Shoulder Pain

Dr. Marc Darrow, M.D., J.D.

The shoulder is really a combination of several joints, combined in such a way by an intricate arrangement of muscles and tendons, that provides the arm a wide range of motion, flexibility and stability.

The rotator cuff is a group of four shoulder muscles that surround the top of the upper arm bone, the humerus, and holds it in the shoulder joint. These muscles are responsible for moving the arm in various directions, and unlike the massive deltoid muscle of the upper arm, are smaller and generally more vulnerable to injury. The four muscles and tendons of the rotator cuff are the supraspinatus, infraspinatus, teres minor, and subscapularis. It is the supraspinatus that is most commonly inflamed or torn.

The supraspinatus, and the rest of the shoulder, because they are built and expected to allow a remarkable array of motion, frequently are subjected to injuries, causing problems of instability or impingement of soft tissue and in pain. The pain may be constant, or may occur only when the shoulder is moved. In any case, any shoulder pain that persists more than a few days should be diagnosed and treated as necessary.

Shoulder Inflammation- Bursitis

In the shoulder this is often an inflammation of the tendons as a result of the wearing process that takes place over a period of time. It can also occur from an unusual, awkward movement or fall.

Sometimes, excessive use or injury of the shoulder leads to inflammation and swelling of a bursa, a condition known as bursitis. Bursas are fluid filled sacs located around the body and joints. They lessen the friction caused by movement of the shoulder. Bursitis often occurs in association with rotator cuff tendinitis.
A future article will deal with v issues in much more detail. Symptoms of shoulder bursitis include mild to severe pain, limiting the use of the shoulder. In extreme cases the joint stiffens into a condition known as “frozen shoulder,” also referred to by doctors as adhesive capsulitis.

Chronic Shoulder Instability Syndrome

Chronic shoulder instability syndrome results from trauma caused by subluxations, dislocations, from less detectable micro-trauma caused by repetitive strain on the tissues, or from congenitally loose shoulder joints. Recurrent pain or tenderness in the shoulder joint and weakness in the arm are two of the more common symptoms, but severe examples include patients whose shoulders pop in and out of joint. Frequent shoulder dislocations stretch the brachial plexus, the nerves that run from the neck down the arm. This process can cause permanent nerve damage, pain, and loss of use of the arm.