Shoulder Pain: Tendinitis, Inflammation and Injury

Impingement syndrome is marked by inflammation of one of more of the four rotator cuff tendons that run through a tiny space between the bony tip of the shoulder, known as the acromion process, and the ball-and-socket joint directly beneath it. This condition, which is quite common, affects individuals involved in activities requiring repetitive overhead movements, including weightlifting, swimming and volleyball. Impingement syndrome starts out insidiously. One of the rotator cuff tendons, usually the supraspinatus, becomes slightly inflamed. As a result, it swells crowding the already tight subacromial bursa, a water-filled pad designed to reduce friction between the tendons and bones in the area.

Once even the most minute amount of inflammation starts, both the bursa and the tendon become involved in a vicious cycle in which continued movement further inflames the soft tissue. Eventually, the space becomes so tight with swollen tissue that the tendon tears. If deterioration persists it will lead to a complete rupture of the rotator cuff, causing inability to smoothly move the shoulder joint and often making it impossible to raise the arm at all. An overhead throwing athlete, such as a pitcher, tendinitis of the rotator cuff may have different cause completely.

Impingement problems are usually progressive; they start out as small, intermittent, nagging pains, and eventually progress to a full-fledged rupture. Pain begins from deep inside the edge of the shoulder in the form of creaking, snapping, or inflammation. Once this pain has been felt stop the offending activity immediately. Rest the area until the inflammation subsides, stretching lightly and exercising the shoulder within a range of motion that feels comfortable is permitted. For example, when the suprapinatus is inflamed, pain is typically felt when the arm is raised to the side at an arc of 80 to 120 degrees. This means that mobility beneath the horizontal plane can be achieved and is vital to maintain as it will help retain flexibility in the inflamed tendons. If the tendon is only minimally strained, it will heal on its own within 6 weeks. After that time, gradually resume normal activities, adding stretching and strengthening exercises to condition and maintain the scapular and shoulder muscles and tendons. Anti-inflammatory medications, topical analgesics an cold therapy should be applied after exercise to speed the healing process by reducing inflammation.

Calcific tendinitis or bursitis is the result of an injury, overuse or age. Calcium deposits form in the supraspinatus tendon and or in the subacromial bursa. The intense pain experienced along the top and front of the shoulder is relieved only when the elbow is held close to the body. A cortisone injection or a local anesthetic may relieve acute pain. Anti-inflammatory drugs and topical pain gel may be effective too. Radial shockwave therapy is recommended for worst-case scenarios where surgery will be the only remaining option to remove the deposits.

A shoulder separation is a sprain of the ligaments connecting the acromion to the clavicle. The acromioclavicular joint is composed of small bones, so it takes only a moderate impact against the outer edge of the shoulder, such as being slammed against a wall or when falling on the shoulder, for a separation of the bones to occur. The extent of damage varies; a separation can be minor and involve just a slight stretching of the ligaments, in which case it will be painful to raise the arms for a few days. Or the injury can involve a complete rupture of the ligaments that hold the joint together, causing swelling and intense pain. The shoulder will be discolored and the separation may even be obvious to the eye. Treatment is dependent upon the severity of the injury. A minor separation may require only 2 days to recover on its own; icing and NSAIDs will help significantly, avoid overhead lifting during the healing phase. When completely healed, there may be a noticeable bump in the area of the injury because ligaments are stretched out, causing one side of the joint to be higher than the other, this a normal part of the healing process.

Shoulder subluxation and dislocation occurs when a sharp impact against the arm while it’s extended causes the head of the humerus to pop out of the shoulder socket, stretching or tearing the glenohumeral ligaments and joint capsule. If the bone pops right back in on its own, it’s known as a subluxation, or partial dislocation. Subluxation of the shoulder can also be caused by a gradual stretching of the ligaments and joint capsule in the front of the shoulder, such as with repetitive, extreme movements of the sort performed in baseball pitching. This type of injury can be treated successfully through a proper strengthening program that targets the scapular and rotator cuff muscles. Subluxations cause acute pain, but the pain will subside; however, it may return several hours later. Subluxations can heal on their own with rest, repeated applications of cold therapy and strengthening exercises. If the ligaments do not heal properly they will be susceptible to recurrent episodes.

Complete dislocations are obvious in terms of the degree of pain, spasms and the misalignment of bones. Since dislocations aren’t overuse injuries, it’s hard to take preventive measures, except to avoid falling on an outstretched arm, like in skiing and skating falls, which are common scenarios for these injuries. Dislocations demand immediate medical attention and should be iced until reaching emergency care.

One of the most common bicycle injuries, a clavicle fracture or broken collarbone, occurs when falling on the top of the shoulder or an outstretched arm. Intense pain at the site of the fracture will be felt instantly and there will be difficulty moving the arm. Ice and immobilize the injury on the way to the hospital. This injury will require a sling or figure-eight shoulder harness, which is a specially designed sling that will hold the bone in place until it begins to fuse. Healing takes up to 8 weeks.

Tightening and scarring of the joint capsule of the glenohumeral joint is called adhesive capsulitis or frozen shoulder. The capsule is pleated like an accordion, so that as the joint moves, folds separate and expand. The shoulder capsule is peculiar, however, in that after an injury or a period of immobility, the folds can adhere to each other, and the capsule thickens or shrinks, making movement painful and restricted. To counter the condition, the mobility of the shoulder may gradually be restored with the aid of physical therapy and frequent, light stretching exercises. Anti-inflammatory medication, topical pain gel, ultrasound and in some cases, a corticosteroids can speed healing and reduce pain. In severe or persistent cases arthroscopy or manipulation loosens the adhesions.