Understand your shoulder pain symptoms, including 10 causes & common questions.
7 most common cause(s)
Shoulder pain symptoms
You shoulder a lot of responsibility in your life, so what do you do when the pain in your shoulder limits your ability to move?
Our shoulders have a tremendous range of motion. They are what allows us to carry a backpack, lift a child, reach for something on a high shelf, put on a coat, rake leaves, push ourselves up and out of bed and drive a car really anything that requires lifting, pushing or pulling. Ever if you've never had shoulder pain symptoms, you can see how it might impact your daily life.
Common accompanying symptoms of shoulder pain
When you have shoulder pain symptoms, you may also experience:
- Limited movement: Such as being unable to lift your arm overhead, move your arm away from your body, or be unable to rotate your arm
- Arm stiffness
- A loss of flexibility in your shoulder
- Arm weakness
- Loss of function
- Muscle spasms
- Shoulder swelling or bruising
The shoulder is made up of several muscles, tendons, ligaments, bones and nerves. Overuse, or an injury to anyone of those structures, can cause shoulder pain symptoms. Shoulder pain is most often caused by a traumatic injury, such as a car accident, a fall, or from overuse in sports. Let's look at some more specific causes of shoulder pain.
Shoulder pain causes
Muscle injury
Injury to any of the four muscles of the shoulder can cause shoulder pain. The supraspinatus (which helps to lift your arm) is the shoulder muscle most easily and most often injured. Inflammation or tears in this muscle are not uncommon in baseball pitchers, who repetitively and forcefully throw baseballs.
Tendon injury
Injury to the important tendons in the shoulder may also result in shoulder pain.
- Tendon inflammation, tears, and rupture: These injuries can also cause shoulder pain symptoms. Each of the four rotator cuff muscles are attached to bone by tendons. The biceps muscle is attached to the upper arm bone by tendons. A partial or complete tear of any of these tendons is not uncommon after an injury such as a fall or a quick and forceful movement of your arm.
- Tendonitis (inflamed or swollen tendon): This is most common in people who frequently or repetitively work with their arms over their heads. Swimmers, weightlifters and gymnasts often experience tendonitis as a result of overuse.
Brachial plexus (nerve) injury
The brachial plexus is a network of nerves in the shoulder. In addition to pain, injury to the brachial plexus may cause numbness, loss of feeling, burning, stinging and weakness in the shoulder and arm. Because the brachial plexus is well protected in the shoulder, it is not often injured. Injury which can have permanent consequences can be caused by compression or prolonged traction.
This list does not constitute medical advice and may not accurately represent what you have.
Repetitive strain injury of the shoulder ("swimmer's shoulder")
Repetitive strain injury of the shoulder is caused by consistent repetitive use.
Rarity: Uncommon
Top Symptoms: shoulder pain from overuse, shoulder weakness, shoulder numbness
Symptoms that always occur with repetitive strain injury of the shoulder ("swimmer's shoulder"): shoulder pain from overuse
Symptoms that never occur with repetitive strain injury of the shoulder ("swimmer's shoulder"): severe shoulder pain, shoulder injury
Urgency: Self-treatment
Shoulder strain
Shoulder strain means that the muscles and/or the tendons in the shoulder have been overstretched to the point of damage and sometimes partial tearing. (A "sprain" means that ligaments have been damaged.)
Because of its wide range of motion, the shoulder is a relatively unstable joint that is vulnerable to injury. A sudden overloading, especially after long periods of overuse, can finally cause some degree of tearing to the muscle fibers and/or the tendons.
Shoulder strains are most often sports injuries, or are caused by strenuous physical labor.
Symptoms include sudden sharp pain followed by swelling, bruising, and ongoing tenderness.
Diagnosis is made through patient history, physical examination, and sometimes ultrasound.
Treatment involves a short period of rest, followed by gradually increasing exercise to regain strength and prevent stiffness and weakness of the muscles and tendons. Physical therapy will be tailored to the individual and some skills, such as for sports, may need to be relearned. Improving posture while sitting, and adjusting techniques for work and sports, can help prevent recurrence of the strain.
