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12 Reasons Why You Have Shoulder Pain

From TIME - September 4, 2017

What causes shoulder pain?

Shoulder pain is a common ache in the U.S.: By some estimates, as many as 67% of people experience shoulder discomfort at some point over the course of their lives. The most mobile joint in your body, the shoulder is made up of bones held in place by muscles, tendons, and ligaments. They are all designed to work together to allow the shoulder to move freely in many different directions. This allows you to do everything from raising your arms over your head to throwing a baseball and scratching your back. "Unfortunately, this mobility comes at the expense of stability," and that leaves the shoulder vulnerable to injury, says Clifford Stark, DO, medical director of Sports Medicine at Chelsea in New York City. Factor in the wear and tear of everyday life and its easy to see why you are shouldering so much pain.

You will need to consult your doctor for a formal diagnosis of your shoulder pain. That visit will include a physical exam, and possibly an X-ray, MRI, or ultrasound, or you may even be referred for physical therapy right off the bat, Dr. Stark says.

Read on to learn about some of the many reasons why your shoulder might hurt and how to find relief.

Rotator cuff tendonitis

Of all the reasons you can have shoulder pain, injury to your rotator cuff is the most commonin a recent study, two-thirds of people with shoulder pain had a rotator cuff problem. A group of muscles and tendons that attach to the bones of the shoulder joint, the rotator cuff keeps the ball of your upper arm bone centered in your shoulder socket and also helps you raise and rotate your arm.

Doing the same motion over and over again can lead to inflammation of the rotator cuff tendons, also called tendonitis, which can cause shoulder pain. "The rotator cuff is like a tirewith aging or frequent use it gets thinner and thinner and eventually wears down," says Robert Gotlin, DO, a sports and spine physician in NYC and an associate professor of rehabilitation medicine and orthopedics at the Icahn School of Medicine at Mount Sinai. With tendonitis, shoulder pain and weakness are often mild at first and only noticeable when you move the joint; after a while, they can become more severe and occur all the time.

Rotator cuff tendonitis often gets better with a change in activities to avoid provoking pain so the tendon can heal. "There's a fine line between doing too much and doing too little," says Dr. Stark. "You do not want to lift weights, but it's okay to do things that do not aggravate it." Ice or heat to the shoulder and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can reduce pain as well. Your doctor may also refer you to a physical therapist for manual therapy and strengthening exercises to keep your muscles moving and to challenge weaker muscles.

Rotator cuff tears

It's also possible to partially or completely tear a shoulder tendon, either from repetitive motion or from direct trauma, like a fall.

The pain of an acute tear, one that happens suddenly, can be excruciating. But shoulder pain, weakness, and stiffness of a chronic tear worsen slowly over timeso you often do not notice when they begin.

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Rest, ice or heat, and NSAIDs may help heal rotator cuff tears. But your doctor will likely suggest physical therapy to strengthen your shoulder muscles and improve the mechanics of the shoulder joint, as well as provide exercises to do at home. "Your tires will last you a lot longer if your alignment and shocks are good, and the exact same thing is true of the shoulder," says Dr. Stark. Cortisone (steroid) injections, which give temporary pain relief so you can strengthen your muscles, or surgery may also be required.

Frozen shoulder

This injury is exactly what it sounds like, says Dr. Stark. "People with frozen shoulder come in with severe stiffness and inability to move their shoulder the way they normally would, with varying levels of shoulder pain." Medically known as adhesive capsulitis, frozen shoulder results when the connective tissue that lines your shoulder joint becomes thickened and inflamed. Precisely why this happens is not known, nor is the reason why middle-age women are especially prone to frozen shoulder. There are other factors that can put you more at risk of the condition. For instance, up to 20% of people with diabetes develop frozen shoulder, and people with thyroid problems or Parkinson's disease may also be vulnerable to this type of shoulder pain.

You do not just wake up with frozen shoulder though. Doctors break the progression into three stages: "freezing," "frozen," and "thawing." "Over time, you will notice a decrease in your range of motion and then all of a sudden it escalates," says Dr. Gotlin. Most people get better without treatmenteventually. It usually takes about 18 months for a frozen shoulder to completely thaw. "You can cut it down a few months with physical therapy, but it will still last a while," says Dr. Gotlin. Since some people wind up with a frozen shoulder on the opposite side as well, doctors often treat the good side too, just to keep it moving.

Shouler bursitis

Got deep, achy soreness that feels hot and swollen? Chances are you have shoulder bursitis, an inflammation of the bursa, a fluid-filled sac that provides a smooth surface for muscles and bones to glide over. "If you have two muscles aligned side by side and there is not something between them to reduce friction, they would not move," explains Dr. Gotlin. Normally these sacs, which are found in joints throughout the body, are filled with a small amount of fluid. Sometimes, though, when you overdo it (say, by throwing a ball or lifting something over your head repeatedly), the body responds by bringing more fluid to the bursaand the swelling that influx produces is what's known as bursitis. "A bursa is like a balloon that's practically flat, and bursitis is the balloon being filled up with lots of water," says Dr. Gotlin.

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The pain from bursitis is typically on the outside of your shoulder and it's made worse when using your arm above your head. Treatment is usually rest, ice or heat, and pain relievers, but your doctor may recommend physical therapy to stretch or strengthen the shoulder muscles and increase range of motion, and/or cortisone injections to reduce inflammation.

Labral tears

It's not unusual to hear about pro athletes suffering tears to the labrum, a thin rim of soft cartilage that surrounds the edge of the shoulder socket and helps keep the shoulder stable yet mobile. But these tears are a common injury in regular folks too. Indeed, probably half of middle-age men and women have some sort of labral tear from years of using their arms, says Dr. Gotlin. Often you wo not even be aware you have one, since some tears are completely asymptomatic and cause no problems. But others can trigger shoulder pain, specifically when moving your arm in an overhead motion or across your chestsay, to scratch your left shoulder with your right arm.

There are several types of labral tears and treatment depends on the severity of the injury. For instance, if the labrum is still attached to the socket and just frayed, rest, NSAIDs, and physical therapy usually help relieve pain; however, because these tears typically do not completely heal, the problem can flare up again. If the labrum is fully detached, surgery is usually required.

Shoulder impingement

You do not even have to know what impingement means to know it's something you do not want to getthe word itself sounds like trouble. Shoulder impingement often occurs after repeated overhead activity, like swimming. Shoulder tendons and bursa get impinged, or pinched, between the bones of the shoulder, which makes it painful to move your arm. Various positions, including overhead motion, reaching back, or lying on the affected side, may all worsen the symptoms.

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Shoulder impingement can weaken the rotator cuff, so physical therapy is key to alleviating this pain and preventing further damage. "Since one of the main jobs of the rotator cuff is to stabilize the joint, any weakness to it will lead to further impingement, creating an ever-vicious cycle," says Dr. Stark. Properly strengthening these muscles and balancing all the muscles and tissues that affect the position of the shoulder effectively can relieve the impingement.

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