What is shoulder pain?
Shoulder pain is any pain or discomfort affecting the shoulder or surrounding areas. The shoulder is the body’s most mobile joint and enables the arm to have a wide range of motion. Shoulder pain is very common, and most people will experience shoulder pain symptoms at some point in their lives.
The shoulder consists of the upper arm bone (humerus), collarbone (clavicle), and shoulder blade (scapula), along with muscles, ligaments and tendons, nerves, and blood vessels. Any of these structures can become irritated, injured or inflamed resulting in shoulder pain. Shoulder pain causes can include minor muscle strains, repetitive use injuries, and repeated overhead motions, such as pitching a baseball game.
A common traumatic cause of shoulder pain is a tear of the rotator cuff, the muscles and tendons that hold the arm bone (humerus) in place in the shoulder joint. The rotator cuff creates the arm’s range of motion. When the rotator cuff is damaged, you may experience shoulder pain, limited range of motion, or weakness when moving your arm.
Shoulder pain can also result from serious conditions, such as an infection, tumor, nerve condition, arthritis, or even a heart attack. Depending on the underlying cause, shoulder pain may last briefly or persist for weeks. It may feel like a dull ache, or it may be sharp and jolting in a specific area.
Generally, shoulder pain caused by a minor condition, such as a small muscle strain, resolves by itself in a few days or weeks with basic self-care measures. This includes icing the shoulder, resting the shoulder, and taking over-the-counter pain medications.
Because shoulder pain can be a symptom of a condition that requires medical treatment, you should seek prompt medical care for unexplained shoulder pain. In some cases, shoulder pain is a symptom of a serious or life-threatening condition that requires emergency medical care, such as a heart attack or shoulder dislocation.
Seek immediate medical care (call 911) if you, or someone you are with, have a new shoulder deformity or are unable to move the affected arm. Other serious symptoms include chest pain, jaw or neck pain, shortness of breath, dizziness, and sweating.
What other symptoms might occur with shoulder pain?
Shoulder pain may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Shoulder pain may originate in the shoulder itself or may be caused by conditions that affect other body areas, such as the neck, abdomen, chest, or upper arms.
Additional symptoms that may occur with shoulder pain include:
- Back, neck or arm pain
- Clicking and other noises when you move your arm
- Grinding or popping feeling
- Muscle stiffness and weakness
- Painful movement of the arm
- Swelling (edema) of the arm
- Warmth or burning
Symptoms that might indicate a serious or life-threatening condition
In some cases, shoulder pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as a heart attack, which should be immediately evaluated in an emergency setting.
Seek immediate medical care (call 911) if you or someone you are with has shoulder pain accompanied by any of the following symptoms:
- Chest pain, pressure or tightness
- Deformity or serious swelling of the shoulder or arm
- Difficulty breathing or shortness of breath
- Difficulty moving or inability to move the arm
- Neck stiffness after an injury or trauma, such as a fall or motor vehicle accident
- Severe abdominal pain
What causes shoulder pain?
Shoulder pain can be caused by a wide variety of conditions that cause inflammation, infection, nerve compression, or injury of the shoulder. Common causes of shoulder pain include arthritis and injury caused by excessive, repetitive, or overhead motions that involve the shoulder, such as occurs with baseball pitching or construction work.
A common cause of shoulder pain is a tear of the rotator cuff, the muscles and tendons that hold the arm bone (humerus) in place in the shoulder joint. The rotator cuff also enables the arm’s range of motion. A torn rotator cuff results in shoulder pain, limited range of motion, or weakness when you move your arm.
Shoulder pain can also be caused by diseases or conditions of the body outside the shoulder area, such as heart attack or gallbladder disease. This is called referred shoulder pain.
Musculoskeletal causes of shoulder pain
Shoulder pain may be caused by injury or disease of the muscles, bones, tendons or ligaments of the shoulder, neck, or upper arm including:
- Activities involving constant, repetitive shoulder use
- Bone fractures, such as a fractured humerus (upper arm bone) or collarbone (clavicle)
- Bursitis (inflammation of fluid-filled sacs that protect joints and allow movement)
- Cervical spondylosis (degeneration of bones and cartilage in the neck)
- Fibromyalgia (chronic condition causing pain, stiffness and tenderness)
- Frozen shoulder syndrome (muscles, tendons and ligaments become stiff resulting in painful and difficult movement)
- Poor posture or keeping the shoulder in an abnormal position for long periods, such as when sleeping
- Shoulder joint dislocation or shoulder separation (tearing or stretching of ligaments)
- Shoulder or upper arm muscle strain
- Whiplash (sprained or strained neck)
Other diseases and conditions that can cause shoulder pain
Other diseases, disorders and conditions that can cause shoulder pain include:
- Gallbladder disease, such as gallstones
- Heart attack
- Infection of the shoulder joint
- Pinched nerves
- Ruptured spleen
When should you see a doctor for shoulder pain?
