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My mother-in-law is here for a visit. She has ongoing shoulder pain and doesn't seem to know what to do. What can we do to help her?

The first step is to get a proper diagnosis to find out what's causing the pain. If she is from out-of-town, you might want to suggest she see her own doctor when she gets home. If she is open to receiving care in your community, then a referral to her primary care physician or orthopedic surgeon is advised. The most common causes of chronic shoulder pain in an older adult include rotator cuff tear or degeneration, arthritis, a frozen shoulder, or a labral tear. The labrum is a rim of fibrous cartilage around the shoulder socket. It provides increased depth and stability for the shoulder joint. The physician will rule out more serious problems such as fracture, infection, or tumor. For any of the soft tissue problems mentioned, the first step is usually to get the pain under control. That can often be done with a simple pain reliever such as acetaminophen (Tylenol). If a stronger medication such as an antiinflammatory is needed, the physician will prescribe one that is best for her age, condition, and general health. Other conservative measures such as physical therapy or a steroid injection into the joint are additional options should the pain medication fail to do the job. Physical therapy can help a person regain lost shoulder motion while paying attention to posture and alignment. Helping change movement patterns and poor postural habits can also go a long way in preventing a relapse. Stretching exercises to increase flexibility will be followed by strengthening exercises to restore strength. If needed, the therapist will show your mother-in-law ways to move that will avoid impingement (pinching of the muscles and tendons around the joint). There are other treatment options, but this is usually the starting point. Your mother-in-law may just need a little direction in getting started to find the help she needs. Don't hesitate to at least make the offer. If she doesn't pursue treatment in your area, she may feel more encouraged to do so once she returns home.

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