The shoulder is the most movable and the most fragile joint in the body. It is the body's only structure that can rotate in a full circle, allowing you to do everything from throwing a baseball to hugging your spouse. But the flexibility of the shoulder makes it prone to both sudden injury and chronic wear and tear.

Who gets shoulder problems?

Active younger people, especially athletes, are most prone to shoulder injuries such as dislocations.

After age 25 most problems are caused by the effect of repeated overhead motions for a long period of time. Weekend athletes and do-it-youselfers are particularly vulnerable to overuse problems in the shoulder.

The leading cause of shoulder pain are bursitis, tendonitis, and irritated rotator cuff. This group of conditions is called Shoulder Impingement Syndrome.

What is bursitis?

The bursa is a fluid-filled sac that cushions the rotator cuff tendons from the shoulder bone. An irritated bursa is caused by an inflamed rotator cuff. When irritated, the bursa produces extra fluid, the sac expands, and the pressure creates pain.

What is tendonitis?

Deep in the shoulder are a group of tendons and muscles called a rotator cuff. They help stabilize the upper arm bone in the shoulder joint and rotate the arm. The biceps tendon is also present in front of the shoulder.

When the arm is raised repeatedly over the head, the tendons rub against the underside of the shoulder bone and become irritated. The tendons swell leaving even less space between tendons and bone. It is much like a rope being drawn again and again across a craggy rock.

What is an irritated rotator cuff?

Excessive wear on the rotator cuff can lead to severe irritation, roughening and eventually ulceration and tearing of the cuff. An irritated rotator cuff is felt as a clicking or popping in the shoulder from a ragged piece of cuff sliding under the shoulder bone, causing arm weakness.

Occasionally, injuries or infections can also lead to arthritis, although arthritis of the shoulder is less common than in the knee or hip. Arthritis in the shoulder causes a roughening of the joint from worn cartilage and loose fragments of bone.

What are the symptoms?

Bursitis, tendonitis, irritated rotator cuff and arthritis are all inflammatory reactions to overuse. With any of these problems, a continuous dull ache in the shoulder can become a sharp pain when your try to move your arm, especially over your head. The pain may be worse at night after a heavy day of activities using your shoulder.

What do x-rays show?

X-rays provide a view of your bones and can show dislocations and arthritis. An arthrogram is a special x-ray taken after the shoulder joint is injected with a contrast medium. This can show a tear of the rotator cuff. Another test, called MRI, shows detailed views of tissues and provides non-invasive evidence of an irritated/torn rotator cuff.

What is the treatment for shoulder impingement?

A combination of the following will help relieve pain and inflammation:

• Rest: Avoid strenuous activity and motion that causes pain. In some cases a shoulder sling is helpful to rest fatigues muscles and inflamed tendons.
• Ice: An ice pack on the affected shoulder can help ease inflammation when combined with a gentle motion.
• Oral Medicines: Anti-inflammatory medicines such as Motrin, DayPro, Relafen, Celebrex or aspirin will help reduce inflammation.
• Cortisone Injections: Cortisone is a natural hormone and a very powerful medicine for inflammation. When injected directly into the inflamed area it is very effective in decreasing the swelling and inflammation that cause pain.

Once the pain and inflammation are under control, a program of exercise, ice, heat, electrical stimulation, ultrasound and massage is used to help you regain motion. Isokinetic exercise devices and exercises with elastic bands for resistance help strengthen muscles.

When is surgery helpful?