Shoulder Pain

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.

PICTURE 1. Range of motion. Stand up and lean over so that you are facing the 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 you have pain, stop. You can try again later.

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.

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.

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 left arm at your side. With a weight in your left hand and your forearm across your stomach, raise your forearm. Keep your elbow near your side.

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.

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.

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.