By Megan Southwick

The shoulder behaves differently than other joints.

As you age, joints and tissues degenerate, tear, and begin to hurt -- not necessarily because you did anything wrong or were injured, but simply because the joint is wearing down.

The pace of shoulder degeneration can be influenced by a lot of factors, including everyday aging.

Watch a video of a presentation on shoulder pain from Duke Raleigh Hospital’s ongoing Healthy Focus lecture series or read more about shoulder pain and treatments below.

The medical term for getting older is senescent change. Examples of this include your hair going grey or losing some of your hair. These changes just mean that you are aging.

While grey hair doesn’t hurt anything except your vanity, shoulder pain can affect much more than that.

As we age, the following can occur:

• Bone spurs form. Bones grow and the edges sharpen, like a hatchet blade growing out from the edge of a bone, and they can rub on nerves or pinch tendons. Having bone spurs doesn’t necessarily mean that you will have problems – we all get them, but only some are impacted by the pain the spurs might cause.
• Cartilage and tendons soften and tear. Tendons soften as you get older and can’t take as much stress; cartilage softens, causing tearing and a lack of resilience.
• Muscles weaken. The weakness occurs mostly for hormonal reasons -- you are no longer producing as much testosterone as you did when you were younger, so muscles are no longer as strong as they once were.
• Bones soften. This is known as osteoporosis, and while it doesn’t hurt, it makes you vulnerable to bone breakage.

Causes of Shoulder Pain

Bone Spurs

Bone spurs in the shoulder grow like mulberries, just little growths on the outside of the bone. If you are one of the unlucky ones that a spur hurts, you will be in a lot of pain because of the anatomy of the shoulder. Bone spurs that form in the shoulder get in the way a lot more than a spur that might form elsewhere in the body.

Tendons

If your tendon deteriorates and tears, the muscle it’s attached to isn’t going to work properly – or it’s going to hurt when it has to work.

Bursitis

Tendon tears can cause bursitis, which in turn can create more tendon tears – resulting in a circular pattern of shoulder pain.

Types of Shoulder Pain

Different types of pain could indicate the seriousness of a shoulder problem.

• Pain at night when you are trying to sleep. It’s hard to get comfortable and your sleep cycle is disrupted. This is usually an indicator of a shoulder problem that requires treatment.

• Pain that occurs when you use the shoulder in a certain way. There are many treatment options for this more common type of pain, from simple over-the-counter medication to physical therapy.

Five Ways to Control Shoulder Pain

• Keep your shoulder strong. Your shoulder consists of 22 muscles designed to control and stabilize your shoulder. Muscle weakness can cause problems with movement ability and pain. Where intense weight training may harm the shoulder, more frequent repetitions with lighter weight, stretching cords and therapy can help strengthen the shoulder.
• Keep your shoulder flexible. Because your shoulder experiences much more motion than any other joint in the body, even the slightest amount of stiffness can cause pain.
• Warm up before exercise or activity. In any area where there is muscle- or tendon-based pain, a basic warm up before physical activity can help resolve pain during and after the activity.
• Understand the importance of anti-inflammatory medicines. Conditions like bursitis are inflammatory and their symptoms wax and wane dramatically – and often can be controlled using simple medicines. The best over-the-counter medications for controlling inflammation are ibuprofen (Motrin, Advil) and naproxen (Aleve). Tylenol can also be used, especially if you have a sensitive stomach, and supplementing with glucosamine and chondroitin may also help.
• Use your common sense. If an activity causes shoulder pain, don’t perform that activity, and make an appointment with your doctor to determine the root of the pain.

Staying active is key to sustaining musculoskeletal health. If you retreat from pain by retreating from activity, you may feel better in the short term, but this is not a healthy strategy in the long run.

If you can’t perform basic strength training exercises and activities, try taking to the water, where the strain on your joints is lessened by the buoyancy. If you really can’t move or are in a lot of pain, seek out a physician, either your primary care physician or an orthopaedic surgeon.

An orthopaedic surgeon will make a thorough assessment of your shoulder to figure out why you are in pain. She may order some imaging studies, such as x-rays and MRIs that can help her pinpoint the problem and direct treatment.

Treatments may be as simple as physical therapy or cortisone injections, or they may involve surgery. The important thing to remember is that the shoulder can be managed so that pain is lessened and your quality of life improves.