Sudden pain in the left shoulder can be a sign of a heart attack. Call 911 or go to your nearest emergency room for shoulder pain when:
- You have left shoulder pain that radiates from your chest or also involves the jaw, neck, back or arm.
- You have other symptoms, including cold sweat, anxiety, shortness of breath, dizziness, lightheadedness, weakness, nausea or vomiting.
- You have sudden crushing pain or pressure in the left shoulder.
You should also seek emergency medical care for shoulder injuries when:
- You cannot use your shoulder or move your arm away from your body.
- You have intense pain, swelling or bleeding.
- You have lost sensation in your arm, hand or fingers.
- Your shoulder is deformed or a bone has broken through the skin.
See a doctor promptly for shoulder pain when you have any of the following symptoms:
- Fever, redness, warmth or swelling
- Limited range of motion in the shoulder
- Pain that intensifies or changes in character, such as dull to sharp
- Pain that persists for more than two weeks despite rest and home treatment
- Pain that returns when you resume activities
How do doctors diagnose the cause of shoulder pain?
During a shoulder pain diagnosis, doctors must uncover the underlying cause of the pain. The process involves taking a medical history of the pain, performing a physical exam, and perhaps ordering tests. The exam will focus on finding tender areas, looking for swelling, and checking muscle strength and range of motion.
Questions for diagnosing the cause of shoulder pain
Your doctor may ask questions to understand the history of your shoulder pain. Questions may include:
- In what part of the shoulder do you feel pain?
- When did the shoulder pain start?
- How long does the shoulder pain last?
- Are there any activities that cause the shoulder pain?
- What, if anything, makes the pain better?
- Are you experiencing any other symptoms, such as numbness or tingling?
- Have you had this kind of shoulder pain before? How was it treated?
- Have you had any trauma to the shoulder?
- What other medical conditions do you have?
Using your answers and the exam results, your doctor may recommend testing. This could include:
- Blood tests to check for markers of infection or an autoimmune disease
- Electromyogram (EMG), which is a nerve study to evaluate how well your nerves send signals and how your muscles respond to them
- Imaging exams, such as X-rays, CT (computerized tomography) scans, MRIs (magnetic resonance imaging), and arthrograms, which is a specialized X-ray with a dye
- Arthroscopy, which is an invasive procedure doctors use to look inside the joint
It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.
What are the treatments for shoulder pain?
Shoulder pain treatment depends on the cause and severity of the pain. The goals of treatment include relieving the pain and correcting any root problem. For minor shoulder pain, doctors start with conservative treatments including:
- Immobilization with a sling to allow the shoulder to rest
- Medications to relieve pain and swelling, including NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), and corticosteroid joint injections
- Iontophoresis, a form of transdermal drug delivery (TDD), that involves administering pain medications directly to the painful joint using a transdermal patch and a mild electrical current
- Rest, ice and elevation to relieve pain and reduce swelling due to minor injuries
Physical therapy can be very helpful in treating shoulder pain. Goals include strengthening the supporting muscles, increasing range or motion, and learning how to use your shoulder safely. Physical therapists also use various therapies to relieve pain, including heat therapy, cold therapy, ultrasound stimulation, and TENS (transcutaneous electrical nerve stimulation).
In some cases, the cause of shoulder pain will require surgery. For some problems, it is a last resort. Other times, doctors recommend it earlier in the treatment plan, such as for a rotator cuff tear or recurrent dislocations.
Home remedies for shoulder pain
Self-care treatment is often effective for minor shoulder pain. Home remedies include:
- Rest: Take a break from activities that trigger or aggravate shoulder pain. Allow time for healing before resuming these activities. See your doctor if pain returns when you resume an activity.
- Ice: Apply an ice pack to your shoulder for 20 minutes intervals and repeat this several times a day.
- Elevation: Avoid lying flat and keep your shoulder elevated above your heart. This will help reduce swelling.
- Heat: If heat feels better than ice, use a heating pad or hot water bottle several times a day.
- Over-the-counter pain relievers: Take NSAIDs to target pain and swelling from minor injuries. If you cannot take NSAIDs, acetaminophen (Tylenol) may help with pain, but it will not help inflammation.
- Physical therapy exercises: Practice exercises you learn during physical therapy at home.
Alternative treatments for shoulder pain
For shoulder pain due to osteoarthritis, glucosamine and chondroitin is a popular supplement. Research on the combination has had mixed results about whether or not it really works. Many people want to give it a try to see if it helps them. Talk with your doctor before starting it, or any other supplement, to make sure there is not a reason to avoid it.
Acupuncture or dry needling are other alternative treatments that may also help relieve shoulder pain. Research suggests acupuncture may be especially helpful for people with chronic shoulder pain, such as with frozen shoulder.
What are the potential complications of shoulder pain?
Complications associated with shoulder pain and its underlying cause can be progressive. In some cases, shoulder pain may become a chronic condition and affect your daily life. Once the underlying cause is determined, following the treatment plan outlined by your doctor can help reduce any potential complications including:
- Absenteeism from work or school
- Permanent nerve damage
- Poor arm and shoulder movement
- Poor quality of life