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The shoulder is the most flexible and mobile joint in the body. Because of its mobility, it is also one of the most frequently injured joints.

Thomas Burke, M.D., orthopedic surgeon at Mount Auburn Hospital, says, “Whether you’re playing baseball, tennis, golf, or even if you consider yard work your sport, you depend on your shoulder to work correctly. A painful shoulder can interfere with your favorite activities and everyday life.”

The shoulder joint is surrounded by four muscles and their tendons, referred to as the rotator cuff, which is a common site for shoulder injuries. The rotator cuff is surrounded by a bursa (or sac) that helps the tendons slide over each other. Because of the complexity and continuing use of the rotator cuff, it is easily injured by overuse and can result in a number of painful conditions, including tears in the tendons, which may detach from the bone. Rotator cuff injuries also include impingements that occur when the space between the cuff and the bone above it are squeezed, causing inflammation of the tendons (tendinitis) or bursa (bursitis).

Rotator cuff injuries can be caused by a variety of activities. This area of the shoulder is particularly vulnerable to wear-and-tear over time so rotator cuff injuries are more common as people age.

Most rotator cuff injuries can be effectively treated with the application of ice, rest, and anti-inflammatories (such as aspirin); however, if the pain does not go away in two weeks or less, then you should seek medical attention. Shoulder injuries are typically diagnosed through physical exams, medical histories, x-rays, and medical resonance imaging.

Dr. Burke says that his initial approach to rotator cuff injuries is frequently physical therapy and sometimes cortisone injections. If these treatments do not relieve the pain, then you probably have a torn tendon and minimally invasive surgery may be the best next step. During this procedure, small incisions are made in the skin and tiny cameras with microscopes are used to focus on the tear, which is then repaired and the tendon can be reattached to the bone. These procedures are usually performed on an out-patient basis with patients returning home the same day as the surgery. Physical therapy can aid in the recovery process. Most people regain full use of their shoulders within several months after surgery and are able to go back to their regular sports or other activities.

Cartilage tears can also occur in the shoulder joint, particularly in athletes involved in sports such as baseball, swimming, and volleyball. Injuries to the collarbone or clavicle where it attaches to the shoulder joint are also common and are most likely to occur as a result of falls or during contact sports.

Another common injury is a shoulder dislocation, which tends to occur more frequently in younger patients and is usually the result of some kind of trauma. For instance, a shoulder dislocation might occur during sports activities such as basketball or football when major arm motion is involved or when you may fall on your arm. You almost always are aware of the shoulder popping out of position and will need to go to the emergency room to have the shoulder put back in place. However, once your shoulder has been dislocated, it is likely to happen again.

Dr. Burke says, “After more than one shoulder dislocation, we typically recommend minimally invasive techniques to look inside the joint and repair the damage. In most cases, after a minimally invasive procedure, patients can go back to their normal sports activities without worrying about the shoulder popping out again.”

The shoulder can also be affected by arthritis and sometimes a shoulder replacement can be performed if patients have not responded to other treatments. A shoulder replacement is usually effective in relieving pain and also in improving the shoulder’s range of motion.

Dr. Burke says there are ways you can help yourself avoid shoulder injuries, such as stretching before activities and strengthening exercises. He emphasizes that it’s important to perform exercises that maintain muscle balance in the shoulder joint. You need to make sure that the smaller muscles of the rotator cuff are not overpowered by the larger shoulder muscles. A good physical therapy or training program, under the guidance of a physical therapist or gym trainer, can help ensure that you are using the proper weights and training techniques.

Dr. Burke also warns that the old saying, “no pain, no gain,” is not a good approach. If you feel pain, then you should back off from the activity or exercises causing the pain. If you’re involved in an activity you enjoy that is causing pain, then you need to seek medical attention to find out what’s going on and what treatment can relieve your pain so you can go back to the activities you enjoy.”