Dear GeezerJock Doc: I’ve developed pain in my shoulder from playing softball. The pain is getting worse and now is affecting my sleep. Any suggestions?

The GeezerJock Doc responds: This is a great question. Shoulder problems are one of the most common reasons for the middle-aged athlete to visit the doctor’s office. It’s a very common problem that is experienced by many kinds of athletes — swimmers, tennis players, golfers and weightlifters, in addition to baseball and softball players.

Your doctor should ask these key questions about shoulder conditions: Where is the pain? How long has it been there? What was the onset of the pain: was it acute or over a long period of time? What activities make it better or worse? Is there night pain involved? Do over-the-counter medications help?

There are two distinctly different regions of the shoulder where the pain can originate. The first part is the actual shoulder joint. This is a ball and socket joint, and one of the most common problems for the joint arises from arthritic wear and tear. The cartilage lining the bone simply thins and wears out. A doctor can usually diagnose this condition by examination or an X-ray.

Another possible condition related to the shoulder joint is a labral or SLAP tear. These are tears of the cartilage surrounding the socket of the shoulder joint. A doctor can diagnose these tears by examination, but they usually require an MRI for a definitive diagnosis. These tears often require surgical correction and are caused by a violent force to the arm in an outstretched position. A shoulder dislocation is a very common cause of one of these tears. More common injuries in the shoulder involve the rotator cuff, which is a group of tendons that sit on top of the ball of the shoulder joint. A sac called the bursa overlies these tendons. On top of the bursa is the acromial bone.

Problems in this region are referred to as subacromial inflammatory syndrome. SIS encompasses a host of different pathologies that have similar symptoms:

• Pain when raising the arm above shoulder level;

• Difficulty reaching behind to wash the back;

• Discomfort sleeping on the affected shoulder at night;

• Problems with overhead activities;

• General weakness in the shoulder region.

SIS can be caused by a number of problems, such as rotator cuff tendonitis or tears. The rotator cuff tendons can be torn by either a sudden forceful injury such as a fall, or can be torn over time by constant use with the tendon rubbing against the overlying acromial bone. Tendonitis is inflammation of the tendon; it can be caused by overuse or a minor injury.

SIS can also result from the impingement syndrome, which is a condition due to a spur or a narrrowing of the space for the rotator cuff. In the impingement syndrome, the tendon gets rubbed and becomes inflamed. Finally, SIS can be the result of bursitis, which is inflammation of the bursal sac over the rotator cuff.

Now, the big question: How do you treat shoulder problems? The first line of treatment is rest, non steroidal anti-inflammatory drugs, ice and activity modification. If this cautious treatment is not successful, a trip to a health professional is in order. Most SIS conditions can and should be initially treated conservatively.

Among the second line of treatment options are prescription painkillers, physical therapy to improve strength and range of motion, and occasionally an injection of cortisone to diminish the inflammation. If this treatment regimen is not successful or there is a high index of suspicion for a rotator cuff tear, an MRI might be in order. Depending on the results of the MRI, surgery may be a reasonable option for treatment.

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Written by orthopedic surgeon and Masters sprinter Allan Tissenbaum, M.D., GeezerJock Doc is a forum for your questions about injuries, exercise and getting older. Submit questions to geezerjockdoc@geezerjock.com or mail to GeezerJock Doc, 2033 W. Hutchinson St., Chicago, IL 60618.