The shoulder is a complex part of the body made of multiple tendons, ligaments, muscles, and a ball socket bone construction. Pain around the shoulder blade and shoulder injuries can be very uncomfortable and are easily aggravated by movement. If you have any type of shoulder injury or pulled shoulder muscle, you will certainly know about it. Shoulder pain and injuries can greatly hinder your ability to move freely and without discomfort.
What Causes Shoulder Pain - Overview
There are many causes for shoulder pain. Shoulder pain can be caused by inflamed tendons, pulled muscles, a damaged rotator cuff, and even injury to other parts of the body such as the arm or neck. Some of the most widespread shoulder pain causes are arthritis, cuff tendinitis, rotator cuff impingement or damage, or a condition called bursitis, which is caused by the formation of a fluid sac underneath the top part of the shoulder.
Most shoulder injuries are caused by sports, weightlifting, strenuous exercise, or lifting heavy objects.
But where do we draw the line between common shoulder injuries and what could be a more serious cause of pain in the shoulder? In this guide, we’ll explore several different shoulder pain causes, starting with the most common, low-risk causes and working our up to serious conditions that require you to seek medical attention.
Whether you’re dealing with shoulder pain for the first time or seeking shoulder pain relief for a chronic issue, this guide should help you determine the cause of your shoulder and arm pain and point you in the right direction as far as shoulder pain treatment and prevention. But first, let’s look at the anatomy of the shoulder, which will help you pinpoint the exact cause of your pain as well as help you describe it to a physician.
Categories of reasons for shoulder pain
Most causes of shoulder pain can be classified into four key categories.
- Tendon inflammation (bursitis or tendinitis) or a tendon tear
- Instability of the shoulder
- Fracture (broken bone)
Other less widespread causes of shoulder pain include tumors, infection, and nerve-related issues.
Let’s explore some of the most common causes of shoulder joint pain from the lowest risk types of causes to the highest.
Low Risk Shoulder Pain Causes
1. Acromioclavicular (ac) joint injuries (mild)
The AC joint has minimal mobility. Therefore, any overzealous movements can cause injury. A mild AC joint injury can be caused by a traumatic event, like a fall or merely by moving a certain way as you get out of your car. These intensity of the injury depends upon the degree of separation of the joint.
Symptoms of an AC joint injury include general neck and shoulder pain, loss of shoulder strength, a visible bump above the shoulder, and a shoulder popping sound when one moves. The condition can be diagnosed with a shoulder exam or an ultrasound. Shoulder rehab exercises are one of the most effective forms of treatment, along with education on prevention. If you’re performing exercises on your own, remember that shoulder exercises for women are slightly different from those for men because women naturally have less tendon strength in the shoulder area.
2. Adhesive capsulitis of shoulder
Adhesive capsulitis of shoulder is more commonly known as frozen shoulder. The exact cause of frozen shoulder is not fully understood but there are several factors that might play a hand in its development. Individuals with diabetes have a higher risk of developing frozen shoulder, along with those who have been diagnosed with hypothyroidism, hyperthyroidism, cardiac disease, and Parkinson’s disease. It is also thought that immobilization of the shoulder for prolonged periods (lying or sitting in the same position for long periods of time without moving) can lead to a frozen shoulder.
With adhesive capsulitis, the pain is usually dull and located in the outer shoulder area and upper arm. If you would describe your pain as either right shoulder blade pain or left shoulder blade pain, a frozen shoulder could be the problem. X-rays are sometimes used to diagnose the condition. Treatment focuses on pain management, as a frozen shoulder condition usually resolves on its own. But for some individuals, the condition can persist for years. Steroid injections can be administered for serious cases and shoulder exercises are always recommended.
3. Arthritis of the shoulder
Arthritis is often used as a blanket term for joint pain but there are several different types of arthritis, all of which require unique treatment. Arthritis of the shoulder presents as right shoulder pain, left shoulder pain, or a pain in both shoulders that is worsened by activity. The location of the pain varies based on the specific joint affected. If the glenohumeral joint is affected, the pain will be in the center of the shoulder. Arthritis in the ACJ is felt on the top of the shoulder most times but pain in the right side of the neck or left side can occur as well.
You will have limited movement of the shoulder if you have arthritis of the shoulder. Sleeping can become difficult because the shoulder may begin to grind as you sleep or as you move in your sleep during the night, which only worsens the pain of arthritis. Or, you might hear a disturbing shoulder clicking sound when you move. Although this clicking may sound somewhat frightening, know that it is a very common symptom of many less serious shoulder problems.
