Understanding Shoulder Pain

By Robert P. Nirschl M.D., M.S.

Rotator cuff tears are a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem. At the Nirschl Orthopaedic Center we see a tremendous number of rotator cuff injuries.

A torn rotator cuff will weaken your shoulder. This means that many daily activities, like combing your hair or getting dressed, may become painful and difficult.

Shoulder injuries are common in both young, athletic people and the aging population. In both of these age groups there are numerous causes of shoulder pain. 

The most common problem occurs in the narrow space between the bones of the shoulder. Damage to the tendons known as rotator cuff tendinitis or tear (partial or complete), Bursitis, an inflammation of the bursal cushion between the tendon below and the subacrominal bone, can also add to shoulder pain. These problems can exist separately or together. Most likely rotator cuff tears are the result of age-related changes within the tendons, tension stretch (such as pitching), or pinching of the rotator cuff.

The rotator cuff is made up of a group of four muscles and tendons that converge around the top of the humerus, the upper arm bone. These muscles and tendons connect your upper arm with your shoulder blade. Together, they form a ''cuff'' that both holds the ball of your shoulder firmly in place, and allows the shoulder to move in different directions. 

The shoulder is the most mobile joint in the human body, with a complex arrangement of structures working together to provide the movements necessary for daily life. Unfortunately, this great mobility comes at the expense of stability. Too much stress on the shoulder can cause (tendinitis/tendinosis) small tears and swelling in the tendons of the rotator cuff. Abrupt stress may even cause one of the tendons to pull away from the bone or tear in the middle of the tendon. Chronic irritation or impingement can then develop into tendinosis or tendon failure with partial or complete tears.

What are the Signs and Symptoms of Shoulder Rotator Cuff Tendinitis/Tendinosis?

Most often the onset of symptoms is related to chronic overuse. This vulnerability can be associated by a single insult, which may result in a sudden symptom onset. In many patients, the episode occurred sometime in the past and the shoulder failed to return to normal.

  • Symptoms are marked by the onset of pain and/or a decrease in range of motion.
  • The pain is often gradual in onset, and may be sharp and intermittent in its early stages.
  • As the problem progresses, the pain becomes more of a constant ache.
  • Although pain is usually present after tendinosis sets in, the original event that led to symptoms is often relatively minor and not remembered as painful.
  • Once chronic inflammation starts, simple movements may become painful.
  • Overhead motions tend to increase the pain. There is less space for the bursa when the arm is in this position, causing more compression of the bursa and the cuff tendon become pinched (dynamic impingement) under the upper acromial shoulder bone 
  • Arm movements at waist level are usually not painful. In this position, there is more space for the bursa, and therefore it is less compressed.
  • Pain usually increases at night for two reasons. First, inflammation and swelling tend to worsen as the shoulder is used during the day, and this can lead to more pain in the evening. Second, the mind is usually less occupied in the evening, allowing pain to become a major focus of attention. Rolling over on the shoulder is especially painful as compression occurs on the bursa and the sensitive cuff tendinosis.

Nirschl Orthopaedic Center is a leader in sports medicine and general orthopedic services. In addition Virginia Sportsmedicine Institute physical therapy has been rated one of the top sports medicine clinics in the area. If you have an orthopaedic injury, schedule an appointment with one of our doctors today. Visit our websites at nirschl.com and vasportsmedicine.com to learn more about our services. For more info on orthopaedic issues visit our blog at nirschlorthopaedic.com. Follow us on Twitter @nirschlortho

Nirschl Orthopaedic Center for Sports Medicine & Joint Reconstruction
1715 N. George Mason Drive, Suite 504
Arlington, Virginia 22205

© Jane Voigt Tennis 2013