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Published on September 05, 2017

photo showing the backside view of a man holding his shoulder in pain.
Shoulders: Our most mobile and least stable joints

Douglas Stull, MD; OrthoKansas

Douglas Stull, MD

OrthoKansas

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Shoulder problems occur frequently in adults, and even more frequently among older adults.

“The joint relies heavily on muscles, tendons and ligaments for stability, not bony geometry like the hip,” said Doug Stull, M.D., of OrthoKansas.

For the shoulder – which Dr. Stull describes as “human beings’ greatest joint and their most mobile one” – there’s a direct link between high mobility and less stability.

For most common shoulder conditions, pain during even simple movement often is the primary symptom. People also may notice that pain is restricting their range of motion or ability to move their shoulder and upper arm.

Here’s a look at some frequent causes of shoulder pain:

Osteoarthritis

This is the most common type of arthritis and occurs when the cartilage protecting a joint wears down and is lost. “When the incredible normal motion of the shoulder joint is lost, slowly but progressively, especially in patients older than 50, osteoarthritis is generally the most common cause,” Dr. Stull said. Osteoarthritis can occur due to aging, wear and tear over time, and sometimes due to injury earlier in life. In addition to pain, which often increases at night, the affected joint may creak, grate or click because of the loss of cartilage. Many people also experience stiffness, weakness and swelling in their shoulder. Initial treatment recommendations may include over-the-counter anti-inflammatories and pain relievers, physical therapy and low-impact exercises. Surgery to replace the worn-out joint may be recommended if these measures don’t sufficiently reduce pain and increase mobility.

Rotator cuff disease

The rotator cuff is a group of four muscles and tendons that connect the arm to the shoulder. “The rotator cuff plays a crucial role in joint stability and is one of the most common problems patients present with,” Dr. Stull said. This area is very susceptible to damage over time due to normal aging and use. Injuries also can damage this area. Inflammation in or deconditioning of the tendons is common, leading to pain when reaching overhead or behind the back, or when sleeping on the affected side. Sometimes, icing the shoulder area and over-the-counter pain medications may provide adequate relief, and physical therapy is one of the mainstays of treatment. Occasionally, injections of steroids in the area around the rotator cuff can help. If the rotator cuff is severely damaged, surgery to repair the area may be recommended and often can be performed using minimally invasive techniques.

Bursitis

The bursa are thin sacs of fluid that provide cushioning and shock absorption to bones, tendons and muscles around a joint. When inflammation occurs in a bursa, it is called bursitis. Pain during overhead or side movements is common. Frequently, the cause of bursitis is related to repeated motion or overuse of the joint from sports such as tennis or swimming. Common treatment strategies are similar to those for rotator cuff disease and may include: medications to relieve pain, ice, specific exercises and a steroid injection. Avoidance of provocative activities may be required for a short time and, on rare occasions, surgery may be recommended to drain the inflamed bursa.

Frozen shoulder

This condition, also known as adhesive capsulitis, occurs when the capsule of connective tissue that lines the shoulder joint becomes thickened and inflamed. The exact cause is unknown, but it seems to be more common in women older than 50, and in people who have diabetes or thyroid disease. Sometimes, an injury may lead to frozen shoulder but more often it occurs without a clear reason. These are the three stages: painful movement; frozen, when pain decreases but stiffness increases so movement is difficult; and thawing, when movement increases as the stiffness decreases. People with frozen shoulder frequently have pain, even when they are not moving their shoulder. It may take many months to progress through the stages of frozen shoulder. Treatment strategies can include ice, a home exercise program, over-the-counter pain relievers, steroid injections and, rarely, surgery.

When pain occurs in your shoulder, it is important to see your healthcare provider for evaluation and diagnosis. There are many reasons for shoulder pain besides those listed above. In addition to orthopedic causes, other conditions such as heart or gallbladder disease may cause “referred” pain to the shoulder area. A careful history of symptoms, a physical examination and radiologic imaging through an X-ray or an MRI to confirm diagnosis usually are recommended to confirm a diagnosis.

For more information on any of these conditions, visit:

— Aynsley Anderson Sosinski, MA, RN, is community education coordinator at Lawrence Memorial Hospital, which is a major sponsor of WellCommons. She is a Mayo Clinic Certified Wellness Coach. She can be reached at aynsley.anderson@lmh.org.

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