The most movable joint in the body, the shoulder is also one of the most potentially unstable joints. As a result, it is the site of many common problems.
Common shoulder problems include:
- sprains and strains
- tendinitis and bursitis
- torn rotator cuffs
- frozen shoulder
The shoulder is easily injured because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments.
Although the shoulder is easily injured during sporting activities and manual labor, the primary source of shoulder problems appears to be the natural age-related degeneration of the surrounding soft tissues such as those found in the rotator cuff. The incidence of rotator cuff problems rises dramatically as a function of age and is generally seen among individuals who are more than 60 years old. Often, the dominant and nondominant arm will be affected to a similar degree. Overuse of the shoulder can lead to more rapid agerelated deterioration.
Shoulder pain may be localized or may be felt in areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder. However, these other causes of shoulder pain are beyond the scope of this booklet, which will focus on problems within the shoulder itself.
Diagnosis of Shoulder Problems
As with any medical issue, a shoulder problem is generally diagnosed using a three-part process:
- Medical history. The patient tells the doctor about any injury or other condition that might be causing the pain.
- Physical examination. The doctor examines the patient to feel for injury and to discover the limits of movement, location of pain, and extent of joint instability.
- Tests. The doctor may order one or more of the tests listed below to make a specific diagnosis. These tests may include the following:
- Standard x ray. A familiar procedure in which low-level radiation is passed through the body to produce a picture called a radiograph. An x ray is useful for diagnosing fractures or other problems of the bones. Soft tissues, such as muscles and tendons, do not show up on x rays.
- Arthrogram. A diagnostic record that can be seen on an x ray after injection of a contrast fluid into the shoulder joint to outline structures such as the rotator cuff. In disease or injury, this contrast fluid may either leak into an area where it does not belong, indicating a tear or opening, or be blocked from entering an area where there normally is an opening.
- Ultrasound. A noninvasive, patient-friendly procedure in which a small, hand-held scanner is placed on the skin of the shoulder. Just as ultrasound waves can be used to visualize the fetus during pregnancy, they can also be reflected off the rotator cuff and other structures to form a highquality image of them. The accuracy of ultrasound for the rotator cuff is particularly high.
- MRI (magnetic resonance imaging). A noninvasive procedure in which a machine with a strong magnet passes a force through the body to produce a series of cross-sectional images of the shoulder.
Other diagnostic tests, such as one that involves injecting an anesthetic into and around the shoulder joint, are discussed in detail in other parts of this booklet.
Symptoms and Treatment
The symptoms of shoulder problems, as well as their diagnosis and treatment, vary widely, depending on the specific problem.
Treat Shoulder Injuries With RICE (Rest, Ice, Compression, and Elevation)
If you injure a shoulder, try the following:
- Rest. Reduce or stop using the injured area for 48 hours.
- Ice. Put an ice pack on the injured area for 20 minutes at a time, 4 to 8 times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice that has been wrapped in a towel.
- Compression. Compress the area with bandages, such as an elastic wrap, to help stabilize the shoulder. This may help reduce the swelling.
- Elevation. Keep the injured area elevated above the level of the heart. Use a pillow to help elevate the injury.
If pain and stiffness persist, see your doctor or health care provider.