July 19, 2019
Clinical Contributors to this Story
Joshua M. Zimmerman, M.D. contributes to topics such as Orthopedics.
Your shoulder is killing you, but you can’t think of anything you did to make it hurt.
…I didn’t fall.
…I didn’t get into a fight.
…I didn’t go all out at the gym.
Well, there are several conditions that cause discomfort but aren’t caused by a traumatic activity. How can you identify what’s wrong and how to make your shoulder feel better?
Joshua Zimmerman, M.D., an orthopedic surgeon with Hackensack Meridian Health Medical Group, helps by sharing six of the most common causes of shoulder pain without injury that he sees in his patients regularly.
- Rotator cuff tendonitis and bursitis: Rotator cuff tendonitis happens when the tendons in the rotator cuff (the group of muscles and tendons that surround the shoulder joint) become irritated or damaged. While it is often assumed that a certain pattern of activity caused the problem, more accurately, age-related degenerative changes within the tendon predispose the tendon to become damaged with normal daily activities. Similarly, rotator cuff bursitis occurs when the bursa, or lining that provides a cushion between the bones and the tendons becomes swollen or irritated. This process usually occurs as a response to the underlying degenerative process within the tendon. The two are usually closely related and can happen at the same time.
“While tendonitis can be related to an injury, it more often is related to the underlying condition of the tendon,” explains Dr. Zimmerman. “Some repetitive activities that can exacerbate rotator cuff tendonitis are tennis, golf, or housework, like painting or carpentry. When the discomfort is in the upper part of the arm (in the deltoid area) it is usually a sign that the tendon has weakened over time, causing pain and inflammation.”
“Bursitis is definitely a problem, too, but it’s over diagnosed to some extent,” Dr. Zimmerman adds. “Bursitis can happen the same way tendonitis occurs. Less commonly it can also be a sign of infection or other medical conditions, like rheumatoid arthritis.”
Usually rest, ice and anti-inflammatories can help treat these rotator cuff issues.
- Rotator cuff tears: The same overuse that leads to tendonitis can lead to rotator cuff tears. Eventually the chronic inflammation and degeneration can cause the tendon to wear down and tear.
“The pain of a tear is more of an aching or throbbing discomfort that can interrupt sleep,” Dr. Zimmerman notes.
Physical therapy, anti-inflammatories and/or steroid injections can help treat rotator cuff tears. If symptoms are severe, surgery may be an option.
- Arthritis: Patients can experience intense shoulder pain as a result of arthritis as well, Dr. Zimmerman said. Many people have never had a documented injury or trauma to their shoulder area. It’s important to look at the patient’s history to determine if there were any injuries—or injuries that may have gone undiagnosed. Otherwise, a fair amount of people can experience shoulder pain due to arthritis without any prior injury.
“Surgery can be a fix,” mentions Dr. Zimmerman. “But doctors would explore non-surgical options before considering it.”
- Frozen shoulder: This condition is one of the most popular culprits that brings patients with shoulder pain to Dr. Zimmerman’s office. In fact, he sees many patients per day with this condition. Also known as adhesive capsulitis, frozen shoulder happens when there’s inflammation in the lining of the capsule of the ball socket joint. The shoulder capsule thickens and tightens, which creates the discomfort. There is no known cause of frozen shoulder, which presents as progressive pain with motion and stiffness.
Though some experts contend that frozen shoulder is far more common in women, Dr. Zimmerman finds it equally among both genders in his office.
Treating frozen shoulder usually involves performing exercises to expand range of motion. Sometimes, doctors use numbing medications and corticosteroids. A small percentage of patients may benefit from surgery to loosen the joint capsule, allowing it to better move.
It’s unusual for frozen shoulder to happen again in the same shoulder where it first occurred, but people can develop this condition again in the opposite shoulder.
- Calcific tendonitis: Like frozen shoulder, there’s no identifiable cause for calcific tendonitis, but it can be quite painful. Dr. Zimmerman describes calcific tendonitis as a condition where calcium deposits (up to 1 to 2 centimeters in diameter) build up in the muscles or tendons. They can be seen on an X-ray and are typically more common in people who are over the age of 30 but can occur at any age.
Calcific tendonitis can usually be treated by anti-inflammatories or injections. Many cases resolve over time without treatment. In rare cases, surgery is required.
- Spinal issues: “Your shoulder may hurt, but it may not be the result of a shoulder problem in the first place,” Dr. Zimmerman explains.Sometimes it’s hard to determine where pain originates, but cervical spine and disc issues can be the root cause of shoulder pain. Dr. Zimmerman sees this a lot in people who have pain in their shoulder blades. In that case, they may have a spinal issue instead, and a referral will be made to the proper specialist.
As a general rule of thumb, Dr. Zimmerman advises patients who are in pain with no known injury to take a wait-and-see approach in terms of when to seek medical attention.
“If shoulder pain gets to the point when it starts to interrupt your sleep, it’s good to get it checked out,” he adds. “If it gets to the point when you can’t sleep, it may be a significant problem that can benefit from treatment.”
Joshua M. Zimmerman, M.D., practices in Old Bridge and Edison. To make an appointment in Old Bridge, call 732-360-2400. To make an appointment in Edison, call 908-757-1520. Visit HMHMedicalGroup.org to find a practice near you.
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.
American Academy of Orthopedic Surgeons
Journal of Orthopedics & Traumatology