Ask the Expert: Dr. Edward Craig, Shoulder Surgeon, Answers Your Questions on Shoulder Pain

shoulder pain causes and treatment

Q1. What would cause sudden shoulder pain only in the front of the shoulders? Sometimes accompanied by redness and heat. Mostly occurring at nighttime.

Many problems in the shoulder cause pain in the front of the shoulder and most difficulties are made worse at night and can interfere with sleep. The problems can include rotator cuff tendinitis or tear, frozen shoulder, calcium deposits in the tendon and problems with the biceps tendon. You should speak with your physician to determine the cause of pain.

Q2. I play tennis every weekend for the past several years. My shoulder started to hurt after the last game. What can I do to treat the pain and prevent a rotator cuff tear?

Before playing tennis, make certain you do a general body warm-up and stretch both arms in preparation for play. After tennis, ice the shoulder for 10-15 minutes. If pain persists, over the counter anti-inflammatory medications such as ibuprofen or Aleve can be helpful. The rotator cuff usually tears from a process of normal aging, wear and tear and sometimes overuse. Keeping the shoulder flexible with stretching range of motion exercises is important. There are also a number of rotator cuff strengthening exercises that can be done to maintain the tone and strength, and these are also helpful in preventing damage. It?s important to consult with your physician to determine the treatment.

Q3. My shoulder stiffens up and this sometimes makes movement painful. How would you treat the pain?

Most times, stiffness and restricted range of motion is the cause of pain in and of itself. The cause of the stiffness frequently is irritation of the tendons. If the problem is pain and stiffness (this has been called frozen shoulder and adhesive capsulitis), stretching exercises, ice and judicious use of anti-inflammatory medication usually restores flexibility and relieves pain. Working with a physical therapist is often helpful to achieve these goals. If the problem persists, evaluation of the shoulder by your doctor, with imaging studies such as x-ray or MRI may well be warranted. Consult with your physician and/or physical therapist.

Q4. I have shoulder arthritis. The pain is moderate. When would you recommend shoulder replacement for someone with this kind of condition?

The main indication for shoulder replacement is pain that interferes with quality of life and that is not relieved by non-operative means. Each person has his/her own definition of moderate pain and pain threshold, but in general, most people who have shoulder replacement do so because pain is severe often interfering significantly with sleep, activities of daily living or recreation. There may be other treatment for moderate pain rather than joint replacement, such as mild stretching exercises, anti-inflammatory medication or injections into the joint of such medications as cortisone. Consult with your physician.

Q5. What’s the difference between a shoulder dislocation and separation?

The anatomy of the shoulder includes a ball (head of the humerus) that rests against the socket (glenoid fossa). The head of the humerus is held in the glenoid socket by soft tissues. On top of the shoulder is a bump where the collarbone (clavicle) meets the shoulder cap (acromion) to form a joint (acromioclavicular joint). The clavicle is held in place against the shoulder cap by a series of soft tissue ligaments.

With a shoulder dislocation, the main ball and socket of the joint is affected, and the ball moves out of the socket, partially or completely. When this occurs with trauma, most often the soft tissues which hold the ball in the socket are damaged, permitting the ball to go out of the socket, or dislocate.

A shoulder separation does not involve the main ball/socket, but involves the small joint (bump) on top of the shoulder where the collarbone meets the shoulder cap. When the ligaments holding the collarbone against the shoulder cap are damaged, the collarbone no longer is kept in place and separates from the shoulder cap. Thus a shoulder separation is not part of the main ball/socket joint, and is usually less painful and less serious than a dislocation.

Next week Dr. Brion Reichler, Neurologist, will answer your questions on gait and balance disorders. Write your questions on the wall or email



  1. I had a total reversed shoulder done 5 weeks after I had my 4th knee replacement done was walking on my knee after 3 weeks. then I had the TRS done off a xray taken in a nursing home …the pain is unbearable, my shoulder hurts worse then anything I have ever had done …my doctor never did a Mir nor a cat scan …went to the hostipal,and they found bone spurs and more arthritis ..I’m 65 years old and every day is a struggle to even get up the pain never goes away and I’m on oxycontain. Also this was done not 8 weeks ago? I’m scared and the pain has taken away all quality of life. I’m so terrified that they will have to go back in and remove the device. I don’t know if my body can withstand another surgery. I had no rotor cuff left plus there was 2 inches taken out of my collar bone due to a rotar cuff surgery years before,I have had 39 major surgeries and always bounced back but this one has robbed me of my life.

