The shoulder can be thought of as a “ball and socket” joint, although we know that it is quite complicated. There are four muscles in the shoulder that we don’t necessarily consider when we go to the gym, but that are extremely important in stablization of the shoulder. The tendons of these muscles form the “rotator cuff,” which keeps the ball in the socket and controls shoulder rotation.
The tendons degenerate as we age, and can be frayed or worn by the bones of the shoulder, which is called “impingement syndrome.” A frank “rotator cuff tear” can cause pain, limited motion, weakness, or a feeling of instability. Sometimes, degeneration of the rotator cuff leads to severe arthritis.
All of us have rotator cuff abnormalities as we age, but most problems are not symptomatic. Overhead activities often make symptoms worse.
Your doctor can talk to and examine you to determine the cause of your shoulder pain. X-rays are done to look for bony problems. An MRI might be ordered to look at the tendons and other soft tissues, however, 60% of 60 year olds with no symptoms will have a rotator cuff tear on MRI!
Physical therapy, including activity modification, can be very helpful. Anti-inflammatories or in severe cases, steroid injections, can relieve symptoms to allow you to do therapy. If non-operative treatment fails or if there is a big rotator cuff tear, particularly following trauma, surgery might be considered. This can range from a debridement (or “clean up”) to a repair, or even a replacement if you have significant arthritis.
For more information about shoulder pain, click here.