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Shoulder Pain Symptoms You Shouldn't Ignore

Chronic ache, increasing stiffness or serious discomfort could signal these age-related shoulder issues

spinner image Middle aged man sitting on the sofa and holding painful shoulder with another hand.
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Lifting your suitcase into the overhead compartment, stuffing your shoulder bag to capacity, allowing your 80-pound golden lab to yank his way through a daily walk. None of these qualify as risky behavior, but now that you're over 50 you're paying the price. What gives? In short: Your shoulders.

"Think of it as driving a car — you're given one set of tires and that's it,” explains Akhil Chhatre, M.D., director of spine rehabilitation and assistant professor in the departments of Physical Medicine and Rehabilitation and Neurosurgery at the Johns Hopkins University School of Medicine. “The wear and tear that you experience on those tires depends on how much and how hard you use your body."

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Shoulder pain typically comes from the joint itself or from any of the surrounding muscles, ligaments or tendons. And with age, “you'll see changes in the lining of the joint, changes in the integrity of the bones and degeneration of the ligaments,” says Chhatre. “If you don't participate in a strengthening or exercise routine, you'll see some atrophy and loss of bulk (in the muscles) that surround and protect the stability and strength of the shoulder joint.”

While that sort of wear and tear is a natural consequence of living your life, it can make you more vulnerable to several shoulder issues. Various diseases and conditions affecting the structure of your chest or abdomen, like heart disease and gallstones, can also cause shoulder pain.

Whatever the cause, there's plenty you can do to relieve this kind of pain. But first you have to know which symptoms deserve your attention. Here are the ones you should never ignore and the likely culprit for each.

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1. Chronic stiffness in the shoulder that's worse at night and in the morning

The likely culprit: Osteoarthritis

Osteoarthritis — known as “wear and tear arthritis” — is the most common type of arthritis. With shoulder osteoarthritis, the cartilage and other joint tissues that cushion the area gradually break down and, as a result, joints become painful, swollen and stiff. According to the Arthritis Foundation, nearly 1 in 3 people over 60 have shoulder osteoarthritis; it affects women more than men. “Osteoarthritis is a chronic and progressive condition, meaning it will continue to progress at an unpredictable rate over time,” Chhatre says. “The way you manage that is with the help of a physical therapist, who can give you appropriate exercises to maintain a range of motion in your joints.” Doing so, he says, will help relieve your symptoms.

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2. Shoulder pain — often excruciating — when reaching overhead or behind your back

The likely culprit: Rotator cuff tear

Imagine a relatively large ball on a small, shallow socket, says Leesa Galatz, M.D., professor and chair of the Department of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai Health System. The rotator cuff is a group of “four small muscles that function to keep the ball centered on the socket. They glide between two bony surfaces, so they not only work hard, but they're susceptible to tendinitis from both age-related and overuse injuries.”

Rotator cuff injuries are extremely common, especially in people over 50. A tear can happen suddenly — from, say, a fall — but more often it happens gradually over time, as the tendon wears down. “There are degrees of rotator cuff injury,” notes Chhatre. “You could have a partial tear or a complete tear, resulting in loss of the function of the arm and excruciating pain.” For partial tears, the go-to Rx is physical therapy with a focus on exercises that improve flexibility and strength of the muscles surrounding the shoulder joint. For severe tears, surgery is common.

3. Dull ache in the shoulder that worsens when you move your arm up or to the side

The likely culprit: Bursitis

When the fluid-filled pads that cushion the bones, tendons, and muscles in your shoulder — called bursae — become irritated or inflamed, you've got bursitis. Shoulder bursitis is often the result of overuse or repetitive shoulder movements. “Bursitis is typically something you see in conjunction with rotator cuff injuries,” says Andrew Rokito, M.D., professor of orthopedic surgery and chief of the Division of Shoulder and Elbow Surgery at NYU Langone Health.

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Reducing the inflammation is the first step of any treatment plan. If ice packs and over-the-counter pain medication don't get the job done, then treatment may involve physical therapy or surgery. Research suggests both are equally effective. In a study published this year in the British Journal of Sports Medicine, researchers compared the treatment results of patients with shoulder bursitis. After five years, those who underwent physical therapy and those who underwent surgery reported having equally low levels of shoulder pain.

4. Pain in the front and side of the shoulders that radiates toward the elbow

The likely culprit: Tendinitis

If you've had tennis elbow or swimmer's shoulder, you've had tendinitis — inflammation or irritation of the thick fibrous tendons that attach muscle to bone. Like other shoulder conditions, tendinitis can be caused by a sudden injury, but it's more likely to come on gradually after years of doing a particular repetitive movement (such as swimming laps).

Depending on the severity, you may be able to treat tendinitis on your own (with ice packs and over-the-counter pain meds). If not, physical therapy can help strengthen the muscles around the damaged tendon. Surgery is an option if there's a tear of the tendons (tendinitis is common with rotator cuff injuries). Galatz: “Tendinitis, inflammation or degeneration of the tendons, can be due to age-related changes in the tendons and/or overuse secondary to sports or work activity. This can be associated with inflammation of the bursa, which is the tissue that absorbs the friction around the shoulder."

5. Extreme shoulder pain initially, followed by stiffness

The likely culprit: Frozen shoulder

With adhesive capsulitis — or frozen shoulder — the capsule that surrounds the shoulder joint and rotator cuff tendons thickens and becomes stiff and tight. It develops in three stages, each of which lasts around three months, says Rokito. In the initial “freezing” stage, the pain sets in and as it worsens your shoulder loses range of motion; in the “frozen” stage, your shoulder stiffens; and during the final “thawing” stage, your range of motion gradually improves.

The go-to Rx here is physical therapy centered on stretching exercises that improve shoulder flexibility. “If you do nothing and just gut it out, frozen shoulder will run its course and you'll get better,” says Rokito. “The problem with that is you'll suffer for a much longer period of time because it can take a year or sometimes longer to work itself out. And the range of motion may not return to the normal.” Women between the ages of 40 and 60 are most prone to developing frozen shoulder, and people with diabetes are also at increased risk.

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