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Ouch! 5 Common Causes of Shoulder Pain

From arthritis to rotator cuff damage, why your shoulders may hurt and possible treatments

En español l All shoulder pain is not created equal. You can have chronic tenderness, pain from short-term injuries or just plain wear-and-tear aches from age. Dealing with the problem depends largely on the cause of the pain — and its severity. Below are five of the most common causes, along with some treatment options.

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Causes for shoulder pain (Age Fotostock)

Don't let shoulder pain get the best of you. There are treatment options available. — Age Fotostock

1. Osteoarthritis

What it is: Osteoarthritis, the most common type of arthritis, is diagnosed when the cartilage protecting the joints degenerates or wears down. The chronic pain caused by osteoarthritis is often worse at night. The affected joints might creak or click due to the loss of cushioning from the cartilage. In addition to stiffness and weakness, the joint might appear swollen.

Causes: Osteoarthritis is known as wear-and-tear arthritis because it tends to be linked to long-term wear on the joints; traumatic injuries that damage the cartilage can also be linked to this condition. Osteoarthritis most often occurs in people over 50 and can be hereditary.

Treatments: There is no cure for osteoarthritis. A study published in 2000 in the Journal of the American Medical Association found that taking the supplements glucosamine and chondroitin may help ease the symptoms, but more recent research has yielded mixed results.

These supplements "aren't magic bullets and won't rebuild or repair the cartilage, but in moderate cases, they may help with pain," says Edward Laskowski, M.D., a physical medicine and rehabilitation specialist and codirector of the Mayo Clinic Sports Medicine Center in Rochester, Minn.

Taking pain relievers (both over-the-counter and prescription), as well as trying physical therapy and specialized exercises and modifying everyday movements to reduce the stress on the shoulder joint, are all recommended before turning to surgery.

These exercises can help strengthen the muscles around the bone and ease the pain. "The muscles provide stability to the joint," Laskowski says. "The stronger the muscles are, the more they can take the pressure off the joints."

Scientists are currently investigating new treatments for osteoarthritis, including the use of blood platelet injections. Some studies have found that these injections can stimulate repair and regeneration of the cartilage, reduce inflammation and decrease pain, though others suggest that the treatment isn't any more effective than a placebo. Whatever option you explore, if you and you doctor find that the disease is progressing, surgery, including joint replacement, might be recommended.

2. Rotator Cuff Damage

What it is: The group of four muscles and tendons that connect the arm to the shoulder is called the rotator cuff. The tendons are susceptible to inflammation and bruising, leading to pain when performing overhead activities, sleeping on the affected side or reaching behind your back. Left untreated, rotator cuff injuries can cause persistent shoulder pain.

Causes: While injuries and repetitive stress are to blame for some rotator cuff damage, the pain is most often caused by normal wear and tear. In fact, at least 50 percent of 50-year-olds have some evidence of rotator cuff degeneration on MRI scans of the shoulder, according to Laskowski.

Treatments: For minor aches, icing the shoulder and taking an over-the-counter pain reliever might be enough to ease the pain. Until the inflammation or bruising heals, Laskowski recommends avoiding lifting, pulling and overhead activities that will exacerbate the pain or cause additional damage to the rotator cuff. If the pain persists, your doctor may recommend a cortisone injection and physical therapy.

Next page: Bursitis and dislocated shoulder. »

3. Bursitis

What it is: A diagnosis of bursitis means there is inflammation of the bursa, the tissue-thin sacs of fluid that cushion the bones, tendons and muscles in a joint. These sacs reduce friction and absorb shock when the joint moves. Bursitis can cause a dull ache that worsens with movements of the arm upward or to the side away from the body. Infection is extremely rare and typically occurs only in patients who have had surgery for the condition.

Causes: Bursitis is one of the most common causes of shoulder pain, according to J. Scott Quinby, M.D., an orthopedic surgeon at Baylor University Medical Center in Dallas. The pain is often a result of repetitive motion — such as repetitive overhead reaching, or from sports such as basketball and swimming — that irritates the bursa and causes inflammation. Bursitis can also develop spontaneously.

Treatments: Resting the shoulder and avoiding activity or positions that cause pain is often the first course of treatment. Your doctor might prescribe a cortisone injection to reduce the inflammation and control the pain, followed by physical therapy. "If you don't strengthen the shoulder and correct the mechanics of the movements with physical therapy, the pain will keep coming back," Quinby says.

Surgery may be necessary when physical therapy and cortisone don't relieve the pain, but it is a simple outpatient procedure. However, if the condition continues untreated, it can result in tearing of the rotator cuff, which requires further surgery to repair.

4. Dislocated Shoulder

What it is: A dislocated shoulder is the result of the upper arm bone coming out of the shoulder socket, causing intense pain. The shoulder and position of the arm will appear deformed and may show signs of swelling or bruising, or cause numbness.

Causes: It takes significant trauma, such as a fall or car accident, to cause a dislocated shoulder. It is also common in sports.

Treatments: Doctors will often administer a mild muscle sedative before manually maneuvering the arm bone back into the shoulder socket. Once the dislocated shoulder is repaired, your doctor might suggest wearing a sling for a few weeks to immobilize the joint and reduce the likelihood of further damage. While it's relatively easy to put a dislocated shoulder back into place, the injury can cause damage to the rotator cuff that requires surgical repair. But adults rarely experience problems with recurring dislocations like younger patients do.

Next page: Frozen shoulder. »

5. Frozen Shoulder

What it is: Frozen shoulder, or adhesive capsulitis, occurs when the capsule of connective tissue that is the lining of the shoulder joint thickens and becomes inflamed. There are three stages of frozen shoulder: the freezing stage, when movements are becoming more and more painful; the frozen stage, when the pain decreases but extreme stiffness makes it difficult to move; and the thawing stage, when stiffness decreases and range of motion increases. Frozen shoulder is different from conditions such as bursitis because the pain and stiffness occur when the shoulder is at rest.

Causes: Frozen shoulder is more common in women over age 50 and those with diabetes or thyroid disease, but the cause of the problem is unknown. "It can be a result of trauma or injury, but many times there is no precipitating factor that can be identified," Laskowski says.

Treatments: It can take 12 to 18 months to progress through the stages of frozen shoulder.

During that time, physical therapy can help improve range of motion and cortisone injections can reduce the pain. In mild cases, you might be encouraged to apply ice to the affected shoulder, perform simple range-of-motion exercises, take over-the-counter pain relievers and wait it out. "The best course of treatment may be to let it run its course — it could disappear on its own," Quinby says.

Jodi Helmer regularly contributes health stories to AARP.

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