Shoulder pain is a common symptom that has several possible causes. Your shoulder allows you to move your arms, and its wide range of motion makes it more at risk of injury. Some of the most common causes are arthritis, muscle strain or dislocation. Treatment could include rest, medications or surgery, but it varies by the cause.
This article covers what shoulder pain feels like, the most common reasons your shoulder may hurt, how it is diagnosed, and the solutions you can try at home or with a doctor.
What Is Shoulder Pain?
Shoulder pain is any discomfort you feel around your shoulder joint. The shoulder is one of the most mobile joints in the body, which lets you throw a ball, reach for an item or give someone a high five. Because you use your shoulder so often, it is more at risk of injury and damage, which can lead to pain.
Your shoulder is a ball and socket joint. It is actually made up of two joints (the acromioclavicular joint and the glenohumeral joint). The shoulder joins with your upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The humerus fits into the rounded socket of the scapula.
Each shoulder is held in place by a group of four muscles and tendons called the rotator cuff, which covers and protects the humerus and allows you to raise and move your arm. Strengthening these shoulder stabilisers helps prevent injuries and keeps your shoulder functioning properly. There are also ligaments that hold bone to bone, and a fluid filled sac (the bursa) that cushions the head of the humerus inside the joint.
Because there are so many parts to the shoulder, there are many reasons why your shoulder might hurt. You might injure it in a fall or accident, or you could have overdone a chore like painting. Sometimes shoulder pain comes from a condition like arthritis. It can even stem from problems in other parts of your body, which is called referred pain.
What Does Shoulder Pain Feel Like?
Shoulder pain varies based on the cause. You may feel the following when in motion or at rest:
- Weakness
- Aching or throbbing
- Stiffness
- Soreness
- Popping
Severe shoulder pain, usually the result of an injury, may cause:
- Sudden pain
- Sharp, stabbing pain
- Limited ability to move your arm
- Swelling
- Bruising
- Pain that does not go away and gets worse
- Discomfort that wakes you up or prevents you from sleeping
Depending on what is causing the pain, it can be sharp or achy. It can be sudden or come on gradually. It can also stop you from doing some of your regular activities. Using a painful shoulder could cause further damage, so it is important to find out why your shoulder hurts and get treatment as soon as possible.
Anatomy of the Shoulder
The shoulder is a joint, or a contact point between bones, that gives your arms a wide range of motion. Your shoulders are located at the corners of your torso, at the top of your arms. You have two shoulders, one on the left and right side of your body. The shoulder joint contains three bones:
- The upper part of your arm bone (humerus)
- The shoulder blade (scapula)
- The collarbone (clavicle)
Two joints within your shoulder help it move:
- Acromioclavicular joint: where the shoulder blade and collarbone meet.
- Glenohumeral joint: where the rounded top of your upper arm bone fits into your shoulder blade.
The shoulder also contains the following parts:
- Acromion: a bone at the top, outer edge of your shoulder blade.
- Bursa: a fluid filled sac within your joint that provides cushioning.
- Coracoid: a bone that extends out from the shoulder blade and attaches muscles and ligaments.
- Labrum: cartilage that stabilises the joint socket.
- Rotator cuff: muscles that sit between your shoulder blade and your upper arm bone that support and stabilise your joint.
Shoulder Pain Causes
Because the shoulder is such a complicated and busy joint, it can be easy to hurt. Most shoulder injuries are caused by overuse (repetitive use injuries), but they can also happen through force or falls.
Common Shoulder Injuries
Overuse injuries can happen when you move your shoulder the same way again and again. These are also called repetitive strain injuries. Reaching above your head, like when you are swimming or washing or painting walls, or simply moving your arm back and forth, as when you are playing tennis or gardening, can cause overuse injuries.
Bursitis happens when the bursa (a fluid filled sac that cushions your joint) gets swollen and irritated if you repeat the same motions over and over again. Bursitis can also be caused by a fall or another injury. If you have bursitis, you may notice the pain most when you move your shoulder.
Cartilage tears, called SLAP tears when they are in the shoulder, can also happen with overuse. You can injure the cartilage (the rubbery padding) that goes around the rim of your shoulder joint. With this type of injury, you might feel pain when you reach over your head, and your shoulder could seem weak. It might also feel like it is catching, locking, or grinding.
A rotator cuff tear damages the group of muscles and tendons in your shoulder that hold your arm in place and let you lift your arm overhead. You can damage it through overuse, and it also begins to show wear and tear as you age. Your shoulder may hurt at night and when you try to lift things. You might hear a crackling sound when you move it.
Impingement happens when the tendons of the rotator cuff get pinched in the bones of the shoulder. It can cause swelling and pain. If you lift your arms over your head a lot, it can set this off.
Tendinitis is when the tendons that make up your rotator cuff get inflamed. It can happen slowly over time.
