Bone & Joint | Fitness
April 28, 2016

3 reasons for chronic shoulder pain


If your shoulder hurts, it’s probably due to one of these common problems.


It’s hard to swing a golf club, blow-dry your hair or even drive if you have chronic shoulder pain. What might be the trouble, and what should you do to relieve it? There are three common shoulder problems that bring people to Vanderbilt Bone & Joint. Board-certified orthopaedic surgeon Ian R. Byram, M.D., explains:


1. Impingement syndrome and rotator cuff disease

What is it?
In impingement, the narrow tip of the shoulder blade, called the acromion, can restrict the space normally occupied by the tendons of the rotator cuff, which lie just below the acromion. The rotator cuff is a set of muscles and tendons that connect the shoulder blade with the ball of the shoulder, to move the upper arm and stabilize the shoulder joint.

Repetitive “impingement” by the acromion on the rotator cuff can cause rotator cuff disease and pain. Rotator cuff disease refers to injury to the rotator cuff.

What it feels like:
If you have impingement syndrome or rotator cuff disease, you may feel pain in your shoulder when reaching overhead or behind you (for example, reaching for the car’s seat belt, or fastening a bra). The pain is usually in the front and side of the shoulder and spreads down the upper arm to the mid-humerus (upper arm bone). You may feel weakness when lifting the arm to the front or side. The pain can vary, but generally it’s sharp pain, usually related to activity.

Who is most at risk?
Repetitive overhead motions can lead to these problems. Vanderbilt Bone & Joint surgeons see this in athletes who serve tennis balls or pitch baseballs; and “weekend warriors” who do physical activity with repetitive arm movements in intense bursts — for example, painting a room.

What’s the treatment?
Treatment will depend on the individual case, but generally, impingement syndrome and rotator cuff disease can improve with physical therapy, oral anti-inflammatory medicines or steroid injections into the “subacromial space” around the rotator cuff (the small space between the top of the upper-arm bone and the bottom of the acromion, the narrow tip of the shoulder blade). In some cases, treatment means arthroscopic surgical repair or “cleanup” of the rotator cuff.


2. Arthritis

What is it?
Athritis is a degenerative condition in which cartilage in a joint wears away, leaving bone to rub against bone. It causes pain and stiffness in the area of the joint. Arthritis in the shoulder is usually osteoarthritis — arthritis from wear and tear.

What it feels like:
Arthritis pain or a grinding sound (called “crepitus”) can happen when you move your arm in any direction. The pain may happen in several places at the same time — for example, in both the front and back of the shoulder. People with shoulder arthritis will have difficulty or pain with repetitive motions, and generally feel stiffness in the shoulder joint. The pain can vary, but usually it’s a dull aching pain, often worse with cold weather.

Who is most at risk?
Older patients in general are at risk for arthritis. People who have had previous shoulder surgery or trauma to the shoulder are also vulnerable to arthritis in this joint. To some extent, arthritis has a genetic component, so if your parents have arthritic joints you may be at risk.

What’s the treatment?
Arthritis in the shoulder is usually treated with a stretching program and/or steroid injections into the joint. Severe cases may require replacement of the shoulder joint.


3. Frozen shoulder

What is it?
Frozen shoulder, which is also called adhesive capsulitis, is when the shoulder gradually gets more stiff and immobile.

What it feels like:
A frozen shoulder will cause constant pain, even when you’re resting it. The pain may be throughout the area — in the front, back and side of the shoulder — and the shoulder will be stiff. People with frozen shoulder are often unable to raise their arms higher than waist level, or behind their back. Pain can vary, but usually, a frozen shoulder creates constant pain, both sharp and dull, often pain at night and at rest, and it gets worse with movement.

Who is most at risk?
Frozen shoulder is more common in women than in men. Other groups at risk include people with diabetes or thyroid disease; and those in their 40s to 60s.

What’s the treatment?
Treatment depends on the individual patient. Usually, the treatment for frozen shoulder involves anti-inflammatory medication, pain medicine, physical therapy and/or a steroid injection into the joint. Occasionally it requires arthroscopic “capsular release,” a surgery to break up scar tissue in the joint. Some people are helped by manipulation under anesthesia; they go under general anesthesia while the doctor moves their arm to restore motion.


Keeping shoulders pain-free

The best way to avoid any of these painful shoulder problems, Byram said, is to keep the joint flexible and build strength in the muscles around the shoulder (the rotator cuff, deltoid and trapezius muscles).

“These muscles can be toned with a regular workout program including exercises such as rows, pull-downs and internal and external rotation,” Byram said.

Byram often suggests these conditioning exercises to his patients. Or hire a personal trainer or physical therapist to show you the right way to do shoulder-strengthening exercises found through Google and YouTube searches.


Vanderbilt Bone & Joint’s Cory Calendine, M.D., explains what women should know about arthritis.

Physical Therapy, Joint Health, Arthritis

2 thoughts on “3 reasons for chronic shoulder pain”

  1. James Waldrop says:

    Could you recommend a stretching program for my arthritis?

    1. My Southern Health says:


      Thanks for reading My Southern Health! We aren’t able to make specific recommendations for an individual’s medical concerns. We have published these tips previously, which might be of help: We’ll also check with our medical sources to see if a stretching program is recommended for arthritis pain and stiffness. Thanks for taking the time to comment!

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