    1. Hi Cynthia, thank you for writing. Dr. Joshua Dines, Orthopedic Surgeon, says: “You are less than 8 weeks from the surgery and this sometimes takes 3-6 months before one sees a significant difference. That said, if the pain is that severe, I suggest you see your surgeon to make sure the prosthesis is in the correct position; make sure that there is no fracture and make sure there is no infection. If you are not satisfied with your treating physician, you can seek out a second opinion.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  2. Hi I was diagnosed with antiphospholipid syndrome and lupus anticoagulant when I was 14 years old. Now I am 22 years old and I think I am pregnant and haven’t taken a test yet. I was wondering if I am pregnant I would have to start taking a lovnox injections however my question is what are my chances of having a miscarriage or complications in my pregnancy? What can I do to prevent severe complications with my health and the babies?

    1. Hi Courtney, thank you for reaching out. Dr. Michael Lockshin, Rheumatologist, says: “To answer your questions, I would have to know more about the details of your diagnosis. If you previously had blood clots and are now on Warfarin (Coumadin), you should switch to lovenox as soon as you know you are pregnant. If you have not had blood clots and are not on Warfarin, and have not lost pregnancies in the past,you may not have to take Lovenox. It depends on the details. If you have lupus or kidney disease, risks for your pregnancy are higher than if you do not have these things. Depending on the details, for a woman with a lupus anticoagulant, the risks for a pregnancy complication (mostly a premature delivery) can be as low as 20% to as high as 60%; the likelihood of a liveborn child, who may be healthy, even if premature, and no harm to the mother’s health, is more than 80%.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  3. I had an MRI of my right shoulder. I had a cortisone shot prior to the MRI because of pain. The cortisone shot did nothing for my pain but caused additional pain. The MRI shows complete tear of tendon. Also no cartididge in the glenohumeral joint. I am 72 years old and was wondering if my tendon is too thin to sew. What do you think I should do. I am going to try physical therapy for 6 weeks. Please let me know what you think I should do. Thanks

    1. Hi Eileen, thank you for reaching out. Dr. Lawrence Gulotta, Orthopedic Surgeon, says: “When patients have arthritis, or loss of cartilage, due to a chronic rotator cuff tear, it is called cuff tear arthropathy. The initial treatment for cuff tear arthropathy is physical therapy and a cortisone injection. If the pain and dysfunction continues, then a special type of shoulder replacement can be implanted called a reverse shoulder replacement. If pain continues after physical therapy, then you should be evaluated by a shoulder specialist to see if you are a surgical candidate.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  4. Developed increased shoulder pain, have had x-ray and MRI. Was told I had ”massive” tear in rotator cuff tendon, given medication which did not work (severe pain at night, took a variety of pain killers, none great). Returned with pain, given cortisone shot (which has allowed me to sleep w/o pain but not a permanent solution). Rotator cuff repair not solution since I have osteoarthritis as well as muscle damage (”muscle has turned to fat”). So REVERSE Total Shoulder Replacement is recommended so Deltoid muscle is used. Why isn’t Deltoid muscle degraded?

    1. Hi Gayle, thank you for reaching out. Dr. Lawrence Gulotta, Orthopedic Surgeon, says: “In a patient with ‘cuff tear athropathy,’ which is what you are describing, the deltoid is usually preserved. The deltoid tendon is relatively large when compared to the rotator cuff, and therefore it is stronger and less likely to tear.” It is best to consult with your treating physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  5. thank you for the reply saw surgeon on 2/18/14 xrays ok starting anti inflam’s, decreasing each day over the course of 1 week

    thanks again

  6. I had a “hemi” last year because the cup was too worn to attach anything

    also a reverse could not be done

    I have 60% mobility with pain

    any thoughts/

    thank you

    1. Hi Bud, thank you for reaching out. Dr. Edward Craig, Orthopedic Surgeon, says: “It must be recognized that the primary purpose of arthroplasty of the shoulder, whether total shoulder, reverse arthroplasty, or hemiarthroplasty is pain relief, rather than mobility, motion, or function. That is because mobility to a great extent is related to the health of the soft tissues, including rotator cuff, which moves and stabilizes the implant. That said, the track record of hemiarthroplasty, while it tends to neither be as predictable nor complete as total shoulder or reverse, has been good over the years. There are many possible causes of continued pain after hemiarthroplasty, including infection, incomplete rehabilitation, rotator cuff tearing, implant position, nerve dysfunction, shoulder instability, wear on the glenoid that was not resurfaced, and others. Sometimes we do not find a cause for ongoing pain. What should be done will always depend on trying to establish the cause of the pain. Infection workup might include blood work, aspiration of the joint, or even biopsy. Rotator cuff tear might be evaluated by MRI scan, nerve injury by electrical studies, etc. A plain x-ray to look at implant position and remaining glenoid socket bone is certainly a good place to start. If necessary, a CT scan is sometimes helpful to assess remaining bone. Occasionally, a socket which has been considered to have inadequate bone for a new surface may be able to be handled by smaller glenoid implants, or even custom designed ones to take advantage of available bone. My suggestion is to discuss with your doctor whether any of the above are considerations. If none of these retake to your situation, sometimes an anti-inflammatory medicine or even a cortisone injection in the rotator cuff area or even the joint itself can be considered.” It is important to consult with your treating physician. If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

