What’s Causing Your Shoulder Pain

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Sports Related Shoulder Injuries: Common Sources of Shoulder Pain Among Athletes

The shoulder is an amazing joint, capable of a wider range of motion than any other single joint in the body. When we stop and think about all that our shoulders go through in a day, we gain a sense of respect for this versatile and intricate part of our anatomy. But most of us don’t spend much time thinking about our shoulders until something goes wrong.

Sports related shoulder injuries are quite common, and fortunately, most of them are treatable with skilled medical attention and a degree of patience. An injured shoulder shouldn’t (and often can’t) be ignored, but if we take care of our shoulders, they’ll take care of us. In order to do this, it’s a good idea to recognize some of the causes and conditions that contribute to common forms of shoulder pain.

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Sports Related Shoulder Injuries: Slow Onset

Slow onset shoulder injuries start as small concerns and can gradually grow into serious problems, sometimes within a few weeks or months. Sometimes an injured shoulder will freeze up or lose flexibility until the joint can hardly move at all. Sometimes bursitis or tendonitis can occur, in which a major tendon or the sac of fluid under the AC joint becomes swollen and inflamed. In both of these cases, shoulder pain increases sharply when the arm is lifted sideways.

And sometimes a tendon becomes pinched within the moving parts of the shoulder joint. This pinching, or impingement, can typically be felt during overhead arm movements. The rotator cuff tendons are frequent victims of this type of motion and can easily become trapped or pinched in the bones of the injured shoulder.

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Common Slow Onset Shoulder Injuries

Rotator Cuff Tendonitis: The rotator cuff is a set of four muscles that extend out from the body and reach around the head of the humerus (upper arm bone), joining together like the arms of a starfish at a central point on the outside of the shoulder. These four muscles provide the shoulder with its amazing range of motion, but they (and the ligaments that secure them) are vulnerable to injury. Slow onset rotator cuff problems are usually a result of inflamed ligaments and tendons. Sudden onset problems come from different causes and are discussed below. 

Impingement Syndrome, or Swimmer’s Shoulder: When we reach our arms over our heads, especially in a repetitive fashion, the tendons and ligaments of the rotator cuff can become caught in the bones of the acromioclavicular (AC) joint, the joint where the clavicle connects to the rest of the shoulder. This can cause a pinching sensation and nerve damage that can eventually lead to more serious problems.

Adhesive Capsulitis, or Frozen Shoulder Syndrome: An inflamed joint capsule sometimes makes the shoulder joint stiff and difficult to move. This condition usually starts as a nagging ache, which grows into widespread shoulder pain that can become worse at night. Eventually the entire injured shoulder may become immobile and can stay that way for a few months to a year or more.

Sports Related Shoulder Injuries: Sudden Onset

Sudden onset shoulder injuries can usually be traced to one event or accident that pushes the shoulder outside its natural range of motion. These forms of sudden shoulder pain often happen when we arrest a fall by holding out an arm, when we move unnaturally while supporting our weight with our arms, or when our shoulders experience intense torque or impact (as when we catch a heavy object that’s thrown into our arms).

Sudden onset shoulder injuries are often a result of 1) dislocation (when the head of the humerus comes free from its socket), 2) damage to the ligaments that hold together the AC joint at the top of the shoulder, or 3) damage to the muscles and ligaments that make up the rotator cuff. All three of these tend to result in significant shoulder pain.

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Common Sudden Onset Shoulder Injuries

AC joint separation: The AC joint is strong, but the two bones that make up this joint are held together by ligaments that can be easily strained or torn by impact against an outstretched arm.

Rotator cuff injury: The rotator cuff, or the four starfish-oriented muscles described above, can be injured by many of the movements that are central to gymnastics, swimming, throwing and boxing. A tear or sprain can affect any of these four muscles, or all of them, resulting in intense shoulder pain.

Glenoid Labrum Tear: Where the ball of the humerus meets the bowl of the scapula, a layer of softer tissue lies called the glenoid labrum. This tissue provides a barrier between the bony socket and ball and it also holds them together. When the tissue is torn or damaged, tenderness happens at the front of the shoulder, and shoulder pain is often intensified when the arm is held behind the back.

Sports Related Shoulder Injuries: Fractures

The three major bones of the shoulder are the collarbone, the scapula, and the humerus. Any of these three can be broken by the same kinds of events that damage muscles and ligaments in an injured shoulder.

Some fractures result in bony deformities that can be seen or felt with the hand, but the only real way to diagnose a fracture is with an X-ray. Most of the time, fractures cause very serious shoulder pain. If you experience sudden, intense shoulder pain or loss of mobility, the next step may involve an X-ray or an MRI. But in any case, a doctor will need to diagnose your shoulder injury and determine a course of action. Treatment for an injured shoulder may involve anti-inflammatory medication, supportive bandages, or surgery in some cases. Some shoulder injuries require a course of physical therapy after the initial treatment is complete.

A Few Final Words on Sports Related Shoulder Injuries

If you feel a little ache or pain in your shoulder, go ahead and ignore it. Athletes do this all the time, and chances are it’s nothing. But if your shoulder pain is still there after three days, it’s not nothing. It’s something. Especially if it’s been increasing rather than decreasing. After three days, the time to ignore shoulder pain (no matter how minor) is over.

Attend to your shoulder pain and have it examined by your doctor. In the meantime, rest your injured shoulder and treat the area with ice, heat, and gentle massage. Otherwise the problem will likely get worse, which will mean a longer recovery time and extended obstacles to your training and performance.