Table of ContentsView AllTable of ContentsCausesWhen to See a ProviderDiagnosisTreatmentPreventionNext in Home Office Ergonomics GuideShoulder-Strengthening Exercises
Table of ContentsView All
View All
Table of Contents
Causes
When to See a Provider
Diagnosis
Treatment
Prevention
Next in Home Office Ergonomics Guide
Reasons for why your shoulder hurts can vary, but where you feel pain can help narrow down the cause. You may have an ache from something as simple as poor posture at the computer.You may have a case ofshoulder bursitisdue to repetitive motion, a sudden injury, or even a completely different medical condition. Or, your shoulder can hurt due to:
Shoulder pain can be mild to severe and can come on suddenly or build up over time. Treatment for shoulder pain causes (fractures,tissue inflammation,ligament instability) will vary, too. These treatment options may includerest, medication, and physical therapy. In some serious cases, such as arotator cuff tear, surgery may be recommended.
This article explains some of these shoulder pain causes. It also suggests when it’s time to see a healthcare provider and the various tests they may order to help make a diagnosis and develop a treatment plan for you.
Shoulder Blade Pain Symptoms and Causes
Shoulder Pain Causes
The location of your shoulder pain can help your healthcare provider understand which part of the shoulder is affected. It can also help determine whether the diagnosis is due to a specific activity or event (likeswimmer’s shoulder) or related to a more serious condition (likebreast cancertreatment).
Anatomy of the Human Shoulder Joint
Pain Outside of the Shoulder
Several issues can cause pain on the outside of the shoulder. The most common cause is a tear in the rotator cuff, which helps lift and rotate your arm.
Rotator Cuff Problem
Fourrotator cuff musclesmove your shoulder, including thedeltoid muscle. There are four main types of rotator cuff problems:
Rotator cuff problems cause pain, especially with activities likereaching or throwing. The deep, aching shoulder pain tends to worsen or flare up at night. It can easily wake you up from sleep or make it difficult to fall asleep.
Research suggests thathigh blood pressure, as well as other heart disease risk factors, are associated with rotator cuff pain and inflammation.
Why Does My Shoulder Hurt at Night?Some shoulder issues get worse at night because the area is more compressed when you lie down. It’s common for pain from tendonitis, bursitis, and rotator cuff tears to flare up at night. It’s also possible to have shoulder pain from certainsleeping positions, such as sleeping on one’s stomach with arms overhead.
Why Does My Shoulder Hurt at Night?
Some shoulder issues get worse at night because the area is more compressed when you lie down. It’s common for pain from tendonitis, bursitis, and rotator cuff tears to flare up at night. It’s also possible to have shoulder pain from certainsleeping positions, such as sleeping on one’s stomach with arms overhead.
What Is Rotator Cuff Pain?
Frozen Shoulder
Also calledadhesive capsulitis, frozen shoulder is a common condition that leads to joint stiffness and pain, which can be constant and often occur suddenly. There is also a decrease in both active and passive range of motion.
While many shoulder conditions, including rotator cuff tendinitis, can be associated with frozen shoulder, the cause is often unknown. About 85% of people diagnosed with frozen shoulder have another medical condition, and these risk factors include:
A previous shoulder injury or surgery also can contribute to frozen shoulder.
Calcific Tendonitis
Calcific tendonitisoccurs when calcium crystals are deposited within a tendon, most commonly within the rotator cuff tendons. This condition typically causes progressive shoulder pain that is worse at night and with overhead motions, like putting on a sweatshirt.
Some people develop a chronic case of this form of tendonitis. Many others find that the symptoms resolve on their own with rest, physical therapy and pain management.
Fractured Humerus
A fracture in thehumerus,or upper arm bone, can also cause pain on the outside of the shoulder. This type of fracture may occur when you fall on your shoulder onto an outstretched arm.
Proximal Humerus Fractures
Front Shoulder Pain
Pain in the front of the shoulder is most commonly related to the biceps tendon—a tendon that attaches deep inside the shoulder. Conditions include:
Bicep Tendonitis
Biceps tendon problemsusually cause gradual pain at the front of the shoulder that can continue down over the biceps muscle.The pain often worsens after repetitive lifting, carrying heavy bags, or overhead activities. It can intensify at night.
Problems with the biceps tendon may also cause a clicking sound when the shoulder is rotated in an arc.
Biceps Tendon Rupture
A biceps tendon rupture may occur if the biceps muscle breaks free near the joint. The symptoms of a biceps tendon rupture include a sudden “pop,” along with an acute worsening of pain,bruising, swelling, and often a lump just above theantecubital fossa(in front of your elbow).
