Frozen Shoulder

Shoulder Pain and Problems

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The shoulder is made up of several layers, including the following:

  • Bones. The collarbone (clavicle), the shoulder blade (scapula), and the upper arm bone (humerus).
  • Joints. Facilitate movement, including the following:
    • Sternoclavicular joint (where the clavicle meets the sternum)
    • Acromioclavicular (AC) joint (where the clavicle meets the acromion)
    • Shoulder joint (glenohumeral joint). A ball-and-socket joint that facilitates forward, circular, and backward movement of the shoulder.
  • Ligaments. A white, shiny, flexible band of fibrous tissue that binds joints together and connects various bones and cartilage, including the following:

    • Joint capsule. A group of ligaments that connect the humerus to the socket of the shoulder joint on the scapula to stabilize the shoulder and keep it from dislocating.
    • Ligaments that attach the clavicle to the acromion
    • Ligaments that connect the clavicle to the scapula by attaching to the coracoid process
  • Acromion. The roof (highest point) of the shoulder that is formed by a part of the scapula.

  • Tendons. The tough cords of tissue that connect muscles to bones. The rotator cuff tendons are a group of tendons that connect the deepest layer of muscles to the humerus.

  • Muscles (to help support and rotate the shoulder in many directions)

  • Bursa. A closed space between 2 moving surfaces that has a small amount of lubricating fluid inside; located between the rotator cuff muscle layer and the outer layer of large, bulky muscles.

  • Rotator cuff. Composed of tendons, the rotator cuff (and associated muscles) holds the ball of the glenohumeral joint at the top of the upper arm bone (humerus).

Shoulder pain may be localized in a specific area or may spread to areas around the shoulder or down the arm.

Although the shoulder is the most movable joint in the body, it is also an unstable joint because of its range-of-motion. Because the ball of the upper arm is larger than the socket of the shoulder, it is susceptible to injury. The shoulder joint must also be supported by soft tissues muscles, tendons, and ligaments which are also subject to injury, overuse, and under use.

Degenerative conditions and other diseases in the body may also contribute to shoulder problems, or generate pain that travels along nerves to the shoulder.

Shoulder specialist Edward McFarland, M.D., talks about shoulder dislocation and subluxation (partial dislocation). He discusses common causes of these shoulder injuries, how they can be treated and what the recovery process looks .

Common shoulder problems include the following:

  • Dislocation. The shoulder joint is the most frequently dislocated major joint of the body often caused by a significant force that separates the shoulder joint's ball (the top rounded portion of the upper arm bone, or humerus) away from the joint's socket (glenoid).
  • Separation. The AC joint becomes separated when the ligaments attached to the collarbone (clavicle) are torn, or partially torn, away from the shoulder blade (scapula). Shoulder separation may be caused by a sudden, forceful blow to the shoulder, or as a result of a fall.
  • Bursitis. Bursitis often occurs when tendonitis and impingement syndrome cause inflammation of the bursa sacs that protect the shoulder.
  • Impingement syndrome. Impingement syndrome is caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade. The pain associated with the syndrome is a result of an inflamed bursa (lubricating sac) over the rotator cuff, and/or inflammation of the rotator cuff tendons, and/or calcium deposits in tendons due to wear and tear. Shoulder impingement syndrome can lead to a torn rotator cuff.
  • Tendinosis. Tendinosis of the shoulder is caused when the rotator cuff and/or biceps tendon become worn out and occasionally inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may become trapped under the acromion.
  • Rotator cuff tear. A rotator cuff tear involves 1 or more rotator cuff tendons becoming inflamed from overuse, aging, a fall on an outstretched hand, or a collision.
  • Adhesive capsulitis (frozen shoulder). Frozen shoulder is a severely restrictive condition frequently caused by injury that, in turn, leads to lack of use due to pain. Intermittent periods of use may cause inflammation and adhesions to grow between the joint surfaces, thus restricting motion. There is also a lack of synovial fluid to lubricate the gap between the arm bone and socket that normally helps the shoulder joint to move. This restricted space between the capsule and ball of the humerus distinguishes adhesive capsulitis from the less complicated condition known as stiff shoulder.
  • Fracture. A fracture is a partial or total crack or break through a bone that usually occurs due to a impact injury.

