Shoulder pain can interfere with even simple daily activities, from combing your hair to reaching for something on a shelf. In India, shoulder problems are common due to increased computer use, sports injuries, ageing, and daily household work. Two frequent culprits—rotator cuff injuries and bursitis—often overlap in symptoms, making diagnosis and treatment confusing for many.
This comprehensive guide decodes the causes, symptoms, diagnosis, and management of rotator cuff injuries, bursitis, and other shoulder pain sources. By the end, you’ll know when to seek help and what treatments can restore comfort and strength.
Anatomy of Your Shoulder: The Basics
The shoulder is a complex joint—combining three bones (humerus, scapula, clavicle), multiple muscles, tendons, and fluid-filled sacs called bursae. The rotator cuff is a crucial group of four muscles and tendons that stabilize the shoulder and allow lifting, reaching, and rotation. The bursa sits between the rotator cuff tendons and the top bony part of your shoulder (acromion) to reduce friction.
Common Shoulder Pain Conditions
1. Rotator Cuff Injuries
- Tendinitis (Inflammation): Overuse or age-related change causes swollen, sore tendons.
- Partial or Full Tears: Tendons fray or break, usually from trauma, repetitive movements, or natural weakening past age 40.
2. Bursitis (Shoulder Bursae Inflammation)
- Excess movement or trauma makes the bursa swell and hurt, especially when lifting your arm overhead or sleeping on your side.
3. Shoulder Impingement
- The space for tendons shrinks from swelling or bone changes, causing pinching and pain, commonly seen alongside bursitis and rotator cuff problems.
4. Other Causes
- Arthritis (joint cartilage wear)
- Instability/dislocation
- Fracture
- Nerve problems, tumors, infections (less common)
Causes: Why Does Shoulder Pain Develop?
| Cause | Risk Factors |
| Overuse (sports, repetitive work) | Throwing, painting, computer jobs |
| Trauma/injury | Falls, accidents, sudden movements |
| Age-related wear/tear | Degeneration of tendon, bursa, cartilage |
| Poor posture/stress | Rounded shoulders, weak back |
| Structural abnormalities | Acromion bone spur, abnormal shoulder shape |
| Previous surgery or conditions | Weak tendons, post-operative changes |
| Infections (rare) | Medical history of joint or bone infection |
Symptoms: How to Tell the Difference
| Problem | Typical Location/Sensation | Signs |
| Rotator Cuff | Dull ache deep in shoulder; pain at rest/the night; pain on lifting or reaching overhead; weakness or crackling (crepitus) in joint | Weakness, trouble combing hair, reaching back, popping feeling |
| Bursitis | Pain/tenderness/swelling on top/outside of shoulder; pain that worsens with activity or lying on side; redness possible | Trouble sleeping on side, warmth, sometimes fever if infected |
| Impingement | Sharp pain when lifting arm overhead; may overlap with rotator cuff or bursitis symptoms | Loss of range, pain on movements above shoulder level |
Symptoms can overlap—sometimes only imaging or expert evaluation confirms the exact diagnosis.
Diagnosis: Getting to the Root
- Medical & Activity History: What increases pain? Old injuries? Occupation?
- Physical Exam: Where is tenderness? Can you lift or rotate your arm?
- Tests:
- X-rays: Check bone shape, spurs, arthritis.
- Ultrasound: Shows tendon tears, bursa size.
- MRI: Best for detailed tendon injuries and soft tissue.
Your doctor decides which tests to use based on symptoms and exam findings. If symptoms are mild and resolve with initial treatment, imaging may not be needed.
Management & Treatment
Conservative (Non-Surgical) Options
- Rest: Avoid overhead activities and repetitive motions.
- Ice packs: Reduce swelling, relieve pain.
- NSAIDs: Ibuprofen or naproxen for pain and swelling (after food, as per doctor’s advice).
- Physical Therapy: Stretching and strengthening to restore mobility, prevent stiffness, and support healing. Do prescribed exercises only.
- Modifying activity: Changing routines to minimize pain triggers (alternative work setups, supportive pillows).
- Steroid Injections: Cortisone and anaesthetic, reserved for troublesome cases.
About 80–85% of rotator cuff and bursitis cases improve with these conservative steps over 6–12 weeks.
Surgical Options
- Reserved for:
- Large tendon tears not improving
- Severe joint instability or repeated dislocation
- Structure abnormalities causing pain
- Persistent bursitis or impingement despite all treatments
- Procedures may involve tendon repair, removing bone spurs, cleaning inflamed tissue, or replacing parts of the shoulder (rare).
Recovery & Prevention
- Follow physical therapy plans carefully—home exercises keep results long term.
- Focus on posture—desk ergonomics, regular stretching, strong back and core.
- Regular breaks from repetitive activities—especially sports or computer work.
- Strengthen shoulder and upper back muscles—improves stability and lowers reinjury risk.
- Maintain ideal body weight—extra weight strains joints including the shoulder.
- Protect during high-risk sports/activities—warm-up, proper form, and safety gear.
- Address minor pain early—don’t wait for severe pain or disability before seeking guidance.
FAQ
- Can I treat shoulder pain at home or do I need a doctor?
Mild pain from minor overuse or strain can often be managed with rest, ice, NSAIDs, and gentle stretching. If pain persists for more than 2 weeks, becomes severe, limits movement, or is associated with swelling, fever, or nighttime pain, see a doctor for focused diagnosis and treatment. - What are the risks of ignoring rotator cuff tears or shoulder bursitis?
Delayed care can lead to chronic pain, permanent weakness, loss of range of motion, and worsening tears. Tendon tears may spread and bursitis can become infected or calcified, making later treatment more complex. - Will I need surgery for my shoulder pain?
Most cases resolve with conservative management. Surgery is only considered if there is failure to recover, major tendon tears, instability, or anatomical issues. Early diagnosis and therapy minimize the need for invasive treatment.