What hurts? - shoulder

The shoulder can be described as several joints that combine with tendons and muscles to allow a full range of motion to the arm, from scratching your back to throwing the perfect pitch. Mobility may come with a price, however. The shoulder movement can lead to increasing problems with instability or impingement of soft tissue resulting in pain. Pain may be felt only when the shoulder is moved, or all of the time. The pain may be acute and disappear in a short time, or it may continue and require medical diagnosis and treatment.

Common causes of pain

Rathan than bones, many shoulder problems involve the soft tissues, muscles, ligaments, and tendons. A majority of these problems fall into three major categories:

• Tendinitis/bursitis
• Injury/instability
• Arthritis

Other much more rare causes of shoulder pain are tumors, infection and nerve-related problems.

Tendinitis

A tendon is a cord which connects muscle to bone or other tissue. Similar to the wearing process on the sole of a shoe which eventually splits from overuse, most tendinitis is a result of the wearing process that takes place over a period of years. Typically, tendinitis is one of several types:

• Acute tendinitis following some overuse problem such as excessive ball throwing and other sports- or work-related activities.
• Chronic tendinitis which can be attributed to degenerative disease or repetitive wear and tear due to age.
• The splitting and tearing of tendons which may result from acute injury or degenerative changes in the tendons due to advancing age. Rotator cuff injuries are among the most common of these disorders. The rotator cuff is composed of muscles and their tendons which provides shoulder motion and stability.

Bursitis

In some cases, excessive use of the shoulder leads to inflammation and swelling of a bursa, a condition called bursitis. Bursas are often described as fluid-filled sacs located around the joints which lessen the friction caused by movement of the shoulder. Bursitis ususally occurs in association with rotator cuff tendinitis. Sometimes the many tissues in the shoulder become inflamed and painful, which in turn may limit the use of the shoulder. The joint may stiffen as a result, a condition known as a "frozen shoulder." The good news is that with appropriate care, this condition will usually resolve itself.

Injury/Instability

Sometimes the bones in one of the shoulder joints move (or, in an injury, are forced) out of their normal position. This condition, instability, can result in dislocation of one of the joints in the shoulder. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. When you lift your arm over your head, the shoulder may feel as if it is slipping out of place or an uncomfortable, unusual feeling that some people refer to as having a "dead" arm.

Arthritis

Shoulder pain may also result from arthritis. There are many types of arthritis, but generally it involves wear and tear changes with inflammation of the joint, causing swelling, pain and stiffness. Arthritis may be attributed to sports or work injuries.

People will often avoid shoulder movements in an attempt to lessen the pain arising from these conditions. Unfortunately, this can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.

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