Nonsurgical treatments for this type of arthritis involve getting adequate rest, shoulder pain exercises, heat and ice treatments, and corticosteroid injections. If your pain has severely limited your daily activities and overall quality of life, there are surgical options.
4. Biceps tendonitis
A deep, throbbing pain in the anterior shoulder could be a sign of bicep tendonitis. The condition can be defined as inflammation of the tendon of the biceps muscle and is similar to a pulled shoulder muscle. Shoulder tendonitis can be caused by extreme repetitive movements, making it common with athletes. It is also a symptom of aging as well.
Ultrasounds are typically used to diagnose tendonitis as it provides more information on the condition of the tendon than examination or x-rays can. Rest is the best tendonitis treatment, along with physical therapy or corticosteroid injections for severe cases where there is a lot of discomfort present. If there is severe damage to the shoulder tendons or traditional treatments show little to no improvement, surgery is an option.
5. Rotator cuff tendinitis
Rotator cuff tendinitis, also called simple tendonitis, occurs when the tendons and muscles attached to the shoulder joint are inflamed or injured.
Tendonitis most frequently arises in individuals who engage in sports that constantly require extending the arm above the head. Many people with rotator cuff tendinitis recover without any pain after treatment.
Rotator cuff tendinitis is also referred to as impingement syndrome. Shoulder impingement occurs when the top of the shoulder blade (acromion) exerts pressure on the underlying soft tissues when you lift your arm away from the body.
Impingement means that as you lift the arm, the acromion rubs, or "impinges" on, the rotator cuff tendons and bursa. This can result to bursitis and tendinitis, causing pain and making it difficult for you to move the hand. Eventually, serious impingement can result in a rotator cuff tear.
RC tendinitis normally develops gradually. It can result from resting your shoulder in one position for too long a long time, for example when sleeping in the same position every night or taking part in activities that require raising your arm above your head, like swimming, tennis, volleyball and weight lifting, especially.
This is why this condition is often known as
- swimmer’s shoulder
- pitcher’s shoulder
- tennis shoulder
Frequently, rotator cuff tendinitis can occur without any identifiable cause. Many people with rotator cuff tendinitis are capable of regaining normal function of the shoulder without any pain.
The early symptoms of rotator cuff tendinitis can be managed simply with rest, but over time, the symptoms typically worsen and the condition becomes extremely painful and exasperating. Symptoms that extend beyond the elbow normally signify a different type of shoulder problem or problem with another area of the body, like the neck.
The most common symptoms of rotator cuff tendinitis are
- pain and swelling in the front part of your shoulder and side of your arm
- pain activated by lifting or lowering your arm
- a clicking sound when lifting your arm
- pain that disturbs your sleep
- pain when trying to reach your back
- immobility and loss of strength in the arm affected
6. Impingement syndrome of rotator cuff
Although some people with rotator cuff tendinitis develop impingement syndrome, some individuals have the impingement syndrome only. As the name suggests, this condition occurs when the tendons in the shoulder are impinged upon (rubbed upon, grinded upon) from one of the shoulder bones.
The most common cause of impingement syndrome is participation in sports and activities that involve lots of arms over the head kind of work, like swimming and weight lifting.
Pain is usually persistent and makes daily activities difficult. If not treated, the syndrome can lead to inflammation of the rotator cuff tendons, causing thinning and tearing in extreme cases.
If you have difficulty reaching up behind your back or experience pain when lifting your arm up, impingement syndrome or acromion pain could be to blame.
Diagnosis requires a physical exam with a shoulder impingement test and sometimes x-rays. Treatment focuses on pain relief using anti-inflammatory medications and resting the shoulder as much as possible. Healing can take up to eight weeks.
7. Myofascial pain syndrome
Myofascial pain syndrome is characterized by shoulder tenderness, shoulder muscle pain, and spasms. The cause of the syndrome is unknown, but there are common underlying conditions that are believed to play a role in its development, like depression, poor sleep, prior shoulder injuries, and stress.
With myofascial pain syndrome, pain is typically localized to one arm, and stiffness typically worsens with inactivity. Myofascial pain is treated in several ways, typically with medication or physical therapy.
