Getting to the Source of Shoulder Pain

The shoulder is a highly mobile joint, able to move in multiple planes due to its versatile ball-and-socket structure. But the tradeoff for mobility is complexity, with multiple nerves, muscles, ligaments and tendons surrounding the joint to stabilize it and produce movement. When shoulder pain sets in, it is important to work with a specialist who understands shoulder anatomy and biomechanics, who can pinpoint the exact source of pain.

Shoulder pain is fairly common among physically active people, especially athletes who engage in sports that involve throwing or overhead movements. Baseball, tennis, golf, swimming, volleyball, lacrosse and many other sports can lead to overuse injuries of the shoulder. However, shoulder pain can also be occupational, or it can simply occur from lack of physical activity and aging.

Common causes of shoulder pain include:

• Rotator cuff tears
• Shoulder joint instability
• Arthritis or bursitis
• Nerve impingement in the neck or shoulder
• Bone spurs
• Fracture

In addition to structural sources of pain, shoulder pain can originate from stimulus of the central nervous system through various neurological pathways. In some patients, central sensitization takes place, where the patient experiences a heightened sense of pain in the absence of, or out of proportion to, injury or pathology.

Shoulder pain diagnosis includes a clinical exam that begins with a medical history of the pain onset and associated activities. The exam will include assessments for strength and range of motion, along with imaging by Xray, MRI or ultrasound to get a thorough picture of any structural abnormalities.

In the vast majority of cases, shoulder pain can be completely resolved with conservative care, without surgery.

Common treatment approaches include:

• Change or rest from activities that cause pain
• Anti-inflammatory medications
• Physical therapy exercises to restore strength, stability and range of motion