Shoulder Pain

The shoulder is the body's most mobile joint, making it particularly vulnerable to injury and pain. Shoulder pain affects people of all ages and can range from mild discomfort to severe pain that limits daily activities. Understanding the complex anatomy of the shoulder and recognizing different pain patterns helps determine the cause and appropriate treatment for lasting relief.

Quick Facts

  • Most mobile body joint
  • Common in all ages
  • Often from overuse
  • Many causes possible
  • Usually treatable

⚠️ Seek Emergency Care Immediately If Shoulder Pain Occurs With:

  • Chest pain, pressure, or tightness (may indicate heart attack)
  • Difficulty breathing or shortness of breath
  • Sudden, severe pain with visible deformity
  • Inability to move the shoulder or arm
  • Numbness or paralysis in the arm
  • Severe pain after a fall or accident
  • Bone protruding through skin
  • Signs of infection (fever, redness, warmth, pus)
  • Sudden swelling with severe pain
  • Pain radiating to jaw or left arm
  • Dizziness, sweating, or nausea with pain

Left shoulder pain with chest symptoms may indicate a heart attack. Call 911 immediately.

Understanding Shoulder Pain

The shoulder is a complex ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). These bones are held together by a network of muscles, tendons, and ligaments, including the crucial rotator cuff - a group of four muscles that stabilize the shoulder and enable its wide range of motion.

Shoulder pain can originate from any of these structures or be referred from nearby areas like the neck or chest. The pain may be sharp or dull, constant or intermittent, and can worsen with specific movements or positions. Understanding whether pain occurs during overhead activities, at rest, or at night helps identify the underlying cause.

Because we use our shoulders constantly - from lifting and carrying to reaching and throwing - shoulder problems can significantly impact quality of life. Early diagnosis and treatment are important to prevent minor issues from becoming chronic conditions that may require more intensive intervention.

Common Causes

Rotator Cuff Problems

  • Rotator cuff tendinitis: Inflammation from overuse
  • Rotator cuff tears: Partial or complete tendon tears
  • Impingement syndrome: Tendons pinched during movement
  • Calcific tendinitis: Calcium deposits in tendons

Joint Conditions

  • Frozen shoulder (adhesive capsulitis): Stiffness and pain
  • Shoulder arthritis: Joint degeneration
  • Shoulder instability: Loose joint, dislocations
  • Labral tears: Damage to cartilage rim
  • AC joint arthritis: Where collarbone meets shoulder

Inflammatory Conditions

  • Bursitis: Inflamed fluid-filled sacs
  • Biceps tendinitis: Inflamed bicep tendon
  • Polymyalgia rheumatica: Inflammatory disorder
  • Rheumatoid arthritis: Autoimmune joint disease

Other Causes

  • Neck problems: Herniated discs, pinched nerves
  • Heart conditions: Can cause left shoulder pain
  • Lung problems: Tumor, pneumonia
  • Gallbladder disease: Right shoulder pain
  • Fractures: Broken collarbone or upper arm
  • Thoracic outlet syndrome: Nerve compression
  • Referred pain: From abdomen or chest

Types and Patterns of Pain

Acute Pain

  • Sudden onset
  • Often from injury
  • Sharp or severe
  • May have swelling
  • Limited movement
  • Recent trauma

Chronic Pain

  • Gradual development
  • Lasts over 3 months
  • Often from wear and tear
  • May worsen over time
  • Good and bad days
  • Affects sleep

Activity-Related

  • Pain with overhead motion
  • Lifting triggers pain
  • Reaching behind back
  • Throwing motions
  • Better with rest
  • Specific movements hurt

Night Pain

  • Worse when lying down
  • Difficulty sleeping
  • Can't lie on side
  • May indicate tear
  • Throbbing quality
  • Position dependent

Associated Symptoms

Shoulder pain often occurs with other symptoms that help identify the cause:

  • Stiffness: Limited range of motion
  • Weakness: Difficulty lifting or carrying
  • Swelling: Visible enlargement
  • Clicking or popping: Joint sounds with movement
  • Instability: Feeling shoulder may "give out"
  • Numbness/tingling: Down arm to fingers
  • Muscle spasms: In shoulder or neck
  • Warmth or redness: May indicate infection
  • Neck pain: Often related
  • Arm pain: Radiating down from shoulder
  • Headache: With neck involvement
  • Grinding sensation: Crepitus with movement