Both over the counter and prescription pain medication may be prescribed for myofascial pain syndrome. Then it is recommended that the patient work with their medical provider to come up with a plan for lifestyle changes, like lessening stress, exercising, and eating a healthy diet. The syndrome is not permanent and can be reversed, but for individuals who are reluctant to make significant lifestyle changes, chronic shoulder pain can last for several years.
8. Neck sprain
Neck sprains occur when any of the ligaments or muscles in the spinal column are overstretched or torn. Car accidents are a common cause of neck sprains, along with falls that bend the neck muscles in an unnatural manner.
Symptoms include pain in the back of the neck that peaks about 24 hours after an injury, pain in the upper shoulder region, a sore throat, difficulty concentrating, and numbness in the arms or hands.
A physical exam is required for proper neck sprain diagnosis, and it is important that you get one to ensure that the injury is not a break rather than a sprain.
A neck sprain is treated just like any other sprain. Over the counter pain relievers are typically advised and a shoulder ice wrap can be used to minimize swelling. Massage and exercises for shoulder pain can also be effective, if recommended by your doctor. A soft neck brace can also help speed up the healing process. The sprain should resolve in a little more than a month with proper treatment.
9. Shoulder contusion
A shoulder contusion (bone bruise) is typically caused by an injury. Symptoms include localized pain, swelling, and bruising. Depending on the severity of the injury, a sore shoulder could last anywhere from several days to several weeks.
A sling is the best treatment for a shoulder contusion, along with icing the area to prevent swelling. Over the counter pain meds like aspirin are advised for pain.
Eventually, exercise can help with the healing of a contusion, but only when recommended by a doctor. It’s not uncommon for pain to worsen before noticing improvement with a shoulder contusion but call your doctor if the pain consistently gets worse, your fingers or hand become cold, numb, or blue, or if you feel as if your shoulder is popping out.
10. Shoulder strain
There are a variety of causes behind shoulder strains. Falls, osteoarthritis, rheumatoid arthritis, and tendinitis are all possible reasons for this type of shoulder pain. Symptoms include swelling, bruising, or redness in the injured area, constant pain (even while resting), weakness of the muscles in the shoulder, and not being able to move the shoulder.
An x-ray is typically needed for a proper diagnosis. Treatment includes anti-inflammatory drugs, heat and cold therapy, and physical therapy to regain strength. With advanced strains, surgery may be recommended, but this is highly unlikely.
Moderate Risk Shoulder Pain Causes
11. Acromioclavicular (ac) joint injuries (more serious grades)
We’ve already discussed less serious ACJ injuries. More serious grades of the condition require regular treatment as the discomfort can continue to worsen over time. Rest, physical therapy, and over the counter pain medications can all help to alleviate some of the pain and discomfort of advanced ACJ, but more drastic options may be needed if your pain is constant and severe.
Steroid injections are sometimes advised to treat severe pain, and these injections help alleviate pain by reducing swelling and improving mobility in the shoulder.
Surgery is also an option for severe cases. During surgery, loose pieces of damaged cartilage can be removed and the joint can be modified to reduce friction. In some cases, a small piece of the clavicle is removed to lessen friction as well. With the right treatment plan, pain management can be a success.
Bursae are small, fluid-filled sacs that are situated in joints all through the body including the shoulder. They function as cushions between bones and the surrounding soft tissues. They help to minimize friction between the gliding muscles and the bone.
Occasionally, overuse of the shoulder results in inflammation and swelling of the bursa between the rotator cuff and the section of the shoulder blade referred to as the acromion. This lead to a condition referred to as subacromial bursitis.
Bursitis frequently accompanies rotator cuff tendinitis. With bursitis, a number of tissues in the shoulder can get inflamed and cause pain. You may find it difficult to carry out most day to day activities like combing of hair or getting dressed.
13. Acute and Chronic Shoulder Tendinitis
Over time, tendinitis can become more advanced..
In general, more advanced cases of tendinitis can be classified into one of two categories:
- Acute tendinitis: which is typically caused by repeat actions, such as throwing a ball or other activities requiring one to raise their arms over their head.
- Chronic tendinitis: is typically caused by degenerative diseases like arthritis or repetitive wear and tear on the shoulder joint as a result of aging.
Therapy for tendinitis usually focuses upon regaining range of motion in the shoulder through exercises and physical therapy, lessening pain through either prescribed pain medication or over the counter pain medications, using anti-inflammatory drugs and cortisone injections to ease inflammation in the shoulder area, and frequent appointments with a doctor to monitor progress of the healing and to strategize any further needed action.