Rarity: Uncommon
Top Symptoms: pain in one shoulder, pain in the front of the shoulder, shoulder pain from overuse, shoulder pain from an injury, sports injury
Symptoms that always occur with shoulder strain: pain in one shoulder
Symptoms that never occur with shoulder strain: arm weakness, arm numbness
Urgency: Phone call or in-person visit
Shoulder arthritis
Shoulder arthritis means that there is inflammation and abnormal wear of one or both of the two joints in the shoulder.
Arthritis in any joint is most often be caused by long-term wear and tear, called osteoarthritis; by an autoimmune condition that attacks the joints, called rheumatoid arthritis; or by an injury, called post-traumatic arthritis.
Symptoms include pain, which becomes worse with use of the joint; limited range of motion, meaning the shoulder joint cannot move as far as it once did; and pain when resting or trying to sleep.
Shoulder arthritis cannot be cured, but symptoms can be managed to improve quality of life and ease pain and discomfort.
Diagnosis is made through patient history, physical examination, and x-rays. To confirm, an injection of anesthetic may be placed into the joint. If the pain is eased, arthritis is almost certainly the cause.
Treatment involves physical therapy; nonsteroidal anti-inflammatory drugs to ease discomfort and inflammation; and corticosteroid injections into the shoulder to relieve pain. Surgery and shoulder joint replacement can be done in some cases.
Rotator cuff tendinitis
The rotator cuff is an arrangement of muscles and tendons that holds the head of upper arm bone within the shoulder socket. If these muscles become inflamed, the condition is called rotator cuff tendonitis.
The most common cause is overuse, especially with athletes or laborers.
Repeatedly throwing or swinging an object causes extensive wear on the muscles and tendons. It can also happen with an acute injury.
Symptoms include a nagging, aching pain in the upper arm and shoulder that gets worse with raising the arms or reaching backwards.
Diagnosis is made through physical examination, x-ray, and sometimes MRI.
Early treatment involves immediately stopping use of the affected shoulder, applying ice to the painful area, and taking nonsteroidal anti-inflammatory drugs such as ibuprofen to ease pain and inflammation. Careful stretching can sometimes help. Cortisone injections may be tried, as well as ultrasound and therapeutic massage.
Surgery may be advised to remove damaged tissue or any bone spurs. Follow-up care and exercises will be very important in gaining full recovery.
Pinched nerve in the neck
A pinched nerve in the neck is also called cervical radiculopathy. It means that a nerve in the neck, at a point where it branches off from the spinal cord, is being compressed by the surrounding bones, muscles, or other tissues.
It can be caused by a traumatic injury, such as from sports or an automobile accident, especially if the injury results in a herniated disk. It may also arise from the normal wear and tear of aging.
Symptoms include sharp, burning pain with numbness and tingling from the neck to the shoulder, as well as weakness and numbness into the arm and hand.
Diagnosis is made through patient history, physical examination, and simple neurological tests to check the reflexes. Imaging such as x-ray, CT scan, or MRI may be done, as well as electromyography to measure nerve impulses in the muscles.
A pinched nerve in the neck often improves with simply a few days or weeks of rest. Physical therapy, nonsteroidal anti-inflammatory drugs, and steroid injections into the spine can all be very helpful.
Rarity: Common
Top Symptoms: pain in one shoulder, spontaneous shoulder pain, pain that radiates down arm, pain in the back of the neck, severe shoulder pain
Urgency: Primary care doctor
Non-specific shoulder pain
Non-specific shoulder pain, also called NSSP, means that the cause of pain in the shoulder is not immediately obvious.
There are many structures in and around the shoulder. The pain may be from a condition or injury in the joint itself, or in any of the bones, muscles, tendons, and ligaments surrounding it. Anything from a broken arm to arthritis can cause shoulder pain.
Symptoms include pain that worsens with movement of the arm and shoulder, especially following overuse, or injury. Swelling, redness, joint deformity, inability to move the arm, or severe pain should be seen right away by a medical provider.
Shoulder pain with shortness of breath and/or pain or tightness in the chest can be signs of a heart attack. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through physical examination and through x-ray or CT scan.
Treatment usually begins with rest and over-the-counter, nonsteroidal anti-inflammatory pain relievers. Further care will be determined by medical providers once the exact cause of the pain has been determined.
