There are many causes of shoulder pain, however the most common are impingement syndrome and rotator cuff tears. The rotator cuff is the network of four muscles and several tendons that form a covering around the top of the upper arm bone, or humerus. The cuff holds the humerus in place in the shoulder joint and enables the arm to lift and rotate. Impingement syndrome typically occurs when the rotator cuff tendon gets pinched between a part of the shoulder joint called the acromion arch and the humerus head. Once it progresses, it results in tearing of the tendon. This may cause pain while lifting the arm and inability to sleep on that side at night.

A rotator cuff tear is a common cause of pain and disability among adults. The cuff can be torn from a single traumatic injury triggering onset of pain lasting for several months. A cuff tear may also happen at the same time as another injury to the shoulder, such as a fracture or dislocation. Even so, most tears are the result of overuse of these muscles and tendons over a period of years. People who are especially at risk for overuse are those who engage in repetitive overhead motions. These include participants in sports such as baseball, tennis, weightlifting, and rowing. Symptoms usually include:

1. Pain when lifting the arm

2. Pain when lowering the arm from a fully raised position

3. Weakness when lifting or rotating the arm

4. A crackling sensation upon certain shoulder positions

5. Inability or difficulty in removing and wearing clothing

6. Thinning of  the muscles about the shoulder

Cuff tear diagnosis is based on symptoms and physical examination. X-rays and MRI are also helpful. In many instances, nonsurgical treatments such as these can provide pain relief and improve function:

– Rest and limited overhead activity

– Use of a sling

– Medications

– Steroid injection

– Strengthening exercises

– Physical therapy

Surgery may be recommended if nonsurgical treatment does not relieve symptoms. It is also indicated if the tear has just occurred and is very painful, it is a full-thickness tear, or the tear is in the dominant shoulder of an active person. In the event maximum strength in the arm is needed for overhead work or sports, surgery can also be considered.

Many surgical repairs can be done on an outpatient basis. After surgery, the arm is immobilized to allow the tear to heal. An exercise program will help regain motion and strength in the shoulder. Of course, a strong commitment to rehabilitation is important to achieve a good outcome.

Apurva Dalal, M.D., is a board-certified orthopaedic surgeon specializing in arthroscopic surgeries of the knee and shoulder joints. He completed his residency in orthopaedic surgery at the Albert Einstein School of Medicine, Bronx-Lebanon Hospital, New York, and his fellowship training in total joint replacement surgery at the Center for Hip and Knee Surgery, Mooresville, Ind.