For very severe cases of tendinitis, surgery is sometimes recommended but only if and after every possible attempt is made to alleviate pain and discomfort through less drastic actions.
14. Bicep Tendon Injury and Tears
Shoulder muscles are attached to bones with tendons. If you tear the biceps tendon in your shoulder, you might find yourself with less strength in the affected arm and the inability to turn your arm from palm down to palm up.
The split and tear of tendons can result from acute injury or degenerative changes in the tendons. This is usually caused by increasing age, long-term overuse and wear and tear, or a sudden injury.
Bicep tendon tears can either be partial or complete. Most are partial, where the tendon is not completely severed. But without treatment, the tendon can continue to tear and eventually separate into two pieces. This is, of course, very painful and eradicates all possibility of movement at that point.
In many instances of complete tears, the tendon pulls away from its site of attachment to the bone. Rotator cuff and biceps tendon injuries are among the most widespread types of these injuries. Injury and overuse of the shoulder are the most common causes.
Symptoms of a bicep tear include sudden and sharp upper arm pain accompanied by an audible snapping noise, bruising from the middle of the upper arm that goes towards the elbow, and a bulge in the upper arm above the elbow.
A physical exam is typically all that’s needed to diagnose a biceps tendon tear. Treatment includes applying ice several times a day to the injured area, resting the arm and shoulder, pain medications (over the counter or prescribed, depending upon the severity of the pain and doctor’s recommendations) to lessen discomfort, and physical therapy to restore movement. Surgery is rare but could be needed for a severe tear or one that keeps reoccurring.
15. Brachial plexopathy
Brachial plexopathy is caused by a nerve problem in the neck and shoulder area. If there is damage to the brachial plexus, an area found on both sides of the neck containing nerve roots from the spinal cord, brachial plexopathy can develop.
Causes of the brachial plexopathy include birth defects that put pressure on the nerves, exposure to toxins, and inflammatory conditions.
Symptoms include numbness of the shoulder, hand, or arm, generalized shoulder pain, weakness, and tingling or burning in the injured area.
Blood tests and x-rays are usually needed to diagnose brachial plexopathy.
Treatment focuses on addressing the underlying cause.
You can recover on your own from brachial plexopathy. But for those who don’t notice an improvement in due time, physical therapy is often advised.
With brachial plexopathy, over the counter pain medications are usually enough to lessen pain and enable movement of the shoulder without much discomfort. If not properly diagnosed and treated, however, deformity of the arm or hand can occur along with partial arm paralysis.
If you’re experiencing pain along with tingling and weakness in your shoulder, seek medical attention.
16. Cervical radiculopathy
Cervical radiculopathy is more commonly known as a pinched nerve. This condition occurs when a nerve in the neck is irritated or compressed, forcing it to branch away from the spinal cord.
The pain of a pinched nerve tends to radiate into the shoulder and cause muscle weakness and numbness that can reach through the arm and into the hand. Arthritis is a common cause for a pinched nerve in the shoulder, but pinched nerves often occur because of injuries as well.
A common symptom described by those with pinched nerves is a “pins and needles” sensation in the affected area.
If you suspect a pinched nerve problem, try placing your hands on topof your head. If the pain decreases, a pinched nerve is most likely the cause of your discomfort.
Treatment is normally not necessary, with the condition improving on its own with time. To manage pain, over the counter pain medications are advised along with cold and heat treatments. Physical therapy is an option for stubborn cases of pinched nerves and, in rare cases, surgery might be necessary to relieve the discomfort for good.
17. Recurrent subluxation of shoulder (Partial to Recurrent Partial Dislocation of the Shoulder)
Shoulder instability is typically caused by a sudden injury or through repeated motions. Shoulder instability, also called a partially dislocated shoulder, occurs when the head of the upper arm bone is forced out of the shoulder socket. Shoulder dislocations can be partial, when the ball of the upper arm comes out just partially out of the socket. When this happens, it is known as a subluxation. If the shoulder continuously slips partially out of place, it is known as recurrent subluxation of the shoulder.
Signs of this condition include consistent shoulder pain, repeated dislocations, repeated occurrences of the shoulder giving out during activities, and a persistent loose feeling in the area. Repeated episodes of subluxations can lead to an increased risk of developing arthritis in the joint.
An MRI can help diagnose shoulder instability.
