Shoulder Pain Treatment Options for Adults and the Elderly

What causes shoulder pain?

Shoulder pain can originate from structures inside the joint, the surrounding tendons and muscles, or referred pain from the neck. Common causes include acute injuries (falls, strains), overuse syndromes, degenerative changes, and inflammatory conditions. In younger adults, sports-related tendon or labral injuries are frequent, while in older adults degenerative issues and chronic tendon wear become more common. Symptoms may include aching, sharp pain with movement, stiffness, and reduced range of motion. A careful history and physical exam help guide initial assessment and imaging decisions.

How does arthritis affect the shoulder?

Arthritis in the shoulder typically refers to osteoarthritis (degenerative joint disease) or inflammatory types such as rheumatoid arthritis. Osteoarthritis develops from cartilage wear and can cause persistent pain, stiffness, and reduced function, particularly in older individuals. Arthritis pain is often worse with activity and improves with rest, but can also cause night pain and loss of mobility. Management focuses on symptom control, maintaining joint mobility, and slowing functional decline through targeted exercise, anti-inflammatory medications when appropriate, and lifestyle adaptations that reduce joint stress.

What is a rotator cuff injury and treatment?

The rotator cuff is a group of four tendons that stabilize and move the shoulder; tears or tendinopathy of these tendons are frequent causes of shoulder pain. A rotator cuff injury may present as pain with overhead activities, weakness when lifting, or difficulty sleeping on the affected side. Initial treatment usually includes activity modification, physical therapy focused on strengthening and flexibility, and short-term pain control with acetaminophen or NSAIDs if suitable. For persistent tears or significant functional loss, further options include corticosteroid injections, platelet-rich plasma in some settings, or surgical repair depending on tear size, patient health, and goals.

Treatment options for the elderly

In the elderly, treatment emphasizes preserving independence, minimizing side effects, and improving quality of life. Non-surgical approaches are often preferred: tailored physical therapy to build strength and maintain range, assistive devices for daily tasks, and medication adjustments to manage pain safely alongside other conditions. Injections (e.g., corticosteroid) can provide temporary relief but require careful consideration due to systemic effects. Surgery is considered when conservative care fails and when expected benefits outweigh risks; less invasive procedures may be chosen based on overall health. Coordination with primary care and geriatric assessment can optimize outcomes and reduce complications.

Non-surgical and surgical treatment choices

Non-surgical treatments are the first-line approach for many shoulder conditions. These include structured exercise programs, manual therapy, activity modification, cold or heat therapy, and pain medications chosen to suit comorbidities. Physical therapists can provide progressive, home-based programs that improve function and reduce recurrence. When conservative measures are insufficient, minimally invasive procedures such as arthroscopic decompression or tendon repair are options for rotator cuff disease. Joint replacement (arthroplasty) may be recommended for severe arthritis with loss of function. Surgical decisions are individualized, considering imaging findings, symptom severity, rehabilitation capacity, and patient preferences.

Conclusion

Managing shoulder pain requires a structured approach: identify the likely cause, use conservative measures first when appropriate, and consider procedural or surgical options for persistent, function-limiting problems. For elderly patients, the balance between benefits and risks is especially important, and multidisciplinary care often yields the best results. Open communication with clinicians about goals, daily limitations, and treatment tolerance helps shape a realistic plan that improves pain control and preserves independence.