Rarity: Common
Top Symptoms: shoulder pain
Symptoms that always occur with non-specific shoulder pain: shoulder pain
Urgency: Self-treatment
Frozen shoulder (adhesive capsulitis of the shoulder)
Frozen shoulder is also called adhesive capsulitis of the shoulder. The "shoulder capsule" is the strong web of connective tissue which holds the ball joint of the upper arm inside the socket of the shoulder blade. If this connective tissue is damaged, scar tissue – or adhesions – may form and cause the shoulder capsule to become tight, painful, and inflexible.
The condition can happen if an injury to the shoulder forces it to stay immobilized while healing. Additional risk factors may be diabetes, thyroid abnormalities, and heart disease.
Symptoms include gradual worsening of the ability to move the shoulder, due to increasing pain and stiffness in the outer shoulder and upper arm.
Diagnosis is made through physical examination, with simple tests to measure how far the shoulder can move, as well as imaging such as x-ray or MRI.
Treatment involves physical therapy to help restore range of motion; over-the-counter, nonsteroidal anti-inflammatory drugs to ease pain; and sometimes cortisone injections to the shoulder joint. Surgery may be needed in some cases.
Rarity: Common
Top Symptoms: spontaneous shoulder pain, stiff shoulder, dull, achy shoulder pain, shoulder pain that gets worse at night, difficulty moving the shoulder
Symptoms that always occur with frozen shoulder (adhesive capsulitis of the shoulder): stiff shoulder
Urgency: Primary care doctor
Brachial plexopathy (shoulder nerve issue)
A shoulder nerve injury, also called brachial plexopathy, is when damage occurs to a network of nerves in the front of the shoulder known as the brachial plexus. This damage can occur from injury, inflammation, radiation therapy, or other medical conditions. Symptoms include sharp pain in the shoulder, arm, or hand. Numbness or weakness in the shoulder or arm may also occur.
You should consider visiting a medical professional to discuss your symptoms. A doctor can evaluate shoulder nerve issues with a review of your symptoms and medical history. You might also be asked to do an EMG, a test that checks the connection between muscles and nerves. Once diagnosed, some options for treatment include pain or nerve block medication, physical therapy, and braces or splints. Some cases may require surgery. Depending on the severity, recovery times can range from weeks to years.
Rarity: Uncommon
Top Symptoms: pain in one arm, shoulder pain that shoots to the arm, arm weakness, numbness in one arm, shoulder pain
Symptoms that never occur with brachial plexopathy (shoulder nerve issue): pain in the front middle part of the neck
Urgency: Primary care doctor
Biceps tendonitis
Biceps tendinitis, also called biceps tendonitis, is an inflammation of one of the upper tendons of the biceps muscle in the upper arm.
The biceps is anchored at its lower end near the elbow. About halfway up the arm it divides into two parts, one a little longer than the other. One part, the "short head" or shorter of the divided muscles, attaches to the shoulder blade. The other, the "long head," attaches to the top of the shoulder.
Biceps tendinitis is usually caused by overuse, especially repetitive throwing-type motions of the arm. It is primarily a sports injury.
Symptoms include a throbbing, aching pain in the shoulder that may radiate down the arm. Any throwing, lifting, or pulling movement may produce pain in the shoulder.
Diagnosis is made through physical examination and ultrasound, and possibly with CT scan and/or MRI.
Treatment begins with rest, ice, over-the-counter pain relievers, and physical therapy. It may also include injections of local anesthetic and/or corticosteroids into the biceps tendon sheath. Surgery may be needed in some cases.
Biceps tendon rupture
The biceps muscle in the upper arm is anchored at the top by two separate tendons. One connects to the shoulder blade and one connects to the top of the shoulder joint. If one of these tendons is strained enough to completely tear it in two, this is called a rupture.
The injury is most common in people over age 40, especially after years of overuse of the shoulder. The person may have had episodes of biceps tendinitis in the past, which is a sign of fraying and damage to the tendon. In younger people it is primarily an acute sports injury, from weightlifting or from falling.
Symptoms include a pop or snap at the top of the shoulder, with sharp pain. There may soon be bruising halfway down the upper arm with obvious "balling up" of the partially disconnected muscle.
Diagnosis is made through patient history, physical examination, x-rays, and sometimes MRI.
Treatment involves over-the-counter anti-inflammatory medication; rest; ice; and physical therapy. Surgery may be done in some cases.