For treatment of subluxations, nonsurgical options are always recommended first, such as modifying activities to lessen the risk of shoulder dislocation, and exercise and physical therapy to improve strength in and range of motion of the joint. When shoulder ligaments are extremely damaged, surgery is sometimes recommended. Physical therapy is also necessary when recovering from these types of surgeries to help the patient regain as much mobility as possible.
18. Repetitive shoulder strain injury
Repetitive strain injuries are some of the most common injuries of all kinds seen by hospital physicians. Shoulder strains caused by repetitive actions are very common, especially in individuals whose careers involve repeated lifting of objects or in athletes who challenge the shoulder muscles in the same way every day. Repetitive shoulder strains can be caused by simple tasks such as reaching for objects high on shelves, cleaning, or throwing a ball.
Signs of a repetitive strain injury in the shoulder include burning, aching, and shooting pains along with tremors, clumsiness, and numbness. Weakness in the hands and forearmcan make it nearly impossible to perform simply tasks, like opening doors or writing. Cold hands are also common, especially in the fingertips.
Causes of a repetitive strain injury include fast and repetitive movements, working in cold conditions, and not allowing the body to properly recover after strenuous activities. The muscles, tendons, joints, and nerves in the shoulder can all be damaged with a repetitive strain injury. Catching a repetitive strain injury early is crucial. When left untreated, pain can become permanent.
Repetitive shoulder strains are treated much in the same way as shoulder tendinitis or bursitis. Doctors recommend the individual avoid further strain to the area, seek relief with over the counter pain meds, and may prescribe anti-inflammatory drugs to ease swelling and inflammation at the shoulder site. A physical therapist is typically recommended to help the individual regain a full range of motion with these types of strains. Warm water soaks in Epsom salts can also help reduce stiffness and ease the pain of shoulder strains.
Arthritis is another common cause of shoulder pain. There are different types of arthritis. The most widespread type of arthritis in the shoulder is osteoarthritis, which is also referred to as "wear and tear" arthritis. With this type of arthritis, the most common symptoms are swelling, pain, and stiffness. The typical onset of osteoarthritis is middle ate and after.
Osteoarthritis develops gradually with pain that increases as the condition worsens over time.
Osteoarthritis may be connected to sports or work injuries and acute wear and tear on the shoulder joint. Other types of arthritis can be caused by rotator cuff tears, infection, or an inflammation of the joint lining.
Frequently, individuals are advised to avoid shoulder movements that strain the shoulder area to reduce arthritis pain. This lack of movement, however, occasionally results in a tightening or stiffening of the soft tissue parts of the joint, leading to a painful limitation of movements.
20. Rheumatoid arthritis (RA)
.Rheumatoid arthritis is an autoimmune disease that usually affects the hands and feet first but can attack the shoulder joints as well. RA causes joint problems and can cause pain, stiffness, and greatly limit movement in the part of the body affected.
The cause of rheumatoid arthritis is an autoimmune condition. With these types of diseases, the immune system mistakes the body's own cells for invaders. Rheumatoid arthritis occurs when antibodies improperly attack your own bodily tissues, causing an inflammation response. Painful swelling occurs that can cause joints to become deformed and which can lead to bone erosion as well.
Other symptoms of rheumatoid arthritis include fevers and fatigue.
There is no cure for rheumatoid arthritis and for some, symptoms come and go. Care by a rheumatologist is recommended to deal with symptoms and discomfort.
21. Rotator cuff tear
As discussed above, the rotator cuff is a group of four muscles that cover the head of the humerus. They attach the bone to the shoulder blade, allowing you to lift and twist your arm.
Rotator cuff pain is caused by a tearing of the supraspinatus muscle, which lies on top of the shoulder. Its tendon moves under the bone on the outside of the shoulder (the acromion). This tendon is one of the most frequently torn because of its location between the bones. While the tendon tears, it becomes sore and swollen and can then become stuck between the shoulder bones. It can as well damage the sac of fluid that cushions the tendon.
The rotator cuff is a common site of shoulder injuries. The most common injuries to the rotator cuff are tears, strains, tendinitis, and bursitis.
A rotator cuff tear can weaken the shoulder and make daily activities very painful.. Several factors can cause one of the rotator cuff muscles to tear, including repetitive stress from repeating the same motions, a lack of blood supply, and bone overgrowth that occurs with age.