In addition to a complete medical history and physical examination (to determine range-of-motion, location of pain, and level of joint instability/stability), diagnostic procedures for shoulder problems may include the following:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in a surrounding ligament or muscle.
  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Electromyogram (EMG). A test to evaluate nerve and muscle function.
  • Ultrasound. A diagnostic technique that uses high-frequency sound waves to create an image of the internal organs.
  • Laboratory tests (to determine if other problems may be the cause)
  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.

Treatment of shoulder problems

Specific treatment of shoulder problems will be determined by your doctor :

  • Your age, overall health, and medical history
  • Extent of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment may include:

  • Activity modification
  • Rest
  • Physical therapy
  • Medications
  • Surgery


Frozen Shoulder

Frozen Shoulder | Johns Hopkins Medicine

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  • A frozen shoulder is one that has become stuck and limited in movement.
  • Frozen shoulder is often caused by inflammation of the capsule, tissue surrounding the shoulder joint.
  • Diagnosing frozen shoulder requires a physical examination and possible X-rays or additional tests to rule out other causes of symptoms.
  • Physical therapy and anti-inflammatory medication are usually prescribed to treat frozen shoulder.
  • Surgery is not usually indicated to treat frozen shoulder unless non-operative treatments have failed to improve range of motion and decrease pain.

Frozen shoulder results from the gradual loss of movement in the shoulder (glenohumeral) joint. This joint consists of a ball (the humeral head) and socket (the glenoid).

Normally it is one of the most mobile joints in the body. When the shoulder is frozen, the joint has become stuck and its movement is limited.

Although many shoulder diseases involve pain and loss of motion, frozen shoulder is most often caused by inflammation (swelling, pain and irritation) of the tissues surrounding the joint. The tissue that envelops the joint and holds it together is called the capsule.

Normally the capsule has folds that can expand and contract as the arm moves into various positions. In a frozen shoulder, the capsule has become inflamed and scarring develops. The scar formations are called adhesions. As the capsule's folds become scarred and tightened, shoulder movement becomes restricted and moving the joint becomes painful.

This condition is called adhesive (scarring) capsulitis (inflammation of the capsule).

It is not known exactly what causes this condition. Immobilization of the shoulder (after an arm injury, for instance) can lead to frozen shoulder. Inflammation of the muscles and/or tendons, as with rotator cuff tendinitis or bursitis, can also cause the shoulder joint to become frozen.

How is frozen shoulder diagnosed?

The first step is to have a complete history and physical examination by your physician. Your physician may order several tests, such as X-rays, to rule out other potential causes of a painful shoulder or limited shoulder motion (arthritis, calcium deposits, etc.).

Reverse total shoulder replacement surgery may be an option for patients with shoulder degeneration and debilitating shoulder problems. Johns Hopkins shoulder surgeon Dr. Uma Srikumaran explains how this technology can be used to treat people who are not candidates for normal total shoulder replacement.

The two main goals of treatment are to increase motion and to decrease pain. To increase motion, physical therapy is usually prescribed.

The physical therapist moves the patient's arm to stretch the capsule and teaches the patient home exercises that may include use of a wand or overhead pulley. He or she may also use ice, heat, ultrasound or electrical stimulation.

The therapist will demonstrate a stretching program that you should do at least once or twice a day. These exercises include the use of a cane, a home pulley system and an elastic cord to increase motion of the shoulder.

To decrease pain, physicians frequently recommend anti-inflammatory medications such as aspirin, ibuprofen (Motrin, Advil), Naprosyn or Aleve.

