A common cause of shoulder pain is soreness of the tendon (a cord that attaches a muscle to a bone) in the rotator cuff. This is the part of the shoulder that helps circular motion. Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder).
You might experience soreness after painting, lifting items, or playing a sport—anything that requires you to lift your arms, especially overhead. Or you may not remember any specific injury, but you still feel pain in your shoulder.
How does the rotator cuff get hurt?
The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder steady as the arm moves.
The supraspinatus muscle rests on top of the shoulder. Its tendon travels under the bone on the outside of the shoulder (the acromion). This tendon is the one most often injured because of its position between the bones. As the tendon becomes inflamed (sore and swollen), it can become pinched between the 2 bones. The sac of fluid that cushions the tendon can also be irritated and swollen.
How do I know the rotator cuff is hurt?
If the rotator cuff is involved, the pain is usually in the front or outside of the shoulder. This pain is usually worse when you raise your arm or lift something above your head. The pain can be bad enough to keep you from doing even the simplest tasks. Pain at night is common, and it may be bad enough to wake you. It also may worsen when lying down or onto that side.
Path to improved health
Your doctor can help you with a treatment plan to relieve the pain and help you restore your shoulder to normal function. Pain relief strategies include active rest. During active rest, you can and should move your shoulder. Avoid difficult activities like lifting heavy objects or repetitive overhead movements. You may also get relief by applying ice, taking nonsteroidal anti-inflammatory medicine such as ibuprofen (brand names: Advil, Motrin) or naproxen (brand name: Aleve), and, occasionally, an injection of anti-inflammatory steroids. Special exercises may also help.
The first step of rehabilitation therapy is simple range-of-motion exercises. By bending over and moving (rotating) your shoulder in large circles, you will help to avoid the serious complication of rotator cuff injury, called a frozen shoulder. You should follow these range-of-motion exercises with resistance exercises using rubber tubing or light dumbbells. The final step is resistance training with weight machines or free weights.
What exercises should I do?
The following exercises may help you. Ask your doctor if you should do other exercises, too. You can also try these rotator cuff exercises.
Range of motion
Stand up and lean over so you’re facing the floor. Let your sore arm dangle straight down. Draw circles in the air with your sore arm. Start with small circles, and then draw bigger ones. Repeat these exercises 5 to 10 times during the day. If you have pain, stop. You can try again later.
Having good shoulder posture can help prevent shoulder pain. Many people with shoulder pain often lift up or hunch their shoulder forward. Work on improving your posture if you find yourself slumping or hunching. Throughout the day, focus on bringing your shoulder or shoulder blade down and holding there. Another exercise is to stand against the wall with the back of your head, shoulders, legs, and heels touching the wall. Notice if your painful shoulder blade doesn’t touch the wall completely. Keep trying that position throughout the day.
Upper extremity strengthening
As your pain goes away, try adding a general upper body weight-lifting program using weight machines or free weights. Lie on your right side with your left arm at your side. With a weight in your left hand and your forearm across your tummy, raise your forearm.
Keep your elbow near your side.
What else can I do to help this injury heal?
An aerobic exercise program will help improve the blood flow to the tendon or bursa. The blood flow will help reduce soreness. Smokers should quit smoking so more oxygen reaches the injured tendon. This will help the injury heal faster.
Things to consider
It often takes a shoulder a long time to heal. The earlier you address the pain, the better. Depending on your injury, you should be able to make a full recovery. However, many people complain that even with a full recovery, their shoulder is not as strong as before.
When to see a doctor
If you fell or felt a sudden pull, you shouldn’t wait more than a few days before you see your doctor because it could be a torn tendon. Tell your doctor if your pain goes on in spite of a good treatment program. Or when there is weakness in certain motions of the arm. You may have torn your rotator cuff. This type of injury may need surgery.
Questions to ask your doctor
- What is causing my shoulder pain?
- Could my shoulder pain be caused by my sleep position?
- How much should I limit my activities?
- Why is it taking so long for my shoulder to heal?
- How can I prevent a repeat of my shoulder pain if I don’t know what caused it?
- Will my shoulder heal completely?
National Institutes of Health, MedlinePlus: Shoulder Injuries
National Institute of Arthritis and Musculoskeletal and Skin Diseases: Shoulder Problems
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.