Shoulder Pain 101: Bursitis, Impingement Syndrome and Rotator Cuff Tears

Devi E. Nampiaparampil, MD ("Doctor Devi”) gives the basics on shoulder injuries and common treatment options.

Posted on | By Devi E. Nampiaparampil, MD

Shoulder pain is so common that even Dr. Oz can't escape it! Our shoulders are prone to overuse injuries because we use our shoulders to move our arms, and we use our arms for so many tasks.

What does the shoulder look like?
A long rod-shaped bone called the humerus forms the upper arm. An umbrella-shaped structure called the acromion hovers over the humerus without touching it. The acromion is the bone that you feel when you press directly on top of your shoulder. It connects to your collarbone in front and it extends into the shoulder blade in back.

Because the humerus and the acromion don't touch, several muscles and ligaments help stabilize these two bones in place. Without these supporting structures, gravity would pull the arm bone (the humerus) right out of its socket.

When you move your arm, four different muscles keep your arm from spiraling out. These muscles form the "rotator cuff." One of these muscles, the supraspinatus, helps to stabilize the shoulder during overhead activities. Whether you are reaching for a glass in an overhead cabinet or throwing a ball to your child, you need the supraspinatus muscle to help lift your arm up.

The shoulder has its own insulation. A fluid-filled cushion, called a bursa, pads the space between the arm bone, the supraspinatus, and the acromion above.

What causes shoulder pain?
As we get older, these structures can break down. The acromion may become rough and coarse. When you lift your arm, you bring the humerus closer to the acromion. The jagged acromion can saw away at the bursa caught in between. If the pain starts when you lift your arm, and improves when you bring your arm down, it might be because the acromion is irritating the bursa and the supraspinatus muscle. This is called impingement syndrome. When the bursa gets inflamed, it's called bursitis.

If there's not much space between the acromion and the arm bone, the acromion can actually cut into the supraspinatus muscle or tendon and tear it apart. If it's partially torn, you might feel pain and weakness, but you can still do overhead activities. If it's completely torn, you might not have the strength to lift your arm overhead. The supraspinatus has been severed and can no longer lift the arm bone. Because the supraspinatus is part of the rotator cuff, both types of tears are known as "rotator cuff tears."


What are my treatment options?
If you have pain when you lift your arms, avoid overhead activities for a short period of time. "It used to be terrible at night when I slept on my arm," says Kunjumol Dilip, President of the Occidental Construction Company. "Massage helped a lot. Before that, I couldn't even move my arm."

If the pain lasts longer than four weeks, is severe or progressively worsens, talk to your doctor and consider physical therapy. When we don't use the muscles in our arms, they become weaker. It's important to have an exercise regimen that strengthens the muscles supporting the shoulder.

Your goal is to reduce the pain and inflammation. Anti-inflammatory patches can be helpful. There are FDA-approved over-the-counter patches that work locally. You can avoid certain side effects, like an upset stomach, that you might get with a pill. "The medication in the patch goes directly to the area that hurts,” says Sorena Harmanson, a busy New Yorker who deals with chronic neck and shoulder pain. Because of her job and lifestyle, she can't afford to be sleepy during the day. "Patches are the best option if you don't want to – or are not able to – take pain pills."

Because we use our arms so much, it can be tough to keep the patches on. You can use surgical tape as an additional adhesive. There are a few over-the-counter patches that you can cut into smaller strips. Smaller pieces are easier to stick on a curved surface, but you must check the patch's instructions first. Cutting certain patches can be unsafe as it may cause them to release more medication more quickly.

Sometimes it's better to take an anti-inflammatory pill. The medication gets digested in your gut and goes into your bloodstream. It decreases inflammation throughout the body. This makes sense when you have pain in multiple areas. You don't want to put patches all over your body.

In physical therapy, there are devices that help push anti-inflammatory medications through the skin and into that space between the arm bone and the acromion that covers it. There are battery-powered patches, like what Dr. Oz uses. Sound (ultrasonic) waves can also help drive medication into the body.

If the pain progresses, you might consider injections. Steroids injected around the bursa and supraspinatus, can decrease inflammation. When there is a full thickness tear, surgery is a treatment option.

Remember that pain can come directly from the shoulder or it can be referred to the shoulder. Pinched nerves in the neck can cause pain to shoot into the arm. Heart and lung disease can refer pain to the chest and shoulder. In some cases, gallbladder disease can result in shoulder pain because of irritation around one of the nerves that travels from the belly to the shoulder. It's important to get checked out to make sure your shoulder pain is not a sign of something more dangerous.

Read more from Doctor Devi at DoctorDevi.com.

Article written by Devi E. Nampiaparampil, MD
Assistant Professor Rehabilitation Medicine, NYU School of Medicine - www.doctordevi.com