Pain pills such as Tylenol or narcotics may be prescribed to decrease the pain after therapy or to help with sleep at night. Occasionally, steroid injections of the joint or the bursa may be indicated.

Steroids prednisone, taken by mouth, may be given to help decrease the inflammation.

How long does rehabilitation take?

Supervised physical therapy usually lasts from one to six weeks, with the frequency of visits ranging from one to three times per week. The patient should engage in home exercises and stretching throughout the healing process. The stretching exercises should be done at home at least once or twice daily, as noted above.

In general, frozen shoulder will resolve almost completely with time and consistent compliance with the prescribed treatment program. This process can take up to six to nine months for some patients, although it may take only a few months for others.

Internal rotation (moving the hand to the back pocket or up the middle of your back) is usually the motion that takes the longest to regain.

When is surgery indicated?

If the above program does not improve the range of motion and decrease the pain, then surgery may be indicated. After the patient has had a general or regional anesthetic, the physician may manipulate the shoulder in the operating room to break down the scarring.

Occasionally, an arthroscope (a small instrument with an attached camera placed into the shoulder through a small puncture-type incision) is used to directly cut or release the capsular adhesions.

Most patients begin physical therapy the same day of the manipulation or the following day.

Other operations, such as the removal of spurs, may also be indicated or required at the time of the manipulation. These operations can sometimes be done with the arthroscope, but may require one or two larger incisions around the shoulder (open surgery).


Rotator Cuff Tendinitis

Frozen Shoulder | Johns Hopkins Medicine

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  • Rotator cuff tendinitis may also be referred to as shoulder bursitis, shoulder impingement or biceps tendinitis.
  • Symptoms of rotator cuff tendinitis include pain and swelling in the shoulder area, limited motion or weakness of the arm.
  • Rotator cuff tendinitis usually occurs over time after repeated stress on the rotator cuff.
  • If left untreated, rotator cuff tendinitis can worsen and lead to a partially or completely torn tendon.
  • Surgery is rarely used to treat rotator cuff tendinitis unless the rotator cuff is severely damaged or torn.

The upper arm bone (the humerus) is connected to the shoulder by muscles and tendons. Four of these muscle-tendon groups form the rotator cuff, which controls rotation of the arm out away from the body and stabilizes the shoulder. The cuff part comes from the four tendons merging together to form a “cap” or “hood” around the head of the humerus.

The head of this bone can be thought of as the ball in the ball-and-socket joint, which is your shoulder. This joint allows motion in a full circle, but this may be limited by tendinitis in the cuff.

What is rotator cuff tendinitis?

Rotator cuff tendinitis is also called impingement, bursitis or biceps tendinitis. These are all different names for the same problem. They mean that there is pain and swelling of the cuff tendons and the surrounding bursa. The bursa is a soft sack that contains a small amount of fluid and cushions the joint.

The shoulder is one of the most complex joints in the body and is susceptible to wear and tear just the hips. Johns Hopkins shoulder surgeon Dr. Uma Srikumaran discusses some of the most common shoulder conditions associated with everyday wear and tear, including their symptoms and treatments.

Rotator cuff tendinitis does not occur all at once. Usually, it happens over a long period with repeated irritation to an area. It happens more often in people with loose joints, people with abnormal bony anatomy in the shoulder and people who do heavy or repetitive lifting above shoulder level.

Lifting overhead or just moving the arm above the head may cause pinching of one of the tendons of the rotator cuff between the upper part of the arm bone and the acromion (which is part of the shoulder blade). This pinching is called impingement. Other causes include calcium in the tendons or a sudden injury to the shoulder.

What are the stages of rotator cuff injury?

The first warning sign of cuff injury is pain and swelling of the bursa, as described above. Shoulder weakness and/or limited range of motion can also occur with long-term irritation or outright injury to the shoulder. The tendinitis can progress to a partial or complete tear of a tendon due to progressive weakening of the fibers.

