The shoulder is one of the most remarkable joints in the human body. We use it constantly, often without realising its importance, to reach overhead, comb our hair, wear our clothes, lift objects, stretch sideways or rotate our arms behind or across the body. This is true for athletes and those who engage in recreational sports such as basketball, swimming, racquet games or even gardening.

The shoulder is unique because of its range of motion. It is quite unlike the hinge joints of the hip or knee. The shoulder needs to move freely in almost every direction. This is possible because what we call a “shoulder joint” is actually a complex system of seven joints working together.

The head of the upper arm bone (humerus) fits into a shallow, cup-shaped socket in the shoulder blade. The shoulder also forms articulations with the collarbone and the rib cage. This remarkable design provides mobility but also leaves the joint vulnerable to injury, strain, wear and tear.

A fracture or dislocation can occur with a fall at any age. Repeated overhead movements — as seen in swimmers, basketball players, throwers, dancers, martial arts experts and even household activities involving reaching and lifting — can strain the ligaments. Over time, these ligaments may stretch and become lax, causing the joint to feel “unstable”. In some people, the shoulder may suddenly “pop out”, leaving it painful and difficult to move.

The bony surfaces of the joint can also wear out with age, leading to arthritis. Tendons may degenerate or tear. The lubricating fluid-filled sacs that facilitate smooth gliding may become inflamed, leading to bursitis. Fortunately, both shoulders are rarely affected at the same time. Most of us favour one arm, either the right or the left, so the symptoms are often more pronounced on that side.

Some people are more likely to suffer from shoulder problems. Sometimes the cause is clear, such as an accident, fracture or prolonged immobilisation after an injury. In many cases, however, no apparent single cause is found.

Shoulder pain may be acute, arising suddenly after an injury, may appear suddenly one morning for no reason at all or may develop gradually. Common reasons include ligament tears, tendon degeneration, inflammation of the lubricating fluid or arthritis. Irrespective of the cause, initial management includes icing, rest and anti-inflammatory medicines (NSAIDs). Gentle stretching should be done only within the limits of pain.

If the pain, stiffness or restricted movement lasts longer than a week, it is best to seek medical evaluation. The doctor may examine the joint, order blood tests, X-rays or a ultrasound or MRI to identify the underlying cause.

Shoulder issues are more common in women, especially after age 40. They are also associated with medical conditions such as cervical spondylosis, stroke, Parkinson’s disease, diabetes and thyroid disorders. Sometimes, despite tests, no correctable cause is found.

Treatment focuses on pain relief and preserving the range of motion. Physiotherapy plays a vital role. Exercises strengthen the surrounding muscles and stabilise the joint. Some problems — such as ligament tears, recurrent dislocations, loose bodies, fractures or bony spurs — may require intervention with steroid injections, arthroscopy, or occasionally open surgery for repair, replacement or reconstruction.

Recovery is usually quick if the cause is recent and treatable. Chronic or long-standing problems, however, may require prolonged physiotherapy. Mobility exercises need to be performed lifelong, even after symptoms improve. Neglecting exercises for a few days can result in the recurrence of pain, sometimes even in the opposite shoulder.

The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in