What Causes Shoulder Pain? How Does It Go Away?

The structure that most people refer to as the "shoulder" is actually a complex system made up of several joints connected by tendons and muscles, which enables us to perform a wide range of arm movements—from scratching our back to spiking a volleyball. As a price for this extensive range of motion, soft tissue injuries or impingement problems that cause pain may occur from time to time. The pain may be felt only when you move your shoulder, or it may be present all the time. It can be temporary and disappear quickly, or it may persist and require medical diagnosis and treatment. In this context, the Orthopedics and Traumatology Specialists at Yeditepe University Hospitals have answered frequently asked questions such as "What can shoulder pain be a sign of?", "What are the causes of shoulder pain?", and "How is it treated?"

What Causes Shoulder Pain?

Most shoulder problems are related to soft tissues such as muscles, ligaments, and tendons rather than bones. These issues are grouped into three main categories: tendinitis/bursitis, injury/instability, and arthritis. Other causes may include tumors, infections, and nerve-related problems. Common causes are as follows:

Tendinitis

A tendon is the structure that attaches muscle to bone or another tissue. Most cases of tendinitis develop as a result of wear and tear due to overuse. This can be compared to a shoe sole that wears out over the years. Tendinitis can occur in the following forms:

• Acute tendinitis: Develops as a result of overuse due to forceful throwing, sports, or work activities.
• Chronic tendinitis: Occurs due to repetitive wear and tear related to illness or aging.
• Tendon tears: Result from acute injury or tendon degeneration that develops with advancing age.

Rotator cuff injuries are among the most common shoulder problems. The rotator cuff consists of muscles and tendons that provide movement and stability to the shoulder. As a result of overuse, bursitis may develop due to inflammation of the fluid-filled sacs called bursae. These structures facilitate shoulder movement by reducing friction. Bursitis is most often seen in conjunction with rotator cuff tendinitis. Occasionally, inflammation of many tissues in the shoulder increases pain, restricts movement, and causes the joint to stiffen, leading to a "frozen shoulder." However, with appropriate treatment and care, this condition can be corrected.

Injury / Instability

Sometimes, one of the bones that forms the shoulder joint comes out of its normal position or slips during an injury. This leads to a shoulder dislocation. The dislocation can be partial or complete and may recur. In such cases, lifting the arm or extending it sideways can cause pain. When the arm is raised overhead, a feeling of the shoulder "giving way" may occur, or the arm may feel weak, described as a "dead arm."

Arthritis

Shoulder pain can also be related to arthritis. Although there are many types of arthritis, the most common involves wear and tear and inflammation of the joint surface, resulting in swelling, pain, and restricted movement. Arthritis may develop as a result of sports or work-related injuries.
Patients often use their shoulders less to reduce pain. However, this can cause the soft tissues around the joint to contract or stiffen, which may increase pain and further restrict movement.

How Does Shoulder Pain Go Away?

Treatment for shoulder pain initially includes the following methods:

• Avoiding movements that cause pain
• Rest
• Physical therapy applications to strengthen the shoulder and improve flexibility
• Medications that reduce inflammation and pain
• Pain-relieving injections when necessary

Approximately 90% of shoulder problems resolve with these methods without requiring surgery. However, frequently recurring shoulder dislocations or some rotator cuff tears may require surgical intervention. Avoiding activities that overstress the shoulder and heavy exercises you are not accustomed to will speed up recovery.

When Is Shoulder Pain Dangerous?

Many patients may dismiss shoulder pain as temporary and not take it seriously. However, patients should consult an orthopedist without delay if they experience the following:

• Significant pain after an acute injury,
• Pain that gradually increases,
• Pain that restricts daily movements.

If the pain is not very severe, it can be monitored for a few days; however, if the problem persists, it must definitely be evaluated.

How Is Shoulder Pain Diagnosed?

Determining the source of the pain is important for correct treatment. Therefore, a detailed evaluation is performed. The diagnosis of shoulder pain involves the following steps:

Medical History

• When and how the pain started
• Whether it has occurred before
• Which activities increase it
• Your general health status

Physical Examination

• Swelling, deformity, tenderness
• Muscle strength
• Range of motion

Imaging Methods

• X-ray
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Ultrasound
• Electromyography (EMG)
• Arthrography

Arthroscopy

This is a method of directly visualizing the inside of the joint using a small camera. It is effective in detecting problems that may not be noticed during physical examination or other imaging studies.