A physical examination of the shoulder by a qualified physician is the first step. This includes movement and strength testing to evaluate range of motion, pain, weakness and instability.

X-rays are useful for ruling out other causes of shoulder pain, such as broken bones, arthritis and other bone diseases. If a cuff tear is suspected, magnetic resonance imaging (MRI) may be used to visualize it. The MRI can detect even small partial tears of the rotator cuff.

Another study called the arthrogram, in which dye is injected into the joint, may also be useful for diagnosis.

How is rotator cuff tendinitis treated?

The injured shoulder should be rested until the pain and swelling subside. Then physical therapy is used for gentle stretching and strengthening to preserve full motion of the shoulder.

However, exercises above shoulder level should be avoided because they will only continue to pinch the tendons and increase inflammation.

Total inactivity is not recommended, however, as it may cause the joint to stiffen and result in a “frozen” shoulder.

  • Ice. Putting ice bags or cold packs on the shoulder reduces inflammation and pain. Ice should be applied twice a day for at least 20 to 30 minutes. Just massaging an ice cube over the painful area can also help reduce the pain and swelling.
  • NSAIDs. These aspirin- drugs (Motrin, ibuprofen, Nuprin, Naprosyn, Advil, Aleve, etc.) can also reduce pain and swelling. There are a number of different kinds available and your doctor can choose the right one for you. These drugs may have some side effects and should be taken only as directed.
  • Steroids. If other treatments do not work, steroid treatment may be used to reduce inflammation and pain. These drugs can be taken at home as pills or injected directly into the space just above the injured tendons. Injections of steroids can offer long-term pain relief but are used only when they are specifically indicated.

When should you have surgery?

Rotator cuff tendinitis without a cuff tear normally does not require surgery, and treatment as described above is usually enough to cure the inflammation.

If pain continues after several months of these treatments and steroid injections have provided only temporary relief, then surgery becomes an option. The most common procedure for rotator cuff tendinitis is called acromioplasty.

Using an arthroscope (a small camera inserted into the shoulder joint through an incision about the size of a buttonhole), the surgeon can view the affected area and shave the underside of the acromion to increase the space between it and the cuff tendon that is injured.

This space helps prevent pinching of the tendon and irritation during shoulder movements. Also, damaged tissue can be removed and minor tears can be repaired.

To repair severe damage or serious tears in the rotator cuff, open surgery is necessary. Compared with arthroscopy, the incision is larger and the time required for healing and rehabilitation is somewhat longer.

During open surgery, the space between the acromion and the damaged tendon is increased, the tendon is trimmed and a small area of bone is cut the humerus.

The injured tendon is then reattached to the humerus with tacks or stitches.

Reverse total shoulder replacement surgery may be an option for patients with shoulder degeneration and debilitating shoulder problems. Johns Hopkins shoulder surgeon Dr. Uma Srikumaran explains how this technology can be used to treat people who are not candidates for normal total shoulder replacement.

Rehabilitation usually begins the first week after arthroscopic surgery or an open rotator cuff repair. It is very important to follow the program that the surgeon recommends.

The physical therapist will demonstrate how to do the exercises to increase range of motion and to build muscle strength. A typical program might start with stretching and some minor strengthening exercises with rubber bands and light weights.

It might take up to several months before strength is back to normal, but with hard work and adherence to the recommended program, in most cases a full recovery is ly.


Partial Rotator Cuff Tear

Frozen Shoulder | Johns Hopkins Medicine

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  • Rotator cuff tendons inside the shoulder may wear down with age, which may lead to partial rotator cuff tears.
  • Some partial rotator cuff tears may go unnoticed because they don’t always cause pain.
  • A condition called frozen shoulder can sometimes mimic the symptoms of partial rotator cuff tears.
  • Treatment is not necessary if there is no pain associated with the partial rotator cuff tear.
  • Surgery is rarely necessary.

