Ask an expert: Shoulder pain

Q: “My shoulder has been hurting lately, and I don't know why. What could be the problem, and what can I do about it?”

Answered by Thayer White, M.D., sports medicine physician, Providence Medical Group-Sports Care

When shoulder pain shows up for no apparent reason, one of three causes is usually to blame:

  • Overuse and poor body mechanics: Examples of this include hunching over a computer every day with your shoulders rolled forward, or launching a weekend-warrior yard-work marathon when your body isn't used to it.
  • Degenerative wear and tear: Arthritis is the most common degenerative problem, occurring naturally over a lifetime as the cartilage protecting the shoulder joint wears down. Arthritis is most common in people older than 50, but can develop in younger people who have had a shoulder injury. 
  • An old injury flaring up: Old shoulder injuries can lie dormant for years without causing any problems, and then suddenly start acting up all over again. A typical example is the high school baseball pitcher who experienced some shoulder problems way back when, and now, 10 years later, the pain is back. 

There are certainly other possible causes, but these are the most common. None of these is an emergency, so as long as there's no obvious injury and the pain doesn't extend beyond your elbow, it's perfectly safe to try home treatment before you call a doctor.

Home care

Here are three home treatments that often help:


  • Rest: Take it easy and avoid any activities that aggravate your shoulder. Give it three to five good days of total rest.
  • Ice: Apply an ice pack (a bag of frozen vegetables works, too) to your shoulder for about 20 minutes, three or four times a day for a couple of days to relieve any swelling.
  • Anti-inflammatories: Ibuprofen (Advil or Motrin) and naproxen (Aleve) can relieve pain by reducing inflammation. Be sure to take them with food to avoid stomach irritation, and don't take more than the recommended dosage. If you have stomach problems, such as an ulcer, you should avoid these medications. 

When to see a doctor

If your pain gets better after a few days of home treatment, that may be all you need. If it's still bothering you after a week – especially if it's keeping you from your normal activities – or if it gets better and then comes right back, it's probably time to see a doctor.

A doctor can usually discover what's causing your pain by examining you and asking a few simple questions about your work, daily routines, past injuries and activities that make the shoulder hurt. 

Treatment

The vast majority of shoulder pain will improve with some fairly simple steps – often as simple as the three home-care steps mentioned earlier. Depending on your diagnosis, your doctor might also prescribe additional therapies, such as:

  • Gentle exercises to build the muscles that protect your shoulder joint
  • Physical therapy to help you stretch and regain the use of the joint, and to teach you proper body mechanics to protect the joint
  • Cortisone injections to relieve inflammation and help you return to activity sooner 

Very few causes of shoulder pain ever require surgery, but there are a few, such as large rotator cuff tears, that do. Surgery isn't generally helpful for the small rotator cuff tears that occur with normal use over time, but large tears caused by traumatic injuries can definitely benefit from surgical repair.

Prevention

Once you've got your pain under control, start practicing prevention to make sure it doesn't come back. Poor posture is one of the most common reasons why people end up in my exam room with shoulder complaints. If you spend a lot of time at a desk or computer station, pay attention to your posture. Sit with your neck straight rather than craned forward, and your shoulders back rather than slumped forward. Get up frequently to stretch, too, and move your arms around when you're on breaks. Here are three good stretches that you can do anywhere, any time you have a couple of minutes: 

  • Neck rolls: Roll your head around very slowly to stretch your neck.
  • Shoulder rolls: Slowly roll your shoulders forward and up to your ears, then backward and down. 
  • Chest stretches: Raise one arm to the side and rest your hand on a wall, then rotate your body away from that arm until you feel a mild stretch across your chest; repeat with the other arm. 

With a history of shoulder trouble, you also should avoid lifting anything heavy over your head. That's a common cause of injuries.

Most people don't pay much attention to their shoulders until they start to hurt. Now's the time to learn as much as you can about preventing shoulder problems and taking good care of your body. There is plenty you can do to prevent pain and keep your shoulder joints in good shape from here on out.


More information:

Shoulder problems and injuries

Throwing analysis