A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle) of the rotator cuff (the part of the shoulder that helps circular motion). Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder). You might have soreness after activities such as painting, lifting or playing a sport, which require you to lift your arms. Or you may not remember any specific injury.
The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.
The supraspinatus muscle rests on top of the shoulder. Its tendon travels under the bone on the outside of the shoulder (the acromion). This tendon is the one most often injured because of its position between the bones. As the tendon becomes inflamed (sore and swollen), it can become pinched between the 2 bones. The sac of fluid that cushions the tendon can also be damaged.
If the rotator cuff is involved, the pain is usually in the front or outside of the shoulder. This pain is usually worse when you raise your arm or lift something above your head. The pain can be bad enough to keep you from doing even the simplest tasks. Pain at night is common, and it may be bad enough to wake you.
Treatment should help your pain and help you restore your shoulder to normal function. Pain relief strategies include active rest (you can and should move your shoulder, but you shouldn't do strenuous activities like lifting heavy objects or playing tennis). Physical treatments such as ultrasound and application of ice, nonsteroidal anti-inflammatory medicine such as ibuprofen (some brands: Advil, Motrin, Nuprin) or naproxen (brand name: Aleve) and, occasionally, an injection of anti-inflammatory steroids can also help.
Normal function can be restored with special exercises. The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. These range-of-motion exercises are followed by resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.
The following exercises may help you (see pictures 1, 2 and 3). Check with your doctor to see if you should do other exercises, too.
Sometimes an injury that lasts a long time will cause the tendon to tear. This type of injury may need surgery. A tear of the rotator cuff is suspected when the pain goes on in spite of a good rehabilitation program or when there is weakness in certain motions of the arm.
The shoulder bursa can become inflamed from repetitive motion of the shoulder. Shoulder bursitis often occurs in sports with overhead activities such as swimming, tennis, or throwing. It may also occur in occupational activities such as painting or carpentry.
You have pain on the outer front side of your shoulder. Your shoulder may hurt when you lift your arm above your head. The outer side of your shoulder may become swollen and may at times feel warm.
Your health care provider will review your symptoms and examine your shoulder.
Treatment may include:
The length of recovery depends on many factors such as your age, health, and if you have had a previous injury. Recovery time also depends on the severity of the injury. A bursa that is only mildly inflamed and has just started to hurt may improve within a few weeks. A bursa that is significantly inflamed and has been painful for a long time may take up to a few months to improve. You need to stop doing the activities that cause pain until your shoulder has healed. If you continue doing activities that cause pain, your symptoms will return and it will take longer to recover.
Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your shoulder recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.
You may safely return to your activities when:
Be sure to warm up properly and stretch your shoulder before such activities as throwing, playing tennis, or swimming. If your shoulder begins to hurt during these activities, you may need to slow down until the pain goes away.
You may do these exercises when your pain has improved.
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