1. Trauma such as broken bones or shoulder dislocation. This trauma could be from getting hit by a car or falling down the stairs. But this trauma could also be from tripping on a curb or falling off your bike and dislocating your shoulder, which in this case we must ask why would this relatively small impact cause such severe damage to you when most people survive this trauma injury free?
The answer comes down to what position was your shoulder in when you fell on it? Was it square and balanced supported by strong muscles? Or was it rounded forward and down with little muscular support? In the first case you would probably dust yourself off, get back on your bike, and forget it ever happened. In the second case you might be in agony as you wave down the first car you see to take you to the ER to pop your shoulder back into socket and repair the torn rotator cuff muscles.
a) We think too much running causes knee arthritis, or too much swimming causes rotator cuff tendonitis. If this was true every runner would eventually get knee arthritis and they don't, and every runner who gets knee arthritis would get it in both knees and they don't. If swimming causes rotator cuff tendonitis every swimmer would eventually get tendonitis and they don't, and every swimmer who gets tendonitis would get it in both shoulders and they don't. There must be something else going on.
b) If aging causes degeneration, then every person who is say 60 years old would have degeneration in their shoulder and that just isn't true. There are 30 year olds with shoulder degeneration and 90 year olds without shoulder degeneration. There must be something else going on.
- over-the-counter anti-inflammatory medicines
- physical therapy
- cortisone injections
Over-the-counter anti-inflammatory medicines are treating the symptom of inflammation, but again doing nothing about the cause of the inflammation.
Physical therapy is often focused on the area of symptom and at reducing symptoms, but usually does not look at the underlying cause of the pain and correct it.
Cortisone injections might relieve inflammation and pain, but again do nothing to address the cause of the inflammation and pain.
Surgery treats the symptom of say a rotator cuff tear, but does not fix the cause of the rotator cuff tear.
As you can easily understand, these "treatments" for shoulder pain might temporarily relief shoulder pain, but do nothing about the underlying cause of the pain. Treatments focused on the symptom will almost always guarantee that the same or a related symptom will reappear and that further tissue damage is occurring.