Common causes of shoulder pain over age 40

Thomas Baumgarten, MD

Orthopedic Sports Medicine, Orthopedic Surgery

An increase in aches and pains is often considered just another part of the aging process. However, shoulder pain after 40 can have a variety of causes above and beyond simple stress after a long day. Orthopedic surgeon Thomas Baumgarten, MD, explained how to minimize pain and regain a comfortable range of motion.

Rotator cuff injuries

The most common cause of shoulder pain over 40 is an injury or other issue with the rotator cuff. When a doctor mentions the rotator cuff, they’re using the term to represent the four muscles/tensions that help to move the shoulder. These include:

• Subscapularis
• Supraspinatus
• Infraspinatus
• Teres minor

There are two categories of rotator cuff problems.

Inflammation of the rotator cuff and bursa

This injury doesn’t involve any actual tear in the muscles or tendons, but instead involves inflammation. “This type of injury (or bursitis/tendonitis) can be quite painful, especially with overhead activity,” Dr. Baumgarten said. “Throwing motions, reaching out, or working with the arm out in front of the body can aggravate and worsen the pain. The pain is usually in the shoulder area, but it can also be in the upper arm due to referred pain from the rotator cuff.”

The pain may increase at night even during rest, interrupting sleep or making it difficult to relax.

Treatment can include anti-inflammatory medication (NSAIDs), physical therapy and, in certain circumstances, injections. Since there isn’t a tear, surgery is less common as a treatment option, but may be necessary depending on how severe the pain is or the level of disability it causes.

Torn rotator cuff

The other main category of rotator cuff injury is a tear in the tendon. This can happen gradually over time through wear and tear, or suddenly after an injury, like a fall. There are two types of tears:

• Partial tear, in which the injury doesn’t go all the way through the tendon
• Complete, or full-thickness tear, where the injury goes all the way through the tendon itself

A torn rotator cuff can be very painful, especially at night, and cause weakness and limited movement. Treatment options are similar to the treatment of inflammation (NSAIDs, physical therapy, and injections). However, surgery is often necessary for repair a full rotator cuff tear.

Arthritis and shoulder pain

When arthritis causes shoulder pain, it usually involves the shoulder joint itself. This is the large ball-and-socket joint of the upper arm, which includes the upper arm bone and the socket, which is part of the overall shoulder blade.

“Arthritis will gradually wear away the cartilage that covers the ends of the bone,” Dr. Baumgarten said. “As it wears away, it thins down and eventually leads to ‘bone on bone’ movement, which can be extremely painful.”

Night pain, stiffness and weakness are all common as a result of arthritis causing shoulder pain.

X-rays will generally show the problem, but sometimes an MRI is necessary to get a clear look. For the most part, treatment is simple: resting the affected area whenever possible, NSAIDs, physical therapy and injections.

Sometimes, surgery is an option to treat the problem. Usually this involves using arthroscopic (or joint-focused) techniques to do what is called ‘cleaning the joint,’ but replacing the joint (similar to a knee or hip replacement) may be required.

Frozen shoulder

Also known as adhesive capsulitis, frozen shoulder is caused by inflammation in the capsule and soft tissues around the shoulder, causing pain and stiffness. This can reduce the range of motion of the arm and make any attempts to use it as normal very painful.

It is seen most often in people with diabetes or whose arms have been immobile for long periods of time. It is usually not caused by a specific injury.

There are two phases of frozen shoulder:

• Acute, which lasts several weeks and is the most severely painful, sometimes with a rapid loss of shoulder motion
• Chronic, which lasts much longer but shows decreasing pain and the eventual return of motion and function

“The most common treatment for frozen shoulder is physical therapy,” Dr. Baumgarten explained. “Often, this will help cure the condition and speeds recovery. Anti-inflammatory medication and injections can help. If the condition isn’t responding to physical therapy or medication, surgery may be necessary.”

Surgical treatment for frozen shoulder involves moving the arm to break up scar tissue while the patient is under anesthesia, as well as surgical cleaning up of scar tissue within the joint itself.

Bottom line: arm pain over 40 isn’t normal

It’s easy to convince yourself that pain in the shoulders is just another part of aging, but ignoring or trying to ‘live with’ the pain might mean much more severe problems down the road. It’s important to schedule an appointment with a physician if shoulder pain starts to interfere with your daily life. The good news is that almost every cause of shoulder pain after 40 is treatable! You don’t have to live with the aches, pains and limited movements. With diagnosis and treatment, you can resume normal activities and get back your quality of life.