Patient education: Shoulder pain (The Basics)

What are the parts of the shoulder? — The shoulder joint is made up of the upper arm bone, collarbone, and shoulder blade. It includes muscles, ligaments, tendons, and bursae (figure 1). All of these parts work together to help the shoulder move comfortably in different directions.

What can cause shoulder pain? — Shoulder pain can happen when you damage or injure any of the different parts of the shoulder.

Different conditions can cause shoulder pain. They include:

●Bursitis – This is a condition that can cause pain or swelling next to a joint. A "bursa" is a small fluid-filled sac that sits near a bone. It cushions and protects nearby tissues when they rub on or slide over bones. Bursitis is when a bursa gets irritated and swollen.

●Frozen shoulder – This is a condition that causes the shoulder to be stiff, painful, and hard to move. If you have a frozen shoulder, the tissue around the shoulder joint gets thick and tight. This might happen after a shoulder gets injury or surgery.

●Rotator cuff injury – The rotator cuff is made up of 4 shoulder muscles and their tendons. Tendons are strong bands of tissue that connect muscles to bones. Rotator cuff injuries cause pain in your shoulder and sometimes in your upper arm.

●Shoulder impingement – This happens when a muscle, tendon, or bursa gets squeezed between bones.

●Separated shoulder – This happens when certain ligaments tear or get stretched too much. Ligaments are strong bands of tissue that connect bone to bone. The most common causes of a separated shoulder are falling on the shoulder or getting hit in the shoulder. A separated shoulder can be mild or severe, depending on how many ligaments are torn.

●Osteoarthritis – This is a common condition that often comes with age. The cartilage in the joints wears down, causing the bones to rub against each other. This can cause pain, stiffness, and swelling in the shoulder joints.

Will I need tests? — Maybe. Your doctor or nurse will talk with you and do an exam. They might also do an imaging test of your shoulder such as an X-ray, MRI, or ultrasound. Imaging tests create pictures of the inside of the body.

How is shoulder pain treated? — Many causes of shoulder pain get better on their own. But it can take weeks to months to heal completely.

Your doctor might recommend:

●Pain-relieving medicines called "nonsteroidal anti-inflammatory drugs" (NSAIDs) – These include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). They can reduce pain and swelling.

●Exercises and stretches – It can help to work with a physical therapist (exercise expert). They can teach you gentle stretches and exercises to help with your symptoms. Follow the physical therapist's advice for how often and when to do the exercises.

●Steroid injections – Steroid medicines help reduce inflammation. Doctors can inject steroids into the shoulder to help reduce symptoms.

●Surgery – Surgery might be an option if other treatments do not work and you have had symptoms for a long time.

Is there anything I can do on my own to feel better?

●Rest your shoulder – Avoid lifting things, reaching overhead or across your chest, or sleeping on the shoulder that hurts. If your doctor gave you a sling to support your arm, follow instructions for using it. Or you might get a bandage that goes around your shoulders and upper back instead.

●Take medicine to reduce pain and swelling – To treat pain, you can take acetaminophen (sample brand name: Tylenol). To treat pain and swelling, you can take ibuprofen (sample brand names: Advil, Motrin).

●Prop your shoulder on pillows – Keep it raised above the level of your heart. This can help with pain and swelling.

●Ice your shoulder – Put a cold gel pack, bag of ice, or bag of frozen vegetables on the injured area every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and your skin. Use the ice (or other cold object) for at least 6 hours after your injury. Some people find it helpful to ice longer, even up to 2 days after their injury. Ice can also be helpful after doing shoulder exercises.

●Put heat on the area to reduce pain and stiffness – Do not use heat for more than 20 minutes at a time. Also, do not use anything too hot that could burn your skin.

●Do pendulum exercises to keep your shoulder from getting too stiff (figure 2):

•Let your arm relax and hang down while you sit or stand. Gently move your arm:

-Back and forth at your side

-Side to side across your body

-Around in small circles

•Do this exercise for 5 minutes, 1 or 2 times a day.

•Start slowly, and make the exercises harder over time. For example, make small circles with your arm at first. Over time, make bigger circles or hold weights in your hand.

●Your doctor, nurse, or physical therapist can show you how to do other exercises to strengthen the muscles around your shoulder. They will tell you when to start them and how often to do them.

●Before exercising your shoulder, warm up the muscles first. You can do this by taking a hot shower or bath, or using a heating pad. Some soreness is normal. If you have sharp, tearing, or worsening pain, stop what you're doing and let your doctor or nurse know.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if:

●You have shoulder pain and start to have trouble breathing or bad chest discomfort.

Call the doctor or nurse for advice if:

●You have very bad pain that is not helped by medicines.

●Your hand or arm becomes weak or swollen.

●Your fingers are numb, tingly, or blue or gray in color.

More on this topic

Patient education: Rotator cuff injury (The Basics)
Patient education: Bursitis (The Basics)
Patient education: Frozen shoulder (The Basics)
Patient education: Biceps tendinopathy (The Basics)
Patient education: Shoulder impingement (The Basics)
Patient education: Osteoarthritis (The Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: Shoulder arthroscopy (The Basics)
Patient education: Shoulder replacement (The Basics)

Patient education: Rotator cuff tendinitis and tear (Beyond the Basics)
Patient education: Frozen shoulder (Beyond the Basics)
Patient education: Biceps tendinitis or tendinopathy (Beyond the Basics)
Patient education: Shoulder impingement syndrome (Beyond the Basics)
Patient education: Osteoarthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)