Q. I enjoy weightlifting but have begun to experience pain in my shoulder with any overhead activity. It seems okay when I’m lifting but I have trouble sleeping at night and also the next day because of discomfort.

A. Your most likely problem involves your rotator cuff. The rotator cuff is a small group of 4 muscles that are important for shoulder function. They help with fine-tuned movement as well as stabilization of the shoulder joint. This muscle group is easily overworked, overloaded, and injured.

Rotator cuff problems are the most common cause of problems for weightlifters, swimmers, and any overhead athletes such as baseball pitchers. The small rotator cuff muscle group is very vulnerable because of its anatomy. These strap-like muscles and tendons surround the ball and socket joint of the shoulder and live between a rock and a hard place. With overhead repetitive movements they are pinched between the ball and socket below and the AC joint above (acromioclavicular joint-collar bone, etc).

Rotator cuff problems can come on gradually with repetitive overhead use or more suddenly with an injury. The range of problems can vary from minor irritation, fraying and partial tears, to complete tears. An Orthopaedic Surgeon or Sports Medicine Specialist can usually make the diagnosis after they hear your story, examine you, and take some x-rays. In some instances an MRI Scan is needed especially if improvement does not occur with some simple measures.

Treatment involves avoidance of overhead activity, anti-inflammatory medication, rehabilitation exercises and occasionally a cortisone injection. Improvement can take months. Chronic tendinitis and impingement syndrome can be treated with arthroscopic surgery and even small rotator cuff tears can be repaired through the scope. The larger tears may need traditional open surgery. Your first step is to get an accurate diagnosis and see if it is indeed a rotator cuff problem or possibly other conditions such as a labral tear, instability or other shoulder problems. Sometimes shoulder pain can come from problems in your neck or cervical spine area.