The rotator cuff muscles attach to the shoulder blade and turn into tendons that attach to the top of the arm bone (humerus) near the shoulder socket. When the rotator cuff muscles contract and pull on the tendons, the tendons then pull on the bone. This pull helps the arm (humerus) move.

There are four rotator cuff muscles and thus there are four rotator cuff tendons. The tendons are about 1 centimeter thick (as thick as your little finger) and about as wide as 2-3 centimeters (the width of two or three fingers). They attach to the humerus bone, around the top near the joint, and help the shoulder move.

How Rotator Cuff Tendons Change As You Age

Changes in the rotator cuff that weaken it occur around the age of 30 and increase after that. Many people are unaware of these changes because they don’t always cause pain. These changes can’t initially be seen without a microscope, but sometimes they can show up on an MRI scan.

MRI scans are read by a radiologist who refers to these early changes as “tendinosis.” Tendinosis changes are a normal part of the aging process and usually don’t need to be treated unless they cause pain.

Why Rotator Cuff Tendons Get Tears

It is not known why rotator cuff tendons develop tears, but it’s associated with aging. By the time someone is 60 years old, there is a good chance they have some partial tears or complete tears of the rotator cuff.

One common theory suggested that the tendon hits against bone spurs, but that is now considered an unly cause. Regardless of how these changes occur, tears happen to people from all walks of life and all occupations. As a result, the consensus is that changes in the rotator cuff with age are part of becoming more “mature.”

Occasionally, patients younger than 35 get partial tears of the rotator cuff. These tears may be associated with an injury.

Partial rotator cuff tears are common in people who are overhead athletes (they play sports with an upper arm and shoulder arc over the head), such as pitchers in baseball.

Partial rotator cuff tears in competitive athletes are treated the same way as partial tears in aging adults.

A partial tear goes only part of the way into the tendon. It’s usually described in terms of how deep the tear is in the tendon and doesn’t refer to length, width or other dimensions. A full-thickness tear is when the wear in the tendon goes all the way through the tendon. Partial tears can be just 1 millimeter deep (only about 10 percent of a tendon), or can be 50 percent or deeper.

When a radiologist looks at an MRI scan, he or she must make a judgment about the type of the rotator cuff changes. They must decide if the changes are tendinosis, a partial tear or a full tear.

Sometimes it is not possible to distinguish tendinosis from a partial tear, or a partial tear from a full tear.

It takes experience and practice to be able to read MRI scans of the rotator cuff tendons.

Symptoms of Partial Rotator Cuff Tears

Not all patients with partial rotator cuff tears have symptoms, but those who do may experience pain in the shoulder. Generally, the most painful motion with a partial rotator cuff tear is lifting things over the shoulder level or far away from the body.

Lifting in this manner is very stressful on the shoulder. Many activities may not hurt at all, including running, cycling, swimming, lifting weights, etc.

If you do have pain, you can try cutting back on that exercise or activity, but there is no evidence that continuing the activity will worsen the tear.

Diagnosis of Partial Rotator Cuff Tears

MRI scans are most commonly used to diagnose partial rotator cuff tears. However, just because an MRI scan shows a tear doesn’t mean it is the cause of your shoulder pain.

The most common condition that mimics a rotator cuff tear is shoulder stiffness or a frozen shoulder. This condition is characterized by reduced range of motion — the shoulder will only move so far before starting to hurt. It is common for a patient to develop a stiff and painful shoulder with no injury.

A radiologist may read the resulting MRI scan as showing tendinosis or a partial tear of the rotator cuff. These findings, although they may be true, may have nothing to do with the source of the pain.

Partial tears of the rotator cuff seen on MRI scans have meaning only if the symptoms and examination are consistent with that diagnosis.

When the MRI finding has nothing to do with the patient’s problem, it is called an incidental finding.

What do partial rotator cuff tears look ?

