Your shoulder joint is like a ball resting on a golf tee. Because it's not tightly secured, the ball can easily move off the tee. This freedom lets you move your shoulder in a lot of different ways, in all different directions.
“It’s fantastically flexible,” says Mark David Price, MD, PhD, a Mass General Brigham orthopedic surgeon and sports medicine specialist. As the head team physician and medical director for the New England Patriots, and a team physician for the Boston Red Sox, Dr. Price specializes in shoulder injuries.
That flexibility, however, comes at a cost: Shoulders are notoriously unstable (like that golf ball on the tee). This means your shoulder and the structures around it may be more prone to injury.
Dr. Price explains that shoulder injuries fall into two broad categories: traumatic and nontraumatic. Traumatic means something specific happened to cause an injury, like falling off your bike or getting tackled on the football field. Traumatic shoulder injury is usually accompanied by sharp or shooting pain.
Nontraumatic refers to injury from overuse injuries such as arthritis. These long-term conditions typically cause dull, aching pain. You could also experience sharp and shooting pain if you irritate a chronic injury.
“The interesting part about the shoulder is that you can get the same injury from either of those sources,” says Dr. Price. “But how you treat and diagnose the injury may be very different based on whether it’s traumatic or nontraumatic.”
Unfortunately, the cause of shoulder pain is rarely as simple as “it’s your rotator cuff.” It very well may be your rotator cuff (the muscles and tendons that support the shoulder joint), but the problem often runs deeper.
“It’s really important to understand all the dimensions of your shoulder,” says Dr. Price. “Pain seldom indicates a problem with just one part. It’s my job to figure out what’s driving your pain.”
Shoulder pain can even stem from a problem in your neck or chest. A diagnosis requires a fair amount of thought and examination, with each detail pointing your doctor in the right direction.
Dr. Price highlights three common causes of shoulder pain:
Wear and tear over time can lead to arthritis (loss of protective cartilage) in your joints. Injuries that happen when you’re young can also contribute to arthritis later in life. Arthritis causes a grinding feeling and a limited range of motion in your shoulder.
Any part of the rotator cuff can get irritated, inflamed or even tear. Pain with movement or in a certain position suggests a rotator cuff injury. For example, you may feel pain when you reach your arm up if your rotator cuff gets pinched between the two shoulder bones (shoulder impingement).
Shoulder instability causes your shoulder to dislocate (pop completely out of the socket). If you feel your shoulder slipping in and out of the socket, you may have injured your labrum (tissue that supports the shoulder joint). You can dislocate your shoulder for a range of reasons, from playing sports, to falling on your arm, to just activities of daily life.
“In my mind, the time to see a doctor is when it bothers you enough to want to come in,” says Dr. Price. “If the pain bugs you and you want to talk about it, we want to hear about it.” He adds that you shouldn’t wait to come in if you’ve had a traumatic accident or have persistent pain.
Your doctor will help you understand what your pain is, where it’s coming from and what to do about it. This first visit involves a conversation with your doctor, a physical exam of your shoulder and surrounding muscles, and imaging of your shoulder.
“Often, just hearing a plan for moving forward can relieve fear, anxiety or apprehension about your pain,” says Dr. Price. “Before you leave, I want you to know what I know about what’s going on in your shoulder.”
The more you think about your shoulder pain before you see a doctor, the more you’ll get out of your visit. You and your doctor will have a better discussion about your pain and address any concerns you have if you’ve already thought about the basics.
Dr. Price recommends asking yourself some questions that will help your doctor understand your pain, including:
Where is the pain and what does it feel like?
When did the pain start?
What causes the pain to worsen? What makes it feel better?
Does the pain limit me from doing anything?
Does the pain wake me up at night?
Have I been taking any medicine for the pain?
Sometimes minor shoulder pain will get better on its own. “Taking it easy and avoiding things that aggravate your shoulder might be the best thing you can do,” says Dr. Price. “Your body will tell you what’s okay if you listen to it.”
In the meantime, over-the-counter pain medications can help manage shoulder pain. But as Dr. Price says, medications are pain control, not pain elimination. They can help take the edge off, but they don’t give you a long-term solution.
Applying ice or heat may also help. You can experiment to see which works best for you. “At the end of the day, you don’t need to do something just to feel like you’re doing something,” Dr. Price says. “In that downtime, your body is often still doing things to heal.”
Dr. Price recommends only using these home remedies when you feel pain and if they provide relief. Let your body guide your healing process.
“Things that are bad seldom go away and get better on their own. Things that go away and get better on their own are seldom very bad,” riddles Dr. Price. “Trust your instincts, and if you feel like things aren’t right, come in to see a doctor.”
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