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Shoulder Pain

By: Dr. Giovanni Silva

Many times people experience shoulder pain in their active daily lives. The pain can become more severe at some times than at others. Though not unheard of for the rest of us, chronic shoulder pain is most commonly found with athletes. For those unfortunate individuals with constant shoulder pain, the cause is usually repetitive abuse of the shoulder whether at work or play. However, a single severe traumatic incident brings on the onset of shoulder pain.

The Nuts & Bolts

Let's explain the basic anatomy of the shoulder. The shoulder joint is primarily made up of two bones: the scapula and the humerus. These two bones make up a ball (head of the humerus) and socket (the glenoid fossa) joint. The ball and socket joint (the shoulder joint) is held together by ligaments and muscles. It is these ligaments and muscles that allow the shoulder joint to enjoy normal range of motion and stability. When either the ligaments and/or muscles are altered from their normal state, stability and normal range of motion are compromised. These ligaments may also become altered by overstretching. When the ligaments are overstretched the shoulder feels loose. This looseness causes a loss of stability in the shoulder, which later may cause pain to the joint.

Ligaments do not have the same properties as muscle. When the muscle becomes stretched, it will return to its normal resting state (like a rubber band would if stretched). Continual overstretching, over a period of time will cause a ligament to lose tensile ability and become overstretched. This is important because when these ligaments lose their tensile ability, the shoulder joint becomes increasingly less stable and laxity is noted in the joint.

#1 Problem

Once the shoulder becomes unstable, lifting the arm may cause pain due to an impingement. The humerus is unable to travel in its normal motion, so the subachromial bursa , the long head of the biceps tendon and the supraspinatus tendon, become impinged (pinched) between the humerus and acromion. Over a prolonged period of shoulder impingement, inflammation follows. As this condition of inflammation worsens, it becomes increasingly painful to use your shoulder, especially when trying to lift your hand over your head.

If this condition remains uncorrected, a supraspinatus muscle tear (rotator cuff) can occur because the tip of the acromion can act like an ax on the ligament. With the repetitive impingement of the subvacromial structures, the supraspinatus muscle, which is one of the four muscles of the rotator cuff, slowly tears.

This is why shoulder pain is more common in sports - especially sports that require overhead movements like pitching or throwing a baseball, going for that winning spike in volleyball or a tennis game, or trying to maximize that swimming stroke. Weight lifting or bodybuilding is another sport in which shoulder pain is common due to instability. Most weight lifters experience shoulder pain during exercises like bench pressing (flat or inclined), dumbbell flies or the pec-deck machine, behind the neck military press , or behind the neck lat pulldowns.

Get It Checked

Depending on the severity of the condition, many surgical procedures exist to alleviate the pain brought on by shoulder impingement and instability. Choosing a good sports doctor is the first step to take so a proper evaluation of the painful shoulder can be performed. After a thorough evaluation, a diagnosis is reached and a recommendation can be made to treat the shoulder conservatively or surgically.