Shoulder Pain: A Common Problem as We Age

As we age, we inevitably put a lot of wear and tear on our body. This becomes problematic for the shoulder, which, out of all our joints, is called upon to do the "heavy lifting" throughout our lifetime.

The shoulder is the only joint that allows us a nearly full range of motion with our arms. In contrast, our knee allows our leg to move up and down, but not turn around. The unique, versatile mobility of the shoulder joint sets it up for special problems that come with repeated use.

Like our hip, our shoulder has a ball and socket joint where the tip of the limb bone is a ball that fits into a circular groove connected to the body. The ball rotates and allows movement. It is held in place by ligaments and cartilage and is cushioned by a bursa, or soft sac, as it moves in the bony joint socket. The various ligaments and cartilage that encapsulate the ball joint shoulder are called the rotator cuff.

Causes of shoulder pain include use and overuse, chronic disease and injury as a result of physical trauma. Pain can develop slowly or immediately. Slow, progressive pain begins as a subtle discomfort and, over time, can become severe and incapacitating. Slower, progressive pain may be managed at home and controlled or cured. Acute, severe pain occurs after an accident, such as a fall or blow to the arm and requires medical attention and may require treatment.

The table below lists many of the most common causes. They may be categorized as use, trauma and disease-related.

Use or Overuse
Rotator cuff tendon impingement	Bursitis
Osteoarthritis	"Frozen" - Adhesive capsulitis
Ligament strain	Tendon and muscle wear or tear
Trauma
Separation	Clavicle fracture
Cartilage tear	Humerus fracture
Tendon tear	Dislocation
Chronic Disease
Calcific tendinitis	Bone spurs
Diabetes, high cholesterol, thyroid disorder	Rheumatoid arthritis

If the pain is not severe and doesn't limit activities, watchful waiting can be tried before going to your doctor, an orthopedic surgeon, or the hospital Emergency Department. If home treatment for mild to moderate pain doesn't work over several months, see a physician.

Your physician will ask you about the history of the pain, its severity and to describe any activities or movement that increase the pain. Next, a physical examination will focus on the movements of the arm/joint that cause or worsen the pain. Your doctor may ask you to move your arm in different directions to assess what positions cause the pain. Diagnostic imaging such as an X-ray, magnetic resonance imaging scan, and/or computed tomographic scan will be needed to make a final diagnosis. Additional tests to evaluate nerve/muscle conduction of affected structures may also be performed. Depending on the diagnosis, your doctor may refer you to an orthopedic surgeon for further diagnosis or treatment.

Treatments for shoulder pain fall into two broad categories: home and physician directed. Home treatment includes stopping activities that cause the pain. Ice applications may also be recommended, as well as over-the-counter analgesics that reduce inflammation, such as aspirin, acetaminophen and ibuprofen. Physical therapy to improve range of motion may also be prescribed. If the pain is an emergency caused by trauma, it is best to go straight to the local Emergency Department where the physician can diagnosis the pain and initiate treatment.

A displaced or dislocated shoulder joint may require emergency treatment. Other traumatic shoulder injuries may be treated at that time or referred to orthopedic surgeons for operation. Chronic pain also can require physician-directed treatment. Various treatment strategies are available. Generally, the physician will start with the least invasive and progress to other treatments as needed.

Surgery to correct shoulder pain may be arthroscopic or traditional. This generally involves cutting some muscle to expose the structures that need repair or reconstruction. Both shoulder arthroscopy and open operation are performed by an orthopedic surgeon.

Recovery from rotator cuff surgery takes time. Your arm will be in a sling for about six weeks and you must refrain from certain activities, including driving, until you recover. Physical therapy is also a key part of your recovery plan to help you recover your range of motion and comfortably resume your normal activities. Choose your surgeon carefully and engage one who specializes in the procedure and the post-surgical rehabilitation