As tendinosis increases, eventually it can be seen with the naked eye. When a tendon begins to tear, it looks fibers of a rope that are splitting and fraying.

Partial tears are very common and it’s not known why one person may have symptoms and another may not.

One study that examined MRI scans from people over age 60 found that more than 50 percent had partial tears of their rotator cuff tendons and never knew it.

Should I worry about a partial rotator cuff tear found on an MRI?

The answer is generally “no,” as these partial tears are very common and considered part of the aging process. A finding of a partial tear of the rotator cuff is essentially normal in people over the age of 40. Partial tears that show up on MRI scans typically don’t need treatment as long as they don’t hurt or cause problems.

While active men and women may be equally ly to get hurt, some sports injuries affect women more often or in different ways. This guide explains the biggest risks active women face and how you can run, play or work out smarter to prevent injury.

If there is no pain, then no treatment is necessary for a partial tear of the rotator cuff tendons. If the shoulder is painful, then you have several treatment options.

Nonsurgical treatments

Generally, partial tears of the rotator cuff are treated without surgery. The treatment is focused on maintaining the range of motion and preventing the shoulder from becoming stiff. It may include:

  • Stretching for five minutes every day to prevent stiffness.
  • Applying ice packs for pain relief for 20 to 30 minutes as often as every two hours, if needed.
  • Taking medication to help control pain.
  • Administering cortisone shots into the bursa near the rotator cuff tendons to reduce inflammation.

If the partial tear causes significant pain and these treatments don’t work, then physical therapy can be helpful. The goal of physical therapy is to help decrease pain and strengthen the muscles and tendons.

Physical therapy can also help increase motion of the shoulder, as sometimes stiffness is the cause of the pain and not the tendon. The exercises should not be painful or they are being done incorrectly.

When does a partial rotator cuff tear need surgery?

It is very uncommon to operate on a partial rotator cuff tear. In cases of deep partial tears — when more than 90 percent of the tendon is torn — surgery is recommended only if the symptoms can’t be controlled with nonsurgical treatments.


Why Does My Shoulder Hurt? 9 Common Causes of Shoulder Pain

Frozen Shoulder | Johns Hopkins Medicine

Whether you’re placing a pile of dishes at the top of your cabinet shelf or throwing a ball across the field, your shoulders are at work. In fact, the shoulder is the most movable joint in the entire human body.

Un the knees, ankles, and elbows—which act more hinges—the shoulders have a much wider range of motion. But having this kind of mobility is what makes them so prone to pain and injuries. In fact, shoulder pain is one of the most common reasons people see a physical therapist, says Robert Kaufman, DPT, a clinical specialist at NYU Langone’s Rusk Rehabilitation.

What causes neck and shoulder pain?

Shoulder pain doesn’t always come from a traumatic injury, however. Sometimes it’s a slow burn from repetitive use, and other times it comes from something completely unrelated to the shoulder, gallbladder disease.

Here are nine common causes of shoulder pain and what you can do about them.

Lifting more than you can handle

Oftentimes, shoulder pain is a result of lifting something that’s heavier than what the shoulders can handle. For example, Kaufman says lifting a heavy suitcase can cause shoulder pain. “It’s a very common theme that the shoulder is simply overloaded and not trained for that,” he says. Overloading the shoulders too soon puts strain on the rotator cuff.

“The most common problems that we see in the shoulders are related to the shoulder cuff,” says Miho Tanaka, MD, director of the women’s sports medicine program and associate professor in the Department of Orthopaedic Surgery at Johns Hopkins Hospital.

The rotator cuff is a sheath of muscles that connects the head of the upper arm bone to the shoulder socket, Tanaka explains. “It also helps with lifting and bringing the arms overhead,” she adds. When the rotator cuff is overused, it can lead to inflammation in the form of tendinitis or cause a tear in the cuff.

This video highlights shoulder exercises you can do at your desk to relieve pain and stiffness.