How to know if you are having rotator cuff pain
If you have a rotator cuff injury, you will typically notice that your pain is located in the front or on the outside of the shoulder. This pain is usually worse when you raise your arm or lift something above your head. The pain can be very severe, so much so that it can prevent you from performing even the simplest of tasks. Rotator cuff tears are usually very painful at night because lying down stretches many of the muscles in this area and the pressure of the mattress against the torn cuff can aggravate the tear and can keep you from sleeping comfortably.
Symptoms of Rotator Cuff Tear
Rotator cuff tear symptoms include pain that doesn’t lessen during rest or shoulder pain at night, shoulder pain when lifting an arm, and a crackling sensation when the shoulder moves. A rotator cuff injury test or a drop arm test could be needed for diagnosis. Sudden tears are usually more painful than gradual tears. A rotator cuff tear requires treatment or it will continue to get worse. For most, adequate rest, strengthening exercises, and performing rotator cuff stretches is enough to heal the tear. For some, steroid injections can alleviate rotator cuff pain. If your torn rotator cuff symptoms last more than six months, surgery may be recommended to alleviate discomfort and restore range of motion. Of course, physical therapy is most helpful, even if surgery is not necessary, to overcome rotator cuff injuries of all kinds.
What causes a rotator cuff injury?
Rotator cuff injuries can vary from mild to severe. They usually fall into one of three categories.
Tendinitis is an injury caused by excessive use of the rotator cuff. This makes it get inflamed. Tennis players, who make use an overhead serve and painters who need to reach upward to carry out their jobs regularly suffer from this injury.
Bursitis is another widespread rotator cuff injury. It’s caused by inflammation of the bursa. These are fluid-filled sacs that are situated between the rotator cuff tendons and the underlying bone.
Rotator cuff strains or tears often result from excessive use or acute injury. The tendons that link up muscles to bones can overstretch (strain) or tear in part or entirely. The rotator cuff can also strain or tear after a fall, a car accident, or after a sudden injury. These injuries basically result to intense and instant pain.
Whiplash occurs when a person’s head moves backward and then forward suddenly with great force. Whiplash is actually the result of the muscles and ligaments of your neck extending beyond their standard range of motion.
Whiplash is often associated with neck injuries, especially from a rear-end car collision during car accidents. It can also result from physical abuse, sports injuries, or amusement park rides. But the injury can also cause general or front shoulder pain, similar to the way a neck strain would. Besides the expected symptoms of neck pain, neck stiffness, headache, dizziness, and other such common symptoms, whiplash can also cause pain in the shoulders, arm pain and heaviness, sleep disturbances, and depression. Whiplash is often viewed as a relatively mild condition, but it can result in long-term pain and discomfort.
In mild cases, whiplash and all associated symptoms will improve in a few weeks, while severe cases usually require three months of healing time. Treatment is noninvasive and involves applying ice to reduce inflammation, taking over the counter pain medication, and completing exercises to improve muscle strength. Surgery is almost never recommended for whiplash injuries.
High Risk Shoulder Pain Causes
23. Septic arthritis
Septic arthritis is caused by bacterial, viral, or fungal infections in a shoulder joint. The infection attacks the fluid within the joint, causing severe inflammation and pain. Though anyone can develop the infection, those who are taking immune-suppression medication, abusing intravenous drugs or alcohol, have diabetes, sickle cell disease, or immune deficiency disorders are more at risk.
Symptoms of septic arthritis include fever, chills, joint pain, swelling, stiffness, and warmth in the infected area. If you have any of the previously listed conditions or risk factors and are experiencing these symptoms, seek medical attention immediately as septic arthritis is a very serious condition that can result in death.
To confirm a diagnosis, some joint fluid will need to be removed and analyzed for infection. Treatment typically involves antibiotics and joint fluid drainage. If the infection is treated quickly, there is little risk for permanent joint damage.
Fractures are broken bones. Shoulder fractures frequently involve the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade).
Shoulder fractures in older patients commonly occur as a result of a fall from standing height. In younger patients, shoulder fractures are frequently caused by a high impact injury, such as a motor vehicle accident or contact injuries during sports, like football.
Fractures frequently result in serious pain, swelling, numbing at the break site, and bruising on the shoulder.
Clavicle fractures are common, typically occurring during a fall onto the shoulder. The pain can be quite severe and will make it nearly impossible to move your arm. Symptoms include a sudden sagging of the shoulder in a downward motion, the complete inability to lift the arm, a grinding sensation when you do try to move the arm, and a dent or bump where the suspected break is located.
