Shoulder Pain: Why Does it Hurt and What Can I Do About It?
Does your shoulder hurt when you sleep on it? When you put away the groceries in kitchen cabinets? When you reach into the back seat of your car? What about that small twinge of shoulder pain when you suddenly move?
Our shoulders are made up of several joints combined with tendons and muscles. They’re designed to allow for a wide range of movement and activity with our arms. Because of this connected relationship, our shoulders are highly susceptible to injury.
Interestingly, many of the causes of shoulder pain are age related. Our bodies go through a process of growth, use, and wear. Therefore, shoulder pain at age eighteen has an entirely different meaning from the same symptoms at age sixty. So, what’s the difference?
Pain as an Adolescent:
In your teens and twenties, shoulder pain is often caused by bursitis. What is that? Our shoulders contain a fluid sac (the bursa) that provides cushioning for movement and pressure. The bursa can become irritated by a direct hit or constant, repetitive motion. Once irritated, the bursa inflames, causing bursitis.
Bursitis most often occurs with athletes constantly repeating a motion, such as a tennis serve. Bursitis may also develop from calcium deposits in the bursal gliding tissues. This can be diagnosed on physical examination and x-rays can confirm the presence of calcium deposits. These are usually treated with a cortisone shot, in other cases, they may be removed surgically.
The teens and twenties are also the time of life when most shoulder dislocations occur. How does that happen? Our shoulder bone is a ball-and-socket joint; so when the upper arm is pulled or pushed in a severe motion, the bone will ‘pop’ partially or completely out of the socket. On rare occasion, the bone may move back in place, or a person may be able to move it back themselves. Most commonly, this injury will need professional treatment, an initial procedure called shoulder joint reduction. For some patients, a serious dislocation will cause a torn shoulder capsule and will need to be repaired via an operation.
Pain as an Adult:
In our thirties and forties, bursitis often evolves into impingement. This condition occurs when the front part of the shoulder inflames from repetitive motion and develops a bone spur, irritating the rotator cuff. Impingement is commonly seen in labor-intensive occupations such as construction, landscaping, or painting. Patients will feel discomfort or pain when lifting their arm or stretching to the side and back. This can be initially treated with a cortisone shot if the pain is mild, however, if the condition is serious, the bone spur will be removed surgically.
Rotator Cuff Tears
People in their fifties and sixties often develop rotator cuff tears, causing pain, weakness, and limited motion.
How does this happen? Many times, acute trauma is to blame – a sudden movement while lifting a heavy object or an unexpected fall on your outstretched arm. More often, it occurs slowly over time with wear and tear – this degeneration happens naturally as we age. The size of the tear often increases with time; if recognized early, the tear is best fixed with surgical repair of the torn muscle back to the bone.
For adults over sixty, arthritis is quite common and often chalked up to genetics or general aging. However, after a rotator cuff tear, arthritis may develop in the shoulder as a result. This is associated with stiffness, grinding pain, and weakness. If diagnosed early, it may be treated with physical therapy, however, if the pain persists, a traditional shoulder replacement may be necessary. For patients with minor tears, the traditional replacement of the rotator cuff will allow for a full recovery and return to unlimited motion. However, for patients with preexisting arthritis and a rotator cuff tear, a new reverse total shoulder surgery would be recommended. In this alternative operation, the roles of the joints are switched, taking the pressure away from the rotator cuff and relying on the muscle to move the arm instead, allowing for a more fluid motion of the arm.
Another cause of shoulder pain may be caused by pinched nerves in the neck, a condition called cervical radiculopathy. Why does this occur? As we age, our bones enter a degenerative process of changing spinal joints, which tightens space in the spinal canal. As this space tightens, nerves become pinched. Patients will feel pain radiating from the neck into the shoulder, as well as numbness and weakness in the arm. This condition can be treated with physical therapy or steroid shots. In severe cases, surgical decompression of the disc (opening the pinched space) or bone pinching the nerve (thinning down the pressing bone) may be necessary.
Carpal Tunnel Syndrome
The final cause of shoulder pain we’ll mention is carpal tunnel syndrome. With the rise of technology in both the workplace and home, carpal tunnel syndrome cases have greatly increased. The movement of hands in quick, repetitive motions on keyboards, smartphones, and tablets can wreak havoc on tendons and nerves. Typing or texting for an extended period of time causes the tendons in our hands to swell, which places pressure on nerves, causing pain in the hand. If left untreated, the condition has the potential to travel to the upper arm and neck. Treatment for carpal tunnel syndrome, if diagnosed early, often includes physical therapy, a temporary splint, or steroid injections. More serious cases may involve surgery to open the tunnel to provide more space for the irritated nerve.
While most orthopaedic patients do not require surgery, surgical procedures are an integral part of the orthopaedic specialty. An extensive array of procedures are commonly performed at BMH. As a patient, you should be encouraged to ask your doctor’s opinion about the full range of treatment options in order to make an informed decision about what is in your own best interest.
BMH Orthopaedics & Sports Medicine, located at 17 Belmont Avenue, Brattleboro, VT, is a specialty practice comprised of board-certified orthopaedic surgeons, physician assistants, and a certified athletic trainer. To learn more about the practice, call 802-251-8611.