Muscle imbalances

Making sure you vary the way you strengthen your shoulders is key to preventing muscle imbalances and improving joint flexibility, Dr. Tanaka says. “Let’s say you’re always doing bench presses or bicep curls, and you never go to the row machine or do shoulder extension exercises, you’re going to have a training imbalance,” Kaufman says.


a cushion for your bones, bursae are fluid-filled sacs that help reduce friction between your joints.

Shoulder bursitis can occur when the joint is overused or strained, causing the bursa to swell with more fluid.

“If your movement is unvaried because of strength and flexibility issues around the joint, then any impediments in and around the joint can irritate the bursa,” Kaufman says.

Normal wear and tear

As we age, the rotator cuff thins and frays. “It can lead to inflammation in the rotator cuff, which typically presents itself as pain on the front and side of the shoulder,” Dr. Tanaka says.

Osteoarthritis is the most common form of arthritis, mostly affecting the hands, knees, hips, and spine. But that doesn’t mean the shoulders are immune to it.

Osteoarthritis can cause pain deep in the back of the shoulders, and stiffness may become more of a problem as it progresses. With repeated use— working a manual labor job or playing sports all your life—Dr.

Tanaka says the cartilage covering the ends of your bones and cushioning them from one another will begin to deteriorate. She notes that this usually begins when you’re in your 30s.

Shoulder instability

There are so many scenarios that can end in a traumatic dislocation of the shoulder, but sometimes you don’t need a hard hit to pop the ball from the socket. “Some people are just lax and prone to dislocations,” Kaufman says. This is called shoulder instability, and it can make people feel their shoulder is about to come place at any time, or move back into the socket.

Just other shoulder problems, strength training will be essential to recovery. Patients will specifically undergo training that stabilizes the shoulders, Kaufman says.

One exercise is to keep the arm and shoulder in one position (maybe somewhere close to where it dislocated) while holding a TheraBand resistance band.

Then, have someone else gently pull the TheraBand in different directions while you resist their motions. “So you’re turning your shoulder on to avoid it from moving,” he says.

Shoulder impingement

Impingement syndrome (also called swimmer’s or thrower’s shoulder) is closely related to bursitis and tendinitis. It happens when the tendons in the shoulder get trapped and compressed in the acromion—the bony arch at the top of the shoulder blade. This leads to pinching.

“It’s a constellation of symptoms, but we don’t know how it happens,” says Zachary Rethorn, a board-certified orthopaedic physical therapist and chair of the Chattanooga district of the Tennessee Physical Therapy Association.

Frozen shoulder

Frozen shoulder (or adhesive capsulitis) occurs when the connective tissue surrounding the shoulder joint thickens and stiffens, restricting movement of the shoulder.

It’s unrelated to arthritis, and is characterized by three stages:freezing, frozen, and thawing. It’s usually during the first two stages that the pain is at its worst.

“It starts out with a lot of pain and progresses from pain to a great deal of stiffness,” Kaufman says.

While there’s no definite cause of frozen shoulder, some people are at a greater risk, including those who are 40 and up, people without previous shoulder problems, and people with diabetes, heart disease, or thyroid problems. Treatments will vary depending on where the impairments are, Kaufman says, and they take a lot of time. “Unfortunately, a lot of people don’t start feeling better until at least a year after they’re diagnosed with it.”

What if your shoulder pain isn't coming from your shoulder at all?

Think of referred pain as a glitch in the nervous system, where pain from one problem area in the body is sent along the nerve pathway to another part. A classic example is the first symptom of a heart attack can be pain in the teeth or jaw. Both gallbladder disease and herniated discs in the neck can cause referred pain in the upper back, near the shoulder, Dr. Tanaka says.

This kind of pain isn’t worsened when you move the shoulder; instead, it’s more of a persistent pain that won’t go away even when you’re resting. Dr. Tanaka advises people who experience this kind of pain should see a doctor right away.

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