If the break is bad enough to have significantly shifted bone pieces, surgery may be recommended. Plates and screws are often needed to hold the bone fragments in the correct place. Follow-up after treating a clavicular fracture is necessary to ensure the bone has healed properly.
25. Dislocated shoulder
A dislocation occurs when a bone slips out of a joint. You dislocate your shoulder when the top of your arm bone slips or pops out of the shoulder joint. Shoulders are one of the most common sites of dislocation because the shoulder has such a high range of mobility, but this very quality makes it the easiest to dislocate as well.
In a partial dislocation, or subluxation, the top of the humerus partially comes out of the socket. A complete dislocation is diagnosed when the humerus has completely separated from the socket.
If you suspect you have dislocated your shoulder, you should seek medical attention immediately. If you leave a dislocation untreated, it could damage your ligaments, nerves, or blood vessels of the arm and shoulder.
A separated shoulder or dislocated shoulder will cause severe shoulder pain and a feeling of unsteadiness in the shoulder along with swelling, numbness, and bruising.
In severe cases, there can be damage to nearby ligaments and tendons as well. Treatment includes placing the humerus back in the joint socket, which should immediately reduce pain, followed by the use of a sling, plenty of rest, and using a shoulder ice pack. Physical therapy is often required to gain full mobility of the shoulder again.
26. Heart Attack
Chest pain might be the first symptom that comes to mind when thinking of a heart attack but shoulder pain is quite common with heart attacks. Shoulder pain in the left shoulder, specifically, is one symptom of a heart attack but there are indicators you should look for to know for sure. If there is burning, squeezing, tightness, or pressure in your shoulder along with a gradual increase of pain in the left shoulder blade or surrounding area over several minutes, your shoulder pain could be a sign of a heart attack. Look for other symptoms, like sudden nausea, cold sweats, or problems breathing along with pain that moves to the back, neck, jaw, or left arm.
If your pain is concentrated in only one spot and becomes sharp when coughing or sneezing, your shoulder pain is most likely due to shoulder injury, not heart attack. If you’re experiencing pain in the right shoulder only, a heart attack is not the likely cause. However, if you believe your shoulder pain is an indicator of a heart attack, dial 911 immediately. Please also read our articles on chest pain and heart attack
Osteomyelitis is more commonly known as a bone infection. It can be caused by bacteria or fungi. The infection can strike both young and old, with children experiencing the condition in their arms or legs while adults’ experience the pain in the hips, spine, and feet. If not properly and quickly treated, osteomyelitis can lead to permanent bone damage.
Symptoms include fever, chills, redness in the infected area, drainage from the area, and stiffness or the inability to use the affected limb or area. Diagnosis involves a physical exam, a blood test, or a bone scan. Antibiotics are normally all that’s needed to cure osteomyelitis, but in severe cases, surgery may be required. Those more likely to experience osteomyelitis are diabetics, intravenous drug users, smokers, and those with sickle cell anemia, peripheral arterial disease, and artificial joints.
28. Thoracic outlet syndrome
The space between your collarbone and first rib is called the thoracic outlet. When the blood vessels or nerves in this space become compressed, the pain might lead you to believe you have a broken collarbone, but it’s most likely thoracic outlet syndrome. The increased pressure can cause shoulder, neck, and arm pain along with tingling in the hands. There are several causes for thoracic outlet syndrome, including injury, repeated overhead movements, and poor posture.
One of the more obvious symptoms of thoracic outlet syndrome is having hands or arms that feel cold to the touch. You might also be unable to lift objects over your head, no matter how light their weight. A physical exam and MRI are typically needed for a proper diagnosis.
Treatment begins with pain management using over the counter pain medication. Thrombolytic drugs are sometimes needed to dissolve blood clots if they have formed from the compression. Physical therapy exercises can eventually relieve the pressure in the thoracic outlet, but in extreme situations, surgery may be necessary.
In most instances, most shoulder pain is a result of a self-caused injury. A little rest and strengthening is all it takes to gain back full use of your shoulder. But if you have concerns that your shoulder pain is a symptom of something more serious, you should seek proper medical attention. Losing full range of your shoulder could drastically limit your functionality and quality of life. An exam is always worth the investment in time.
Shoulder Pain Muscles and Treatments
Shoulder joint anatomy
The shoulder is one of the more intricate joints within the human body. The joint is highly mobile but many parts of the shoulder are susceptible to injury because of the joint’s lack of stability.
There are three bones of the shoulder.
