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 June 15, 2003
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Shoulder Strain
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Shoulder pain is a common malady that becomes more common with age.


Most of us go from day to day without giving a thought as to how we use our shoulders. But anyone who has experienced shoulder pain knows just how important the joint is to daily living. Causes and Risk Factors Age is one of the major factors physicians use to classify and diagnose the condition. The sources of shoulder pain are numerous, including falls and other injuries such as rotator cuff injuries, osteoarthritis and rheumatoid arthritis, tendinitis and stiffness resulting from strains, or alternatively, lack of use. Symptoms and Signs Some of the most common conditions and symptoms associated with shoulder pain are: Tissue tears. Injuries and overuse of the shoulder can cause tears in the tendons or cartilage that help hold the joint together. Pain usually serves notice of the tear, but some types of cartilage damage can produce a clicking sound with movement. Weakness in a shoulder, such as an inability to raise one arm as high as the other, may indicate a tear in the rotator cuff, the collection of muscles and tendons that allow the shoulder to rotate. Degenerative conditions. The major sources of shoulder pain in this category are osteoarthritis and rheumatoid arthritis. In simplest terms, osteoarthritis is the wearing away of this cartilage, often associated with aging and overuse. Signs of the condition can occur early in life, but pain and loss of movement usually do not occur until middle age or later. Rheumatoid arthritis is an inflammatory disease that can wear away cartilage and even bone. Drug treatment brings sufficient relief for many patients, but in severe cases joint replacement may be considered. Avascular necrosis is a degenerative condition. Avascular necrosis develops when the blood supply to the bone is disrupted and the bone begins to die. The surface of the bone changes from round and smooth to flat, hindering shoulder rotation and causing considerable pain. Avascular necrosis is a potentially serious condition that requires surgery, but it sometimes responds to medical treatment.


The diagnosis is often made based on the medical history and physical examination. Radiological studies including X-rays or an MRI (magnetic resonance imaging) may be helpful in some cases.


The good news is that many people respond well to conservative treatment. Many problems can be treated with anti-inflammatory drugs, physical therapy, heat or cold therapy, and other conservative approaches. In most instances, non-surgical treatment is the first approach, and many people can avoid surgery altogether. Persistent pain after conservative treatment may respond to corticosteroid injections but may eventually require surgery.


Many causes of shoulder strain cannot be prevented but some simple steps can reduce the risk of specific types of problems:

  • Falls. Take an inventory of your home and identifying "falls waiting to happen," such as loose stairs and uneven floor tiles.
  • Strains. Take time to warm up before playing sports or participating in activities that require extensive use of the shoulder. Begin a program of stretching several weeks in advance.
  • Underuse. As people grow older, they tend to use their shoulders less. As a result, the muscles and connective tissue can lose flexibility. A well-rounded exercise program should include upper-body activities and strengthening.
  • Tendinitis and Bursitis. Commonly associated with aging, these conditions result from inflammation of the soft tissue in and around the shoulder. Both may result from either overuse of the shoulder or from lack of use, which leads to gradual loss of range-of-motion (the degree to which the shoulder can move in different directions). Anti-inflammatory drugs and physical therapy aimed at restoring motion are the mainstays of treatment in virtually all cases.
  • Impingement. The muscles of the rotator cuff extend through a kind of tunnel between the roof of the shoulder and the ball of the joint. Over time, the size and shape of the tunnel and its soft tissue content can change, causing the muscles to scrape and stick, a condition known as impingement. In many instances, impingement can cause rotator cuff tears. Therapy almost always begins with anti-inflammatory drugs, heat and cold therapy, and exercises to try to improve range-of-motion.
  • Instability. Because of an injury or as a consequence of overuse, the shoulder's soft tissues may loosen and fail to hold the joint together tightly - a condition called instability. In minor cases, the shoulder loosens and has a tendency to slip and slide within the socket. Dislocation is the most extreme form of instability, as the humeral head (ball) actually slips out of the glenoid (cup). Medication and strengthening exercises can improve shoulder stability, but in some instances surgery is necessary to tighten the connective tissue.


What is the cause of the shoulder pain? Is it arthritis? Is it a rotator cuff problem? Will anti-inflammatory drugs help? Should exercises be done to help the injury?

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