The shoulder is the most mobile joint in the human body. The joint includes four tendons. The purpose of a tendon is to hold muscle to bone. Together, these four "rotator cuff" tendons stabilize the upper arm bone to the shoulder socket and allow a wide range of motion in the shoulder.

Any swelling, inflammation, tearing, or bony changes around these tendons causes pain when a person tries to move the arm above the head, behind the back, or straight out in front.

Shoulder pain is an extremely common complaint for which there are many causes. If you have shoulder pain, some common causes include:

• Muscle or tendon tears
• Inflammation of the lining of the joint
• Bony impingement on the nerves or tendons running through the joint
• Dislocations or separations
• Arthritis

Causes
Causes of shoulder pain can be ascribed to the different structures that make up the joint and its surrounding structures. Certainly sports injuries are a large portion, although it is also commonly seen when no precipitating incident can be found. Here are some of the more common causes:

• Bursitis/Rotator Cuff Tendonitis
The most common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff.

• Rotator Cuff Tear
Rotator cuff tears occur when the tendons of the rotator cuff separate from the bone. Surgery is sometimes necessary for this condition.

• Frozen Shoulder
Also called 'adhesive capsulitis,' this is a common condition that leads to stiffness of the joint. .

• Calcific Tendonitis
Calcific tendonitis is a condition of calcium deposits within a tendon -- most commonly within the rotator cuff tendons.

• Shoulder Instability
Instability is a problem that causes a loose joint. Instability can be caused by a traumatic injury (dislocation), or may be a developed condition.

• Shoulder Dislocation
A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula.

• Shoulder Separation
Also called an AC separation, these injuries are the result of a disruption of the acromioclavicular joint.

• Labral Tear
There are several patterns of a torn labrum and the type of treatment depends on the specific injury.

• SLAP Lesion
The SLAP lesion is also a type of labral tear. The most common cause is a fall onto an outstretched hand.

• Arthritis
Shoulder arthritis is less common than knee and hip arthritis, but when severe may require a joint replacement surgery.

• Biceps Tendon Rupture
A proximal biceps tendon rupture occurs when the tendon of the biceps muscle ruptures near the joint.

Signs and Symptoms
Pain in or around the shoulder, especially with motion may represent an internal problem with the shoulder joint. Pain may also be in the deltoid, or the acromioclavicular region. Inability to abduct the arm, or move the arm horizontally away from the body is also an indicator that there may be something wrong internally. A person’s range of motion is also usually compromised when a shoulder derangement is found. Crepitus, or the sound of bone against bone is an ominous sign that may portend shoulder replacement surgery.

Seeking Medical Advice
Some signs that you should be seen by a doctor include:

• Inability to carry objects or use the arm
• Injury that causes deformity of the joint
• Shoulder pain that occurs at night or while resting
• Shoulder pain that persists beyond a few days
• Inability to raise the arm
• Swelling or significant bruising around the joint or arm
• Signs of an infection, including fever, redness, warmth

Screening and Diagnosis

Physical Examination

A complete physical examination includes inspection and palpation, assessment of range of motion and strength, and provocative shoulder testing for possible impingement syndrome and glenohumeral instability. The neck and the elbow should also be examined to exclude the possibility that the shoulder pain is referred from a pathologic condition in either of these regions. Referred or radicular pain from disc disease should be considered in patients who have shoulder pain that does not respond to conservative treatment. The patient should be questioned about neck pain and previous neck injury, and the examiner should note whether pain worsens with turning of the neck, which suggests disc disease. Pain that originates from the neck or radiates past the elbow is often associated with a neck disorder.

• X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.

• MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.

• Myelography/CT scanning: Sometimes used as an alternative to MRI

• Electro diagnostic studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck and shoulder pain, arm pain, numbness and tingling.

Treatment
The treatment of shoulder pain depends entirely on the cause of the problem. Not all treatments listed here are appropriate for every condition, but may be helpful in your situation:

• Rest: The first treatment for many common conditions that cause shoulder pain is to rest the joint, and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint, because prolonged immobilization can cause a frozen shoulder.

• Ice and Heat Application: Ice packs and heat pads are among the most commonly used treatments for shoulder pain. (See chart below)

• Stretching: Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain.

• Physical Therapy: Physical therapy is an important aspect of treatment of almost all shoulder conditions. Physical therapists use different modalities to increase strength, regain mobility, and help return patients to their pre-injury level of activity.

• Anti-Inflammatory Medication: Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with shoulder pain caused by problems such as arthritis, bursitis, and tendonitis.

• Cortisone injections: Cortisone is a powerful anti-inflammatory medication. Inflammation is a common problem in patients with shoulder pain, and is often used as a treatment.

• When to Use Ice: Use ice after an acute injury, such as an ankle sprain, or after activities that irritate a chronic injury, such as shin splints

• How to Use Ice: Apply ice treatments for no longer than 20 minutes at a time. Too much ice can do harm, even cause frostbite; there is no benefit to icing excessively.

• When to Use Heat: Use heat before activities that irritate chronic injuries such as muscle strains. Heat can help loosen tissues and relax injured areas.

• How to Use Heat: It is not necessary to apply a heat treatment for more than about 20 minutes at a time. Never apply heat while sleeping.

Prevention
To minimize the risk of shoulder problems, here are some tips and guidelines:

• Warm up, loosen up and stretch all the shoulder girdle muscles and tendons at least 15-30 minutes prior to undertaking any strenuous activity.

• Do not lift heavy weights at first. Start with lighter amounts that will not risk injury, and then work your way up.

• Overall, your shoulder is very prone to injury by lifting too much weight. It would be smart to not push yourself to the extreme when your shoulders are concerned, if possible.