The shoulder blade (Scapula)
Commonly known as the shoulder blade, this bone serves as an attachment site for several of the muscles in the shoulder used for movement.
The collar bone (Clavicle)
The clavicle, or collarbone, connects the upper arm to the skeleton. Several muscles in the chest and arms are attached to this shoulder bone.
The upper arm bone (Humerus)
If you’re familiar with the ball and socket joint of the shoulder, you should know where the humerus is. Essentially, it’sthe upper arm bone and the head fits into a rounded socket in your shoulder blade called the scapula.
This socket is called the glenoid. A group of muscles and tendons keeps your arm bone centered in your shoulder socket. These tissues are known as the rotator cuff. The cuff envelops the head of your upper arm bone and attaches it to the shoulder blade. The humerus allows you to rotate your arm around the shoulder.
Besides the three bones of the shoulder, there are three joints that give the shoulder its wide range of motion.
Glenohumeral Joint (GHJ)
The GHJ is where the humerus attaches to the scapula. It is responsible for most of movement in the shoulder and is highly susceptible to injury.
Acromioclavicular Joint (ACJ)
The ACJ has minimal mobility but is still an important joint in the shoulder. It transmits forces through the upper arm and shoulder region.
Sternoclavicular Joint (SCJ)
The SCJ can be found at the end of the clavicle, near the cartilage of the first rib. This is the joint that allows you to lift your arm over the shoulder, as you would when throwing a ball.
Understanding the anatomy of the shoulder can help you explain your symptoms to your physician. It can help you use the proper terminology, such as pain in the front of the shoulder, back shoulder pain, pain under the shoulder blade, or shoulder and neck pain, which can make all the difference between getting proper treatment and a receiving an incorrect diagnosis.
You should be aware that neck and shoulder pain can by symptoms of different problems for men and women. For example, with women, although shoulder blade pain is not the most common of ectopic pregnancy symptoms, it is considered one of the many signs of ectopic pregnancy. If you’re a woman experiencing a sharp pain in the shoulder and could be pregnant, make certain to mention this to your doctor.
Exams, X-rays, and Tests and Shoulder Pain: What to Expect
When you see a doctor, a comprehensive examination may be needed to discover the causes of your shoulder pain. Your doctor will check for physical abnormalities, swelling, deformity or muscle weakness, and check for tender areas that may be causing your shoulder pain. The doctor will observe your shoulder range of movements and strength. Your doctor may refer you to some tests to assist you identify the cause of your pain and any other issues.
X-rays are often taken to see if any of the bones that make up your shoulder joint are injured.
Magnetic resonance imaging (MRI) and ultrasound scans also be used, which can detect injuries to ligaments and tendons adjoining your shoulder joint.
Computed tomography (CT) scans may also be recommended. This tool is a combination of x-rays with computer technology to create a very detailed view of the shoulder joint.
Your doctor may order electrical studies and tests like the EMG (electromyogram), to evaluate the quality of nerve function in the shoulder area.
Another test that is frequently conducted is an arthrogram. This involves the use of dye combined with x-rays. The dye is injected into the shoulder for a better view of the joint and its adjoining muscles and tendons.
Arthroscopy is the use of a tiny camera to take picture of organs, bones, and tendons inside the body. Arthroscopy requires a surgical procedure to insert the camera into the shoulder area. With use of this fiber optic camera, your physician can look inside the joint itself, and will be able to detect small, soft tissue injuries that they might miss with physical examination, x-rays, and other test methods. In addition to helping your physician discover the root cause of your pain, arthroscopy can also be used to help correct the issue during surgery as well. Arthroscopy is freuqenly used when corrective surgery is performed upon shoulder tissues, such as removing of scarred tissues.
Treatment for shoulder pain commonly includes rest, changing your activities, avoiding activities which cause pain and strain in the neck or shoulder area, and physical therapy to help you regain shoulder and neck strength and flexibility.
Your doctor may prescribe anti-inflammatory medications, which will reduce swelling in the area and ease pain or may recommend prescribed or over the counter pain medications for severe pain. Another common approach to shoulder pain is to numb the pain in the area with cortisone injections or steroids, which also work to lessen inflammation.
Surgery may be necessary to tackle some shoulder injuries; however, 90% of patients with shoulder pain find relief with simple treatment methods like changing activities, rest, exercise, and medication.
Some types of shoulder pain, like recurring dislocations and a number of rotator cuff tears may not be resolved with exercise. These neck issues often require surgery during the early stage of the treatment process.