Rarity: Uncommon
Top Symptoms: pain in one shoulder, pain in the front of the shoulder, spontaneous shoulder pain, dull, achy shoulder pain, shoulder pain that gets worse at night
Symptoms that always occur with biceps tendon rupture: pain in the front of the shoulder, pain in one shoulder
Urgency: Primary care doctor
Shoulder pain treatments and relief
When shoulder pain is an emergency
Seek emergency medical care if you have shoulder pain symptoms and:
- Chest pain
- Persistent pain that you cannot manage at home with over-the-counter medications
- There is any possibility you have broken your collar bone
- There is any possibility you have dislocated your shoulder
- Other injury: Such as a significant head, neck, or stomach injury
At-home treatments for shoulder pain
For non-emergency conditions, the most important thing to do after any muscle or tendon injury is rest.
- Rest: Rest your shoulder by keeping your arm down, in front of you, and close to your body. Do not use a sling unless advised by a physician. A sling can limit the mobility of your arm and can cause frozen shoulder.
- Ice: Ice your shoulder for 15 minutes every few hours to reduce inflammation and pain.
- NSAIDs: Non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve) will reduce both pain and inflammation.
- Shoulder exercises and stretches: Once the inflammation subsides, you can do progressive shoulder exercises and/or physical therapy to aid in safe recovery. Stretching, range of motion exercises, heat and massage can also be helpful at this stage of recovery.
When to see a doctor for shoulder pain
Significant tears or ruptures might require surgery. The need for surgery depends on the seriousness of the injury. Shoulder surgery is not to be taken lightly. Full recovery from the surgery can take up to six months.
Prevention
Of course, your best bet is to try to prevent shoulder injuries in the first place by:
- Maintaining good posture
- Using proper body mechanics: Such as when lifting, reaching backwards, and performing repetitive movements
- Exercising regularly: Keep the shoulder and surrounding muscles (especially in your chest and back) strong and flexible with regular exercise
FAQs about shoulder pain
What causes shoulder pain?
Shoulder pain is most commonly caused by trauma to the shoulder, either acute or repetitive. Many structures within the shoulder can be damaged and will cause pain in different areas with different movements. There is also a nerve that sends pain signals from both the heart and the shoulder. Because of this nerve, shoulder pain can be "referred pain" from a disease of the heart.
What causes shoulder joint pain?
Shoulder joint pain is most commonly caused by damage to the structures of the shoulder. For example, damage to a rotator cuff can cause shoulder joint pain when the shoulder is lifted particularly above the horizontal.
How to tell if you tore your rotator cuff?
If you suspect a rotator cuff injury, you should visit a health professional to seek evaluation. Rotator cuff injuries are commonly asymptomatic they are not accompanied by any pain or loss of function immediately but you may experience pain along the outside upper-arm and weakness in lifting your arm overhead.
What causes severe shoulder pain?
Severe shoulder pain can be caused by stretching of the joint capsule by swelling or inflammation, or a ligament tear following severe trauma. If it is accompanied by loss of functionality or prolonged pain, you should seek urgent care immediately.
Can shoulder pain cause neck pain?
Shoulder pain does not cause neck pain commonly, but shoulder pain is commonly accompanied by neck pain. This means that while you may have shoulder pain by itself, an injury or action that causes shoulder pain may also injure or strain a muscle within the group of muscles that support the neck. Overhead lifting, for example, engages the shoulder, but without proper stability can cause pain in both the shoulder and the neck.
Questions your doctor may ask about shoulder pain
- How would you explain the cause of your shoulder pain?
- Can you fully move your shoulders around?
- Where exactly is your shoulder pain?
- Have you ever been diagnosed with diabetes?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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References
- Common shoulder injuries. American Academy of Orthopaedic Surgeons: OrthoInfo. Updated July 2009. OrthoInfo Link.
- Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: Diagnosis and management in primary care. BMJ. 2005;331(7525):1124-8. NCBI Link.
- Shoulder tendonitis. Cedars-Sinai. Cedars-Sinai Link.
- Brachial plexus injuries. U.S. National Library of Medicine: MedlinePlus. Updated August 18, 2016. MedlinePlus Link.
- Rotator cuff tears, injuries and treatments. Hospital for Special Surgery. HSS Link.
- Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: Part I. Evaluation and diagnosis. American Family Physician. 2008;77(4):453-460. AAFP Link.