  7. I’m 54 years old. love lifting weights. pretty much a workout fanatic. played high school and college football and also was an electrician for 25 years. even though I have a lot of arthritis in my shoulders I’ve always been able to adapt my workouts so that I’ve been able to lift without much pain at all. recently, the day after a workout my left shoulder is really hurting. i’m sure I tore something. an orthopaedic doctor told me a few years back that I probably will eventually need shoulder replacement surgery. I’m terrified of this surgery because I don’t know if i’ll be able to lift weights anymore. working out is something I’ve always done and hopefully will continue to be able to do. is it possible in your opinion that if I do opt to have surgery that I’d be able to keep lifting weights and still be able to do work on and around the house which I love doing

    1. Hi Robert, thank you for your question. Dr. Edward Craig, Orthopedic Surgeon, says ?It is certainly understandable that you would be cautious regarding shoulder replacement surgery. A few thoughts: While you may have torn something (tears of tendons are seen on MRI scan, not X-ray), it is probably more likely if you have arthritis in the shoulder that you stirred up a damaged joint. There are other options for shoulder pain from arthritis besides shoulder replacement, such as medication by mouth and cortisone injection into joint ? both of which may give you enough relief that you do not feel an operation is necessary.? If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for assistance.

  8. My 82 year old mother-in-law received excellent treatment by you ( rotator cuff surgery) about 10 years ago. Her knee has deteriorated since the accident ( shoulder and knee injury from fall). Who do you recommend? She is on a walker and getting stronger but the knee has become a real issue for mobility. Her situation would improve more if she was more mobile. Medicare patient.

    1. Hi Kathleen, thanks for reaching out. We shared your note with Dr. Craig and his office. Additionally, if your mother-in-law wishes to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for assistance.

  9. I have had an MRI which shows a torn rotator cuff. May I send the MRI for you to review for what course of action to
    take. I had it reviewed by an orthopedic doctor in Pawleys Island, SC. He recommends surgery with the possibility of shoulder replacement surgery now or in the future.
    I had my back operated on by Dr. Camissa about 14 years ago at the HSS.
    Thank you for your consideration of this matter.

  10. This is the right site for anybody who would like to find
    out about this topic. You understand so much its almost tough to argue with you (not
    that I actually would want to?HaHa). You certainly put a new spin on a subject that has
    been written about for ages. Wonderful stuff, just

  11. I have had rotator cuff arthroscopic surgery on left shoulder. 3mos ago. in PT
    still in pain.
    Now have bicipital tendonitis in rightt shoulder had seroid injection . what are the options for this new shoulder. How about botox inection i am 76 yrs old and cannot turn steering wheel in car

    1. Dr. Craig says, ?The options for the problem on the unoperated shoulder depend on what the specific problem is. Usually, when someone has had rotator cuff surgery on one side, and gets biceps tendonitis, the other shoulder may be getting rotator cuff pain as well (30% get cuff pain on other shoulder). Options include: PT and light strengthening exercises, activity modification, anti-inflammatory medication by mouth, and steroid injection into shoulder. To my knowledge there is no role for botox injection for either biceps or rotator cuff problems.? A more specific course of action can be determined for you with a consultation. If you”d like to make an appointment with us, please contact Physician Referral Service at 877-606-1555 or visit them online at

  12. Ramon,

    Gracias por su inter?s en HSS, hemos hecho llegar su solicitud al Centro Internacional. Para su referencia, tambi?n puede comunicarse con ellos directamente al (212) 606-1186 o al correo electronico:

  13. Tengo una Capsulitis adhesiva y algo mas,
    deseo realizar una consulta con usted, ya sea
    en Miami o Nueva York, ya que soy Dominicano, Buenas Noches, a la espera de su respuesta

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