Like your body’s other mobile joints – hips, knees, ankles, etc. – your shoulders are critical to multiple everyday movements. Almost any action you perform with your arms is done thanks, in part, to your shoulders. That’s why understanding common causes of shoulder pain and how to treat them is vital. The sooner you treat a shoulder injury or illness, the sooner you can return to living as you’re used to.

“The vast majority of adults who present to us in-clinic with an atraumatic shoulder pain fall into three overarching categories: arthritis, shoulder stiffness and rotator cuff disease,” according to orthopaedic surgeon Edward Fehringer, MD. “These three categories constitute approximately 90% of the shoulder pain-related issues we see, especially among those 40 years or older.”

Shoulder arthritis

“Arthritis in the shoulder typically affects the ball and socket or the end of your collarbone,” says Dr. Fehringer. “Shoulder arthritis can come from an old injury, prior dislocation or surgery, osteoarthritis, inflammatory arthritis, or crystalline arthritis like gout or pseudo gout.

Usually, shoulder arthritis – like arthritis in other areas – builds over many years; it’s a slow but progressive disease. So, common symptoms include a progressive ache in your shoulder, some catching and popping (as the cartilage surfaces in your shoulder become less smooth), loss of motion and loss of strength.”

Shoulder stiffness

“If you’re experiencing shoulder stiffness, haven’t had prior surgery, and your flexibility is limited in one or more planes; you likely have shoulder stiffness for some reason,” says Dr. Fehringer.

“One of the most common forms of shoulder stiffness is idiopathic frozen shoulder, which is more likely to affect women than men and those with diabetes or hypothyroidism. Those with frozen shoulder will experience pain and stiffness that will incrementally increase before eventually decreasing.

Prior surgery on your shoulder can also result in shoulder stiffness. Such post-traumatic or post-surgical stiffness can result in restricted flexibility to your soft tissues or scarring contributing to stiffness.”

Rotator cuff disease

Rotator cuff disease can include a multitude of causes, including:

• Tendonitis
• Calcific tendonitis
• Tendinosis
• Tendinopathy
• Partial-thickness rotator cuff tear
• Full-thickness tear
• Retracted tear

“Each of these causes generally presents first with an aching pain that slowly but progressively increases,” says Dr. Fehringer. “Rotator cuff diseases are common because as we age, so do our rotator cuffs, which become more susceptible to small tears and other variables contributing to rotator cuff disease.

Rotator cuff diseases are so common as people age that around the age of 60, most people have a partial-thickness rotator cuff tear. By 65, about 25% of people have a full-thickness tear. Similarly, most of the time, these injuries aren’t from activity-related use but are an aging phenomenon. Almost 80% of patients who develop a full-thickness rotator cuff tear do so without injury.”

Factors that have a more substantial negative impact on the health of your rotator cuff than participating in a sport include:

• Smoking
• Drinking
• Poor nutrition
• Steroids
• Diseases
• Certain types of medications

Diagnosing your shoulder pain

“If you haven’t had prior X-rays or an MRI before seeing me, I will start your appointment with plain X-rays,” says Dr. Fehringer. “Then, I would see you for a physical examination, listen to you describe your issues, ask lots of questions, and review your X-rays or previous studies to develop a working diagnosis.

“From this diagnosis, I would then prescribe the best course of action. Your specific treatment plan will depend on your diagnosis. Fortunately, when someone sees me electively for shoulder pain, we can treat most of these issues nonsurgically.”

Treating your shoulder pain

“Maintaining flexibility is very important for treating shoulder arthritis,” says Dr. Fehringer. “Keeping your shoulder’s flexibility for as long as possible while arthritis progresses helps preserve usability and manage pain. Likewise, you can control pain from arthritis with nonsteroidal anti-inflammatories (NSAIDs) or cortisone injections.”

Aside from physical therapy and stretching to maintain flexibility, the only other predictable treatment for shoulder arthritis is shoulder replacement surgery. Still, shoulder replacement surgery works best when it’s the first operation on that shoulder and when your arthritis has progressed to bone-on-bone arthritis.

“As previously mentioned, most of the shoulder stiffness I see is idiopathic, meaning we’re not quite sure what causes the stiffness. Thankfully, we can treat most idiopathic shoulder stiffness through physical therapy, stretching, and pain management through NSAIDs or cortisone injections,” says Dr. Fehringer.

“In rare cases, we can do shoulder manipulation. This procedure entails putting you to sleep for a short time and then stretching the affected shoulder, but there are risks for manipulation like a fracture, rotator cuff tear or dislocation.”

Treating rotator cuff disease will differ slightly based on what’s affecting your rotator cuff. By and large, tendonitis doesn’t need surgery to improve. Similarly, tendinosis and tendinopathy are a function of many variables, but the tendons aren’t torn. Altering your bony anatomy around those tendons won’t change the tendons or the variables that caused their diseased state.

“Likewise, most partial-thickness tears will heal themselves and usually won’t require surgery. On the other hand, full-thickness tears won’t heal back to the bone on their own and without surgical intervention,” Dr. Fehringer says. “However, most full-thickness tears never undergo surgical intervention because they don’t always cause many symptoms, which isn’t perfectly understood.”