Mar 15, 2003 Table of Contents

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education Web site.

Information from Your Family Doctor

Shoulder Pain

Am Fam Physician. 2003 Mar 15;67(6):1319-1320.

What causes pain in my shoulder?

A common cause of shoulder pain is soreness of the tendon in the rotator cuff. The tendon is a cord that attaches a muscle to another body part. The rotator cuff is the part of the shoulder that helps the arm do a circular motion. Another common cause of shoulder pain is soreness of the subacromial bursa (say: sub-ak-rome-ee-all bur-sah). This is a pad of fluid under the highest part of the shoulder. You might have soreness after activities that require you to lift your arms, like painting a house, lifting boxes, or playing tennis. Or you may not be aware of any specific injury or activity.

The main shoulder joint is formed by the arm bone and the shoulder blade. The joint socket is shallow to allow a wide range of motion in the arm. The rotator cuff is made up of four muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.

How does the rotator cuff get hurt?

One of the muscles rests on top of the shoulder. Its tendon travels under the bone on the outside of the shoulder. 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 be pinched between the two bones. The pad of fluid that cushions the tendon also can be damaged.

How do I know my rotator cuff is hurt?

If the rotator cuff is involved, the pain usually is in the front or outside of your shoulder. This pain usually is 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 up.

What can I do to help the pain?

Treatment should do two things: (1) help your pain and (2) help you get back normal function in your shoulder. Pain relief includes the following steps:

  • Active rest (no heavy lifting, but keep moving your shoulder)

  • Physical treatments such as ultrasound

  • Application of ice

  • Medicine such as ibuprofen (some brands: Advil, Motrin, Nuprin) or naproxen (brand name: Aleve)

  • Occasionally, an injection of steroids into your shoulder

Normal function can be restored with special exercises. The first step is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you can help avoid a serious complication of rotator cuff injury, called frozen shoulder. Range-of-motion exercises are followed by exercises using rubber tubing or light dumbbells. The final step is training with weight machines or free weights.

What exercises should I do?

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.

PICTURE 1.

Range of motion. Stand up and lean over so that you are facing floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles and then draw bigger ones. Repeat these exercises five to 10 times every day. If have pain, stop. You can try again later.

View Large


PICTURE 1.

Range of motion. Stand up and lean over so that you are facing floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles and then draw bigger ones. Repeat these exercises five to 10 times every day. If have pain, stop. You can try again later.


PICTURE 1.

Range of motion. Stand up and lean over so that you are facing floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles and then draw bigger ones. Repeat these exercises five to 10 times every day. If have pain, stop. You can try again later.

Are there other things I can do to help this injury heal?

An aerobic exercise program will help improve the blood flow to the tendon and bursa. Increased blood flow helps reduce soreness. Smokers should quit smoking so that more oxygen will reach the injured tendon. This will help the injury heal faster.

PICTURE 2.

Rotator cuff strengthening. Use a piece of rubber tubing made for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With the hand that is closest to the door, bend your arm at a 90-degree angle and grab the loop of the tubing. Pull the band across your stomach. At first, do this 10 times (this makes one set). Try to increase the number of sets as your shoulder pain lessens. Do these exercises every day.

View Large


PICTURE 2.

Rotator cuff strengthening. Use a piece of rubber tubing made for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With the hand that is closest to the door, bend your arm at a 90-degree angle and grab the loop of the tubing. Pull the band across your stomach. At first, do this 10 times (this makes one set). Try to increase the number of sets as your shoulder pain lessens. Do these exercises every day.


PICTURE 2.

Rotator cuff strengthening. Use a piece of rubber tubing made for these exercises. Stand next to a closed door with a doorknob. Loop the tubing around the knob. With the hand that is closest to the door, bend your arm at a 90-degree angle and grab the loop of the tubing. Pull the band across your stomach. At first, do this 10 times (this makes one set). Try to increase the number of sets as your shoulder pain lessens. Do these exercises every day.

Will I need surgery?

Sometimes an injury that lasts a long time will cause the tendon to tear. This type of injury may need surgery. You might have a torn rotator cuff if the pain goes on in spite of a good exercise program or if you have weakness in certain arm motions.

PICTURE 3.

Body strengthening. As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your side. With a weight in your forearm across raise your forearm. elbow near your side.

View Large


PICTURE 3.

Body strengthening. As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your side. With a weight in your forearm across raise your forearm. elbow near your side.


PICTURE 3.

Body strengthening. As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your side. With a weight in your forearm across raise your forearm. elbow near your side.


This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Copyright © 2003 by the American Academy of Family Physicians.
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