Ask Dr. Pat · Fitness

Ask Dr. Pat: What Causes Shoulder Injuries? How Can I Prevent Them?

Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I am 50 years old and a serious weekend tennis player in a league with county-wide and regional competitions. There seems to be an epidemic of shoulder disorders among my tennis pals lately. None of them were aware of any acute injuries but developed significant restrictions of movement and pain that seemed to take forever to resolve. None of them had surgery but everyone did need physical therapy. They were out of play for at least a year and never seemed to recover their former skill at the game.

What causes shoulder injuries? It seems that my tennis friends have been given different diagnoses for their shoulder pain and dysfunction. What can I do to prevent damage to my shoulders?



Dear Felicity,

The shoulder joints move every time you move your arms. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), collarbone (clavicle), and shoulder blade (scapula). These bones are held together by muscles, tendons, and ligaments. The shoulder joint has the greatest range of motion of any joint in the body. Because of this mobility, the shoulder is more likely to be injured or cause problems. The Acromioclavicular (AC) joint, which lies over the top of the shoulder, is also easily injured. The muscles of the shoulder complex provide stability and movement. During shoulder movements such as lifting, certain muscle groups help to move the shoulder, while other muscle groups help to stabilize the shoulder complex. Much of the stability in the shoulder complex is provided by this muscular coordination.

Women in mid-life are more likely to develop shoulder problems, which can be minor or serious. Shoulder injuries most commonly occur during sports activities, exercise without proper form or with the use of weights that are too heavy, and work-related tasks or projects around the home. Poor posture, muscular weakness, or ligament injury can lead to abnormal biomechanics of the shoulder, which can result in abnormal forces in the shoulder. Over time these abnormal forces can cause injury to the soft tissues or the articular cartilage of the glenohumeral joint.

The most common causes of shoulder pain are osteoarthritis, rotator cuff damage, and frozen shoulder.

  • Osteoarthritis occurs when the cartilage protecting the joints wears down. It is known as “wear and tear arthritis” because it tends to be linked to long-term over-use off the joints. Previous injury to a joint is another common cause of this kind of arthritis.
  • Rotator Cuff Injuries involve the group of four muscles and tendons that surround the shoulder joint, keeping the ball (head) of the upper-arm bone (humerus) in the shoulder socket. It protects the shoulder joint and allows movement of arms over the head. It becomes especially important in sports like baseball, swimming, or tennis. Common injuries to the rotator cuff include rotator cuff tear, tendinitis (an inflammation or irritation of a tendon that attaches to a bone), or bursitis (when the bursa, a small sac filled with fluid that protects your rotator cuff, gets irritated).
  • Frozen Shoulder is a common condition in which the shoulder stiffens, reducing its mobility. It occurs when the capsule of connective tissue that is lining the shoulder joint thickens and becomes inflamed.

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