Growing older comes with lots of aches and pain you didn't have in your youth. One of the most common types of pain experienced by many people is shoulder pain. Pain between your shoulder blades or at the top of your arm can make it hard to do even the simplest things, like getting dressed or carrying groceries. But most shoulder pain is treatable ¬– and much of the time, the treatment doesn't require surgery. The orthopedic specialists at Union Health can diagnose and treat the source of your shoulder pain and help get you back to your favorite activities.

Shoulder pain can be caused by overuse, injuries like a fall, or simply from the wear and tear of getting older. The most common causes of shoulder pain include:

• Arthritis. Aging, overuse, past injuries and other conditions can cause arthritis to develop in the shoulder, making it stiff and less flexible.
• Calcific tendinitis. Some people develop calcium deposits in their rotator cuff as they age, which causes shoulder pain. People with diabetes are more likely to develop this condition.
• Dislocation (also called instability). This happens when the top of your arm bone pops out of the joint socket, which can damage the surrounding tendons and ligaments. 
• Fracture. Falls, sports injuries and car accidents can all lead to broken bones in the shoulder. Overuse injuries can lead to smaller stress fractures.
• Frozen shoulder (adhesive capsulitis). This happens when the tissues around your shoulder stiffen and thicken, often after an injury, and you cannot move your shoulder at all without pain.
• Rotator cuff tear. Tears in the rotator cuff (or nearby biceps) can happen from a sudden injury or from tissues deteriorating as you age. Severe tears detach the tendon from the bone and may need immediate surgery. Smaller tears can turn into larger tears without proper treatment.
• Rotator cuff tendinitis or bursitis (shoulder impingement). This happens when your shoulder blade rubs the tendons or bursa (a fluid-filled sac) and causes irritation.

While the main sign that something is wrong with your shoulder is a pain when you use your arm, not all symptoms of a shoulder condition are painful. Different types of symptoms can indicate different problems, so it's important to tell your provider about everything you are experiencing, such as:

• Arm weakness
• Inability to lift your arm over your head or reach behind your back
• Loss of flexibility in your shoulder or arm
• Numbness or tingling in your shoulder or arm
• Pain when lifting or using your arm
• Popping or crackling sounds when you move your shoulder
• Sharp pain in your shoulder or arm
• Stiffness in your shoulder, neck or upper arm

If your shoulder pain started after an acute injury like a fall, you should not postpone seeking care. The Union Health Orthopedic Walk-in Clinic sees patients without a scheduled appointment.

Diagnosing the cause of your shoulder pain will involve a physical examination. Your provider will look at your shoulder and measure your range of motion. In addition to medical history, blood work could be needed to rule out things like infections.

Most diagnoses of shoulder problems are confirmed with imaging. X-rays are often the first line of imaging, as they can detect most fractures and arthritis. For a better look at your shoulder, your provider may turn to advanced diagnostic imaging. These procedures include:

• Arthrogram, which is when a dye is injected so your joints show up better on an X-ray
• Arthroscopy is when your provider inserts a small camera under your skin to see problems in your joint and tissue that other imaging may miss
• Computed tomography (CT) scan, uses radiation (and usually a contrast dye) to create a picture of your shoulder
• Magnetic resonance imaging (MRI), which uses magnetic waves to see damage in your soft tissues
• Ultrasound, which uses sound waves to examine your soft tissues

Additionally, your provider may order studies that show how well your nerves are functioning, like an electromyogram (EMG).

While some pain will go away on its own, treatment is often needed to get your shoulder joint back in order. Many conditions or injuries can be treated without surgery, especially if you receive medical care early on, instead of waiting until your shoulder pain is severely limiting your activities. Nonsurgical treatment for shoulder pain may include:

• Lifestyle changes, like pausing certain activities to allow your injury to heal
• Medication, including anti-inflammatory medications or steroid injections
• Physical therapy, to help strengthen your muscles surrounding the injury
• Putting ice or heat on the affected area
• Simple stretches that keep your shoulder from tightening up

Some types of shoulder injuries require surgery to alleviate pain. Other conditions may need surgery if all other treatment options fail to produce an improvement in pain or range of motion. Most shoulder surgeries are outpatient procedures.

Types of shoulder surgery include:

• Arthroscopy is a minimally invasive option that removes and repairs damaged tissue, including rotator cuff tears
• Mini-open surgery, which uses a small incision to repair torn rotator cuffs
• Open surgery, which uses a wide incision to repair major tears or fractures
• Shoulder replacement surgery, which replaces part or all of your shoulder joint with a prosthesis

Recovering from shoulder surgery can take months and usually requires physical therapy multiple times a week. Older people with weak muscle strength may not be good candidates for some surgeries.