Shoulder pain is all too common. A few of you have shoulder pain following a fall. Many more suffer from shoulder pain due to repetitive stress, and the majority of simply woke up with shoulder pain and have no idea how you injured yourself.
Many of you can’t sleep at night, yet others only have pain when they exercise. A few of you might be worried that your shoulder will dislocate at night.
There are many structures in the shoulder which can become injured and lead to shoulder pain. The 5 most common causes of shoulder pain we see include:
- Labral Tears
- Rotator Cuff Tendinosis
- Rotator Cuff Tears
- Calcific Tendonitis
- AC Joint (Separations and Arthritis)
- Stress Fractures
The cause of your shoulder pain has a lot to do with what age group you are in. Different problems arise in the shoulder and cause pain as we age. In each grouping I provide links which go into more detail on the specific diagnosis which is mentioned.
Causes of Shoulder Pain
- In the pediatric population most of you have shoulder pain due to a traumatic event, a fall, a tackle or a tumble off your new hoverboard. Shoulder dislocations are one of the leading causes of shoulder pain in this age group.
- Labral tears are a very common source of shoulder pain in the pediatric athlete. The labrum is a cartilage disk that helps maintain stability of the shoulder. Pitchers and overhead athletes can develop a labral tear from repetitive stress. Football, soccer and other contact sports can produce a dislocation which leads to a different type of labral tear.
- Stress fractures arise in this age group because their bones might still be growing. The “growth plate” will start to fail with the chronic repetitive stress of pitching in excess.
- Labral tears are still very high on the list of possible causes of shoulder pain, particularly if you are under 30.
- The AC Joint: Especially in the heavy weight lifter and football players the AC Joint — or that little bump above your shoulder can start to wear out from the constant weight training. Following a severe fall you might also suffer an AC Separation where the bump on top of the shoulder becomes much more prominent.
- Rotator Cuff Tendonitis: This is the first group where the rotator cuff can start to become a cause of shoulder pain. In these instances, you were likely working out heavily and now the front or side of your shoulder is very sore with minimal activity. It is very easy to exceed what the rotator cuff is capable of handling. If you exercise the larger muscles around the shoulder and do not pay attention to exercising the rotator cuff the the cuff might simply remind you by causing a deep dull ache on the side of the shoulder for a few weeks.
- The rotator cuff starts to become the number one source of shoulder pain. The most common cause of rotator cuff related pain is a process we call rotator cuff tendinosis. That is a process where your rotator cuff is starting to show its age and it is starting to wear out. Early in the process of wearing out, the rotator cuff doesn’t actually start tearing … it simply starts hurting.
- If the rotator cuff wears out enough then it may develop into something we call a partial thickness rotator cuff tear. Partial tears are very common… even in people without shoulder pain. Again, this is part of the aging process. Some of your tendons will start to degenerate at a younger age than others … and some of you will have more pain than someone else with a partial rotator cuff tear.
- Full thickness rotator cuff tears can occur following a significant injury. Unfortunately the majority of you have a full tear simply because your tendon wore out. This post goes into detail on the causes of rotator cuff tears . Many rotator cuff tears are small. You can have very severe shoulder pain and have no tear or just a small tear. This is one of those moments when size doesn’t matter. The amount of pain that you have will not correlate with the size of your rotator cuff tear. The treatments of rotator cuff tears vary depending on many factors.
- Calcific tendonitis causes very severe shoulder pain. In calcific tendonitis you develop a calcium deposit in the middle of your rotator cuff tendon. When your body is trying to reabsorb or take back the calcium it sets off a series of events which leads to severe pain. The treatment is usually straight forward and doesn’t involves surgery. This post goes into more detail about calcific tendonitis.
- The rotator cuff remains the most common cause of pain.
- Labral tears are rarely a cause of shoulder pain after 50. We all have them… but they are not the reason why our shoulder hurts. The labrum frays and wears out like your favorite pair of blue jeans. Labral tears are a very uncommon cause of shoulder pain after the age of 50.
- Osteoarthritis: After 50 and beyond the cartilage which covers the bones can start to wear thin and degenerate. This is the definition of osteoarthritis. Your symptoms start with a dull ache after activities and sometimes the shoulder starts to click and catch when the osteoarthritis is more severe.
As you can see there are many many reasons why we can have shoulder pain. By far the number one culprit is the rotator cuff. If you are young … don’t ignore your rotator cuff when working out. If you are a pitcher, do not ignore your pitch counts. All the rest of you :-) — if your shoulder has been bothering you for weeks on end, see your sports medicine doctor for a solid diagnosis and treatment plan. Most of you will improve with physical therapy. Some of you may require surgery. Follow the links I provided for a far more in depth discussion about the conditions mentioned.
Disclaimer: this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.