Risk Factors

Age and Lifestyle

  • Age over 40 (degenerative changes)
  • Repetitive overhead activities
  • Poor posture
  • Sedentary lifestyle
  • Previous shoulder injuries
  • Smoking (affects healing)

Occupational and Sports

  • Manual labor jobs
  • Overhead sports (tennis, swimming)
  • Throwing sports (baseball, football)
  • Weight lifting
  • Painting or construction work
  • Computer work (poor ergonomics)

Medical Conditions

  • Diabetes
  • Thyroid disorders
  • Heart disease
  • Autoimmune conditions
  • Previous surgeries

Diagnosis and Evaluation

Medical History

  • Pain onset and duration
  • Injury or trauma history
  • Activities that trigger pain
  • Previous shoulder problems
  • Work and sports activities
  • Sleep disturbance

Physical Examination

  • Range of motion testing
  • Strength assessment
  • Special shoulder tests
  • Palpation for tenderness
  • Stability testing
  • Neurological evaluation

Diagnostic Tests

  • X-rays: Show bones, arthritis, fractures
  • MRI: Detailed soft tissue imaging
  • Ultrasound: Dynamic tendon evaluation
  • CT scan: Complex fractures
  • Arthrogram: Joint injection with imaging
  • EMG: Nerve function testing

Treatment Options

Conservative Treatment

  • Rest and activity modification
  • Ice and heat therapy
  • Physical therapy
  • Stretching exercises
  • Strengthening program
  • Posture correction
  • Ergonomic adjustments

Medications

  • NSAIDs (ibuprofen, naproxen)
  • Acetaminophen
  • Topical pain relievers
  • Muscle relaxants
  • Oral corticosteroids
  • Prescription pain medications

Injections

  • Corticosteroid injections
  • Hyaluronic acid
  • Platelet-rich plasma (PRP)
  • Trigger point injections
  • Nerve blocks
  • Prolotherapy

Surgical Options

  • Arthroscopic repair
  • Rotator cuff surgery
  • Shoulder replacement
  • Labral repair
  • Fracture fixation
  • Decompression surgery

Shoulder Exercises and Stretches

Gentle Stretches

  • Pendulum swings: Let arm hang and swing gently
  • Cross-body stretch: Pull arm across chest
  • Doorway stretch: Stretch chest and front shoulder
  • Towel stretch: Behind back for internal rotation
  • Sleeper stretch: Lying on side stretch

Strengthening Exercises

  • Wall push-ups: Start gently
  • Resistance band exercises: External/internal rotation
  • Scapular squeezes: Strengthen upper back
  • Isometric exercises: No movement strengthening
  • Light weights: Progress gradually

Note: Always consult with a healthcare provider before starting exercises, especially with acute pain.

Self-Care and Management

Immediate Care (First 48-72 hours)

  • Rest the shoulder
  • Apply ice 15-20 minutes, 3-4 times daily
  • Use a sling if needed
  • Avoid overhead activities
  • Take anti-inflammatory medications
  • Sleep in comfortable position

Ongoing Management

  • Alternate ice and heat
  • Gentle range of motion
  • Gradual return to activities
  • Maintain good posture
  • Ergonomic workspace setup
  • Regular breaks from repetitive tasks
  • Stress management

Prevention Strategies

  • Proper warm-up: Before sports or heavy lifting
  • Strengthen rotator cuff: Regular exercises
  • Maintain flexibility: Daily stretching
  • Good posture: Especially at desk
  • Proper lifting technique: Use legs, not back
  • Avoid repetitive overhead: Take breaks
  • Gradual progression: In sports or exercise
  • Ergonomic tools: At work and home
  • Stay active: Regular exercise
  • Healthy weight: Reduces joint stress
  • Listen to your body: Rest when needed
  • Cross-training: Vary activities

When to See a Doctor

Schedule an Appointment For:

  • Pain lasting more than a few days
  • Recurring shoulder pain
  • Limited range of motion
  • Weakness in arm
  • Pain that disrupts sleep
  • Swelling or deformity
  • Clicking or catching sensation

Seek Immediate Care For:

  • Severe pain after injury
  • Visible deformity
  • Cannot move shoulder
  • Numbness or tingling
  • Signs of infection
  • Chest pain with shoulder pain
  • Difficulty breathing

Related Conditions

Arthritis

Common cause of chronic shoulder pain and stiffness.

Neck Pain

Often occurs with shoulder pain due to connected structures.

Arm Pain

May radiate from shoulder problems or nerve compression.

Chest Pain

Can occur with shoulder pain in heart conditions.