SLAP Tears
A superior labrum anterior-posterior tear is a specific type ofglenoid labrum(cartilage in the shoulder joint) tear. One common cause is a fall on an outstretched hand.
It’s also acommon tear in athletes(like baseball pitchers) who throw overhead and workers involved in repetitive overhead activities.Symptoms may include deep shoulder pain and a popping sound with movement.
Shoulder Osteoarthritis
With shoulder osteoarthritis, you can have deep shoulder pain or pain at the front of your shoulder, along with stiffness. There is generally a decrease in both active and passive range of motion.
Pinched nervesare also associated with this type of wear and tear arthritis. This can lead to additional symptoms such as armnumbness.
Fractured Clavicle
A fracturedclaviclemay cause pain in the front of the shoulder. Your clavicle is also called your collarbone. When you break this bone, you may experience sharp pain in the front of your shoulder. There may also be a decrease in range of motion and an audible snapping sound when you try to move your arm.
Top-of-the-Shoulder Pain
The most common cause of pain in the top of the shoulder is an abnormality of theacromioclavicularjoint (AC) joint. Problems of the AC joint include:
AC Arthritis
Arthritis can cause smooth cartilage to wear away, cartilage roughness, andbone spurs, which may limit mobility. Exposed bone and uneven cartilage surfaces may causecrepitus(a grinding sensation), especially when you reach overhead or across your chest.
AC Separation
AC separation, also called shoulder separation, can occur after a fall right onto your shoulder that injures the ligaments surrounding your AC joint.Depending on the severity of your ligament injury, a bump may form above your shoulder due to the separation of yourscapula, or shoulder blade, from your collarbone.
Distal Clavicle Osteolysis
Distal clavicle osteolysis causes sharp or aching pain at the end of the collarbone. It most commonly affects weightlifters or others who repeatedly lift or carry heavy objects.
The clavicle provides support to the scapula, allowing the arm to move freely. A problem with any part of this architecture can cause pain, weakness, or instability in the shoulder.
Poor Posture
Slouching or sitting with your head forward can cause pain at the top of the back side of your shoulder. This kind of pain may occur after sitting with poor posture for long periods in front of a computer or while looking at a phone.
Pain All Over the Shoulder
The tendons, ligaments, and muscles in your shoulder keep it stable. If these tissues become loose or torn, shoulder instability ordislocationmay occur.
Shoulder Instability
Multidirectional instabilitycan result from chronically loose ligaments.This condition usually affects young, athletic individuals, making it feel as if their shoulder is not staying tightly in position (subluxation of the shoulder). The sensation is often described as a “dead arm” with excessive shoulder range of motion.
Shoulder Dislocation
A dislocation is an injury that occurs when the top of the arm bone becomes disconnected from the scapula. If someone hasdislocated their shoulder, the normal ligaments that hold the shoulder in position may be damaged. The shoulder is then more likely to pop out of the joint again.
When to See a Healthcare Provider
It’s time to seek medical attention if you have new, worsening, or severe shoulder pain. Other symptoms that require attention may include:
Shoulder Pain and Heart AttackSudden shoulder pain that causes chest pain can be a sign of aheart attack. This requires immediate medical care.Shoulder pain that causes nausea can be a sign ofunstable angina, a type of heart condition that also requires emergency medical care.
Shoulder Pain and Heart Attack
Sudden shoulder pain that causes chest pain can be a sign of aheart attack. This requires immediate medical care.Shoulder pain that causes nausea can be a sign ofunstable angina, a type of heart condition that also requires emergency medical care.
Since there are many potential causes of shoulder pain, your healthcare provider will do a careful review of your symptoms, physical examination, and sometimes imaging tests to make a proper diagnosis.
Physical Examination
After reviewing your symptoms and medical history, your healthcare provider will perform a thorough exam of your shoulder. They will press on different areas of your shoulder to evaluate it for tenderness or deformity. They will also test your arm strength and your shoulder range of motion.
Your healthcare provider may also examine other areas of your body, like your neck or abdomen, to rule out non-shoulder-related causes of your pain.
Imaging
You might need one or more of the following:
Differential Diagnoses
While it seems logical that shoulder pain would stem from the shoulder, this is not always the case.
Pain in the general shoulder area, often difficult to pinpoint, can sometimes be related to aherniated discin the neck orgallbladder disease. In rare cases, shoulder pain can be a symptom of bleeding from the liver or spleen.
