

  • Chronic. This form develops over time and can be attributed to factors like repetitive wear and tear (due to aging) or degenerative diseases like arthritis.

Within the shoulder, the most commonly affected tendons are the four rotator cuff tendons, along with one of the biceps tendons. There are four small muscles—along with their respective tendons—that make up the rotator cuff. This important anatomical feature covers the head of the humerus bone (so as to keep it in the shoulder socket). Unfortunately, it is also often the source of injury.

When the tendons of the rotator cuff are inflamed, there is simply less space for tissues (other tendons, muscles) to move within the joint.

The result of pressure on soft tissues from the top of the shoulder blade (acromion) is shoulder impingement. This happens when the arm is lifted away from the body. In this movement, the acromion impinges the rotator cuff tendons and respective bursae – thereby causing tendonitis or bursitis (which, in turn, results in pain and limited mobility).

Tendon Tears

Acute injuries and degenerative changes in tendons (on account of advanced aging, natural “wear and tear,” or other sources) can lead to splitting or tearing.

Tendon tears can either be partial or complete (wherein there is total separation of the tendon’s normal attachment to bone).

The most common injuries contributing to torn shoulder tendons are rotator cuff and biceps injuries.

Bursitis

Excessive shoulder use can contribute to swelling and inflammation of the bursa located between the acromion and rotator cuff – a condition known as subacromial bursitis.

Bursitis frequently develops in conjunction with rotator cuff tendonitis. Essentially, a problem with any of the many shoulder tissues can affect other, surrounding tissues as well. These issues can be difficult enough on their own, but when they are combined, it can make daily activities like getting dressed or even brushing your hair rather difficult.

To treat bursitis (and tendonitis), we will recommend resting the injured shoulder and discuss specific positions and activities to be avoided during the recovery process. Depending on the severity of the injury—along with other factors—we may prescribe a cortisone injection and physical therapy program. The cortisone is useful in reducing pain and inflammation, while physical therapy can help to improve mobility and range of motion.

Orthopedic Care for Shoulder Pain

If you have developed shoulder pain that is frequent and disrupting your normal, daily activities—and home care for your injury isn’t helping—it’s time to come see our team here at McDowell Orthopedics & Podiatry Group.

We specialize in treating orthopedic injuries of all kinds, including shoulder conditions and pain. Don’t let painful symptoms disrupt your life any more – instead, contact our Carmichael practice and request your appointment with an orthopedic specialist.

Call us today at (916) 961-3434 to schedule an appointment or take a moment right now and connect with us online.

Dr. Brian McDowell
Dr. Brian McDowell, board-certified podiatrist, provides cutting-edge foot and ankle care in Carmichael, CA.

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