Why Does Your Shoulder Hurt?

By Jennifer Gordon, MSPT, CLT

Physical Therapy and Sports Medicine Center

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Why Does Your Shoulder Hurt?

Shoulder pain may be complicated by your activity or exercises regimen. One of the most common causes of shoulder pain is rotator cuff tendonitis, or impingement syndrome. The rotator cuff, often misnamed rotary cuff or rotator cup, is made up of the subscapularis, the suraspinatus, the infraspinatus and the teres minor muscles connecting the scapula to the humerus.

Shoulder tendonitis occurs when the tendons of the rotator cuff become pinched under the acromion of scapula resulting in inflammation and pain, localized to the front and side of shoulder and upper arm. This pain is commonly reproduced by raising the arm or lowering the arm from overhead, particularly in a painful arc (60-120 of shoulder abduction).

Overhead throwing athletes and workers in building trades are especially prone to rotator cuff tendonitis due to irritation of the soft tissue that occurs with repetitive motions. Motions such as throwing, painting, carpentry, hair care, donning a jacket or belt, pushing/pulling or carrying, or computer work can lead to overuse of the rotator cuff and subsequent tendonitis.

Older patients are also prone to this condition due to arthritic changes causing narrowing of the joint space. Patients who have suffered a stroke also suffer frequently from instability of the shoulder resultant and rotator cuff pathology. If left untreated, rotator cuff tendonitis can become chronic and lead to worsening conditions such as shoulder degeneration, adhesive capsulitis, or rotator cuff tear, requiring more invasive treatment interventions (such as injections or surgery).

Generally, treatment for rotator cuff tendonitis includes conservative physical therapy intervention. A physical therapist will evaluate your unique condition, pinpoint the underlying etiology of your symptoms and rule out other causes of shoulder pain to develop an individualized treatment plan.

Physical therapy may include modalities (such as ice, ultrasound, or iontophoresis) to decrease pain, however a comprehensive treatment program includes appropriate stretching with strengthening exercises, including proprioceptive neuromuscular facilitation (PNF) exercise, rotator cuff strengthening, joint mobilization and functional activities.

A 2007 study showed that patients treated with manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial showed improvement of symptoms including increasing strength and decreasing pain and improving function earlier than with an exercise program alone.

A licensed physical therapist can also provide education in proper posture, avoidance of provocative activities, and functional recovery for long-term management.