If your healthcare provider has concerns about another cause that’s outside your shoulder joint, they may focus on that diagnosis.
For example, anelectrocardiogram(ECG) may be ordered for a suspected heart attack. Anabdominal ultrasoundmay be ordered for suspected gallbladder disease.
Breast Cancer and Shoulder PainShoulder pain can be a symptom of breast cancer, although it’s less common. This can be due to bone pain from breast cancer that spreads to the shoulder, or from fractures due to cancer-related bone weakness. It also can happen when cancer has spread to the liver, with pain that’s felt in the shoulder.In some cases, breast cancer treatment can lead to shoulder pain.
Breast Cancer and Shoulder Pain
Shoulder pain can be a symptom of breast cancer, although it’s less common. This can be due to bone pain from breast cancer that spreads to the shoulder, or from fractures due to cancer-related bone weakness. It also can happen when cancer has spread to the liver, with pain that’s felt in the shoulder.In some cases, breast cancer treatment can lead to shoulder pain.
Can Shoulder Pain Be a Symptom of Breast Cancer?
The treatment of shoulder pain depends entirely on the cause of the problem. And while one treatment protocol may be useful for one issue, it may not be helpful (and can even be harmful) for another.
It’s vital that you seek expert medical advice before embarking on a treatment program. Not all treatments listed here are appropriate for every condition. But, some may help relieve shoulder pain given your situation.
Rest
The first treatment for many common types of shoulder pain is to rest the joint and allow the inflammation or irritation to subside. In some cases, the shoulder may be immobilized.
Use caution when resting the joint; prolonged rest can lead to joint stiffness.
R.I.C.E. Treatment for Acute Musculoskeletal Injury
Improve Posture
If you spend long periods of time sitting in front of a computer or bending over your phone, try to be aware of your posture. Sit straight in your chair and make sure your head is aligned with your screen. Stretch your shoulders. Try to correct your posture whenever you notice you are slouching.
How to Improve Your Posture Naturally
Ice and Heat Application
Ice packs are most often used to reduce swelling and pain from an acute shoulder injury. They can also be used to treat shoulder overuse injuries (for example, rotator cuff tendinitis or bursitis).
In these cases, the ice is applied right after the overhead activity to minimize the onset of inflammation. Heat pads are also used to treat chronic shoulder conditions, but generally,beforethe overhead activity is performed. Heat can relax the muscles, ease stiffness, and reduce pain.
Before applying ice or heat, talk with your healthcare provider or physical therapist. Developing a specific plan for the timing and duration of each treatment is important so that you heal properly.
Is Ice or Heat Better for Treating an Injury?
Physical Therapy
Physical therapyplays an important role in shoulder pain treatment. Your physical therapist may use different modalities to increase your strength, restore mobility, and help you return to your pre-injury level of activity.
10 Neck Stretches and Exercises for Pain, Posture, and Better Sleep
Stretching
Stretching exercises can help relieve pain while you are at home. Try placing one arm across your chest and pulling it gently with your opposite arm to stretch the back of your shoulder. Hold for 30 seconds, then switch arms.
Ask your healthcare provider about other stretches you can do at home to relieve specific types of shoulder pain. These exercises also may follow surgery, if needed to repair your shoulder.
Shoulder-Strengthening Exercises
Medications
The two most common medications used to ease shoulder pain and swelling arenonsteroidal anti-inflammatories (NSAIDs)andsteroid injections.
NSAIDs
Some NSAIDs are available over the counter (for example, ibuprofen), and others are prescribed, like Voltaren (diclofenac). These are commonly used to treat shoulder problems like arthritis, bursitis, and tendonitis.
It’s important to use them only for a short time and only under the guidance of your healthcare provider. NSAIDs present some risks, so notify your healthcare provider if you are pregnant or have any health problems like:
Steroid Injection
With a steroid injection, your healthcare provider will give you ashot of cortisone—a powerful steroid medication that reduces inflammation—into your shoulder. An injection can help reduce pain and help you engage in physical therapy sessions more easily.
Surgery
In some cases, and probably as a last resort, surgery may be needed if conservative measures are not working or if your shoulder injury is severe from the start. Shoulder surgery requires the services of an orthopedic surgeon and may involve one of several techniques, such asLatarjet surgery.
8 Types of Shoulder Surgeries
You can also try to:
Repetitive Strain Injury: Everything You Need to Know
Summary
Pinpointing the cause of shoulder pain can be a huge challenge because there are so many possibilities to consider. It helps to narrow down the region of the pain and where it feels worst: outside of the shoulder, at the front or top region, or all over.
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