The shoulder is the most mobile joint in the human body, and one we usually take for granted. Closing a car door, giving a hug, changing a light bulb or scratching our back seem to require little effort – until we experience shoulder pain. This pain can slow us down and make getting through the day excruciating.

The shoulder is made up of three bones: the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The head of the upper arm bone fits into a rounded socket in the shoulder blade. Muscles and tendons, called the rotator cuff, keep the arm bone centered in the shoulder socket.

Tendon inflammation or tear, fracture of a bone, arthritis or instability are the most common types of shoulder problems.

Texas Health Resources has a multidisciplinary team of experts including physicians on the medical staff who can quickly and effectively diagnose the source of shoulder pain and provide you with a range of treatment options. Texas Health Resources has shoulder specialists on the medical staff who can perform advanced surgeries, as well as make recommendations about other treatments. Many Texas Health hospitals offer rehabilitation services with advanced equipment and experienced therapists.

Plus, you can try these tips for keeping your shoulders healthy and pain free.

Keep your shoulders healthy and pain free

Try the following tips for keeping shoulder pain and injuries at bay:
• If you have had shoulder pain in the past, use ice and ibuprofen after exercising
• Learn proper exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. A doctor or physical therapist can help.
• If you are recovering from tendinitis, continue to perform range-of-motion exercises to avoid "frozen shoulder."
• In sports-related activities, learn proper techniques to prevent painful and expensive shoulder problems.

Diagnosing the source of shoulder pain

Tendon inflammation or tear, fracture of a bone, arthritis or instability can all be the source of shoulder pain. Your physician will diagnose your shoulder pain based on the findings of a medical history, physical exam and diagnostic tests. An early and correct diagnosis of shoulder pain is especially important because in some instances, delaying a surgical repair can increase the likelihood that the problem will be more difficult to treat later.

For your medical history, the physician may ask questions such as:
• When did your shoulder first begin to hurt?
• Do you feel the pain continuously or off and on?
• Is the pain in your entire shoulder or one specific location?
• What activities seem to aggravate the shoulder pain?

During the physical exam the physician will manipulate your shoulder to determine how well it moves and where the pain is located.

Depending on the findings of the medical history and physical exam, your physician may use one or more of the following tests to determine the source of your shoulder pain:
• X-ray
• Computed tomography (CT) scan
• Electrical studies
• Magnetic resonance imaging (MRI)
• Arthroscopy

Texas Health hospitals have some of the most advanced equipment available, such as 64-slice CT scanners, for diagnosing shoulder problems.

Common diagnoses for shoulder pain include:
• Bursitis – inflammation of tissues in the shoulder
• Tendinitis – a wearing down of tendons in the shoulder, can be caused by overuse or arthritis
• Tendon tears
• Instability – dislocation
• Arthritis
• Fracture

Depending on the cause of the shoulder pain, treatment can range from rest and anti-inflammatories to surgery. You may be told to modify your exercise routine or be prescribed nonsteroidal anti-inflammatory drugs (NSAIDS). If these treatment options are ineffective, your physician may inject a steroid to reduce pain and inflammation, or refer you to a physical therapist.

One of the following surgeries might be recommended:
• Rotator cuff repair: Surgery that deals with tears in the muscles or tendons of the rotator cuff. This surgery is usually indicated when shoulder pain does not respond to non-surgical treatments such as medication and rehabilitation exercise.
• Shoulder joint replacement: A surgical procedure that replaces a shoulder joint with a prosthetic implant of metal and plastic; this operation is usually necessitated when injury or degenerative disease has caused loss of mobility in the joint and made it a source of chronic pain that non-operative care does not treat successfully.

Surgical treatment of shoulder pain typically requires extensive rehabilitation to restore the function of the shoulder. A dedication to working at recovery is essential for the best results from shoulder surgery. Patients will receive written instructions concerning rehabilitation when they leave the hospital, and their physician may prescribe specific rehabilitation services.

Texas Health hospitals' rehabilitation services offer advanced equipment and experienced therapists. Patients may want to participate in an Aquatic Program offered at some of our Texas Health Hospitals. In this program, participants are led by certified aquatic fitness professionals through a series of specially designed exercises that, with the aid of the water's buoyancy and resistance, can help improve joint flexibility and muscular strength.

Q: If I am experiencing shoulder pain, what are some signs that would indicate that I should see a physician?

A: Some signs that you should see a physician include:
• Inability to carry objects or use the arm
• Injury that causes deformity of the joint
• Shoulder pain that occurs at night or while resting
• Shoulder pain that persists beyond a few days
• Inability to raise the arm
• Swelling or significant bruising around the joint or arm
• Signs of an infection, including fever, redness, warmth
• Any other unusual symptoms

Q: How likely is it that I will need surgery to relieve my shoulder pain?

A: Not very likely. Most patients can relieve their shoulder pain through simple treatments such as altering activities, rest and medication.

Q: What is bursitis?

A: Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone. Bursae are fluid-filled cavities near joints where tendons or muscles pass over bony projections. They assist movement and reduce friction between moving parts. Bursitis can be caused by chronic overuse, trauma, rheumatoid arthritis , gout , or infection. Sometimes the cause cannot be determined. Chronic inflammation can occur with repeated injuries or attacks of bursitis.

Q: What is tendinitis?

A: Tendinitis in the shoulder is an inflammation (irritation and swelling) of the tendons of the shoulder. Inflammation of the tendons of the shoulder muscles can occur in sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head. Chronic inflammation or injury can cause the tendons of the shoulder to tear.

Q: What causes a dislocated shoulder?

A: A dislocated shoulder is an injury in which your upper arm bone pops out of the cup-shaped socket that's part of your shoulder blade. Unfortunately, once you have experienced a dislocated shoulder your joint may become unstable and be prone to repeat dislocations.