You might take healthy shoulders for granted, at least until you sustain an injury or develop shoulder pain. One of the most common causes of achy shoulders in people over 50 is osteoarthritis, a degenerative form of arthritis and a frequent cause of shoulder pain.
With arthritis of the shoulder, your shoulder might feel uncomfortable when you reach behind your arm behind your back and you might feel stiff or achy. However, on a good day, you still have a decent range-of-motion. But what if the pain and stiffness are severe enough that you can’t lift your arm above your shoulder? More often than not, this isn’t simple osteoarthritis of the shoulder since it rarely causes this degree of movement restriction. But what could it be? First, let’s look at the anatomy of the shoulder and why it’s so prone to injury.
Shoulder Anatomy and Causes of Shoulder Pain
Your shoulder is a complex entity. It’s comprised of a complex of three joints: the clavicle, also known as the collarbone, the scapula or shoulder blade, and the humerus, the big bone in your upper arm. Lying over and protecting these bones is a group of muscles called the rotator cuff muscles. Between the rotator cuff and the bones in the shoulder are bursa, sacs of fluid that cushion the bones and reduce friction when you move your arms and shoulder. Your shoulders need lots of safeguards as they are the most mobile joint in your body. Your hips are a close second. Therefore, it’s not surprising that shoulders and hips prone to injury.
Several things can cause pain in the shoulder when you raise your arm. One is inflammation in the bursa, the fluid-filled sacs that lie between the muscle and the bone, a condition called bursitis. People who have diabetes, thyroid disease, or arthritis are at greater risk of developing bursitis. The tendons that connect the muscles in the shoulder to the bones can also become irritated or inflamed, from degeneration or overuse. In turn, inflammation in the tendons or bursa increases the risk of a condition called impingement syndrome. Impingement causes pain when you raise your arm above your shoulder or reach an arm behind your back.
What is impingement syndrome anyway? Between the humerus in your upper arm and your shoulder blade lie tendons and bursa. If either is inflamed, they expand and take up more space within an already narrow area. When you raise your arm, the space tightens further and presses on the inflamed and irritated tendons or bursa, causing pain. The pain of impingement syndrome is most common in the shoulder and upper arm and gets worse when you lift your arms overhead and when you lie in bed at night. Reaching up to retrieve something off a high shelf worsens the pain too.
When You Have Difficulty Raising Your Arm Above Shoulder Level
If you only have pain when you raise your arm to shoulder height or above, you may have inflammation of the bursa or tendons causing an impingement syndrome, but if you can’t raise your arms above your shoulder because of weakness, you more likely have a rotator cuff tear. The combination of shoulder and upper arm pain combined with weakness and the inability to raise the arm above shoulder level strongly suggests a rotator cuff injury or tear of a rotator cuff muscle.
How can this injury happen? You can develop a rotator cuff from an injury such as a fall, but you can also partially tear a rotator cuff without experiencing an injury. As we age, degenerative changes develop in the tendons that increase the risk of damage even with slight trauma. So, it’s not surprising that tears become more common as people age. Partial rotator cuff tears can sometimes heal on their own with physical therapy while larger tears may require surgery.
A rotator cuff tear also increases the risk of developing a frozen shoulder, known medically as adhesive capsulitis. With this condition, it becomes difficult to move the arm and shoulder at all. People who have diabetes or thyroid problems are at higher risk of developing a frozen shoulder. If you develop adhesive capsulitis, it can take months or even years to resolve. However, physical therapy can help. In fact, physical therapy is essential to restore range-of-motion when you have a frozen shoulder.
The Bottom Line
Because of the complicated nature of the shoulder joint, the risk of developing shoulder pain is high and goes up with age. You can lower your risk by keeping your strength training balanced. This means working the muscles in the back of your upper body as much as the front. If you experience pain when you do high-risk exercises, like overhead presses, don’t do them. Choose an exercise that works your upper body without causing pain. Also, lighten up on the weight when you do riskier exercises like overhead presses. Form is more important than how much weight you can lift.
Too often, people do exercises that work the visible muscle, the deltoids. However, it’s the rotator cuff muscles that need strengthening to keep your shoulders healthy. Weak rotator cuff muscles increase the risk of a shoulder injury. Include exercises that strengthen your rotator cuff. Work on core stability too. If your core muscles are strong, it provides a strong foundation for your shoulders when you do overhead exercises that tax your shoulders. If your core isn’t strong, the stabilization job that the core usually does will be passed to your shoulders.
It’s also important not to lift through the pain. If you have shoulder stiffness or feel twinges of pain when you work your shoulders, stop doing shoulder exercises until you can get a shoulder evaluation. Listen to your body! Your shoulders are too valuable to risk injuring them and then spending months trying to rehab an injury that shouldn’t have happened. Take care of them!
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