The shoulder is one of the more unique joints in the body. The stability of the shoulder is not due to the joint and joint capsule; instead, it’s due to the muscles and tendons as well as ligaments that hold the bones in place. Most of the stability is actually due to the muscles holding the arm into the joint. The excellent motion of the shoulder makes the joint very unstable.

The shoulder joint is like a golf ball on a tee,  it is very easy to bump the ball off , unlike the hip that is more akin to a ball in a cup.  The shoulder can become painful when one of the structures maintaining stability becomes strained or sprained. It is also easy to perform repetitive actions that cause the shoulder to become painful.

The Anatomy of Shoulder Pain

The anatomy of the shoulder is complex and unique. Three bones are part of the shoulder base including the scapula, the collarbone, and the humerus. Muscles and tendons maintain the position of the humerus in the joint region. The muscles and tendons cover the shoulder joint, and damage to any these structures can cause pain. Some common causes of shoulder problems include:

• Bursitis
• Tendonitis
• Tendon tears
• Impingement
• Arthritis
• Fractures

Examining Common Shoulder Problems

Bursitis of the shoulder is categorized by inflammation in the fluid filled sacs that provide cushioning and lubrication between muscles, tendons, and bone. In the shoulder, they are in the area of the deltoid and underneath the scapula. Repetitive motion of the shoulder or lying on your side are common causes. Rest, ice and heat, and anti-inflammatory medication often take care of the problem. Occasionally, a steroid shot in the area is helpful.

Impingement occurs when the acromion bone, the top of the shoulder blade, puts pressure on the muscles, bursa and tendons that move underneath it. The natural shape of the bone can cause this or small degenerative changes. The irritation can lead to bursitis and sometimes rotator cuff tears. If  the impingement is constant, causing inflammation or tears, surgery is may be necessary to open the space and relieve the pressure.

Tendonitis and tendinopathy are irritations of the end of the muscle as it connects to the bone. Acute tendonitis is usually related to repetitive motion, such as overhead activity or throwing. If treated rapidly, often this will resolve with rest and icing. Chronic tendonitis is due to repetitive wear and can lead to tears or tendon ruptures, often seen as rotator cuff issues. These may be best treated with surgery.

Tendinopathy is chronic changes of wear and degeneration in the tendon. Since the muscles and tendons are critical to shoulder function, this is common as a person ages. These changes do not respond to treatment for inflammation, but sometimes they do well with treatments like prolotherapy to rebuild more normal tissue or surgical repair.

Since the shoulder is so mobile and unstable, damage over time can become severe. Torn muscles, ligaments, tendons and arthritic degeneration can make the shoulder painful and difficult to use. When the changes are beyond normal surgical repair, artificial joint replacement sometimes becomes an option. These decisions can only be made with the help of an Orthopedic surgeon after all conservative care has failed.

The shoulder is a complex joint. Intrinsically, it is very unstable by its design. The structures holding the parts together are easy to damage over time because we use our arms for so many activities. If pain is not going away in the shoulder with simple treatment of rest, ice, heat, and over the counter medications, then having a physician help with the diagnosis and treatment would be beneficial.