A nerve injury, such as a brachial plexus injury, can happen when a group of nerves called the brachial plexus, which runs from your spinal cord through your shoulder to your arm, becomes stretched or squeezed. The nerves can even be torn away in rare cases. A minor nerve injury can cause a numbing feeling or weakness in the arm, as well as a feeling like an electric shock throughout the arm. A more severe nerve injury can cause such weakness in your arm that you cannot use it. It can also cause severe pain.
Trauma or a fall, such as a car accident, a fall onto the ground, or getting struck by something, are other ways you can hurt your shoulder.
A dislocation occurs if your shoulder is pulled back too hard or rotated too far, and the top of your arm pops out of its socket. You will feel pain and weakness in your shoulder. You may also have swelling, numbness, and bruising.
A separation affects the joint where your collarbone and shoulder blade come together, called the acromioclavicular (AC) joint. A fall or hard blow tears the ligaments holding it together. If your collarbone gets pushed out of place, you will have a bump on top of your shoulder.
A fracture happens when a bone breaks or cracks after a fall or hard hit. The most common breaks are to the clavicle (collarbone) and the humerus (arm bone closest to your shoulder). You will have a lot of pain and may get a bruise. If your collarbone is broken, your shoulder can sag and you might not be able to lift your arm.
Frozen shoulder (adhesive capsulitis) limits how much your joint will move. Abnormal bands of tissue (adhesions) build up in the joint and keep your shoulder from moving freely. Your shoulder might freeze because pain or surgery have made you use it less, allowing the adhesions to build up.
Bone spurs, also known as osteophytes, are small, smooth pieces of bone that rub up against and wear on your rotator cuff and keep your shoulder from moving the way it should. They can lead to tendinitis or a rotator cuff tear.
Poor shoulder posture and mechanics can also cause pain. How you stand and sit has an impact on how well you can move your arms. If you slouch, it can be harder for your shoulder joint to move. You might cause muscles to tighten and nerves to get pinched.
Other Causes of Shoulder Pain
Arthritis can affect your shoulder as with any joint.
- Osteoarthritis is called the wear and tear arthritis because it usually affects the joints that do the most work, like your shoulder. After a while, the cartilage can start to break down. When the cartilage breaks down enough, it cannot keep the bone from rubbing against bone anymore, which causes the pain.
- Rheumatoid arthritis usually affects more than one joint at a time. This type of arthritis causes swelling in the shoulder lining, which can trigger pain and stiffness.
- Posttraumatic arthritis can develop if you have broken or dislocated your shoulder.
Referred pain can make your shoulder hurt when there is nothing wrong with it. This can be a sign of trouble with your gallbladder, liver, or another organ.
A heart attack may be the cause if you have shoulder pain in your left arm up to your jaw, have a hard time breathing, or your chest feels tight. You might need emergency medical help right away.
Shoulder Pain Diagnosis
Your doctor will start with a physical exam to check for any structural problems and rule out anything that might involve your spine or neck. Next, they will test your range of motion to see how strong and flexible your shoulder is. That will involve moving your arms in various ways, like above your head, across your body, or behind you, and rotating it 90 or 180 degrees.
Your doctor may also recommend one or more imaging tests to get a closer look:
- X-rays can help your doctor find bone spurs, arthritis, and other bone related causes of your shoulder pain.
- An MRI scan uses radio waves and a powerful magnet to make detailed images of your shoulder.
- A CT scan is a series of X-rays taken from different angles. When they are put together, they can give your doctor a better look at what is happening with your shoulder.
- Electromyography (EMG) measures the electrical activity in your muscles to see if there are any problems with your nerves.
- Arthroscopy is a surgery that lets a tiny fibre optic camera show your doctor high definition images of your shoulder. In some cases, your doctor may also be able to treat the problem during the procedure.
- An arthrogram is an imaging test (CT, fluoroscopy, MRI, or ultrasound) done with an injected dye. First, the dye is injected into your joint, where it is absorbed to make it easier for the radiologist to see any problems in your shoulder tissues.
Shoulder Pain Solutions and Treatment
Treatment for shoulder pain varies based on the cause but could include:
- Limiting physical activities that use your arms
- Taking medications to reduce inflammation and pain
- Visiting a physiotherapist or chiropractor to align, stretch and improve your flexibility
- Immobilisation, such as keeping your arm in a sling, to limit movement while your shoulder heals
- Undergoing surgery to repair components in your shoulder or a shoulder replacement
There is not one particular shoulder pain treatment because the type of help you need depends on what type of shoulder injury you have.
Dislocated Shoulder
If you have a dislocated shoulder, it must be put back into the socket as quickly as possible to prevent complications. The most common treatment is called a closed reduction or manipulation. This must be done in the emergency department because it is easy to cause more injury if you try it yourself. The doctor, with help from another healthcare professional, physically moves your arm and shoulder back into the right position. It is a painful procedure, so you will likely need sedation beforehand.
Once the shoulder is back in place, you will need to wear a sling to keep it there and to keep your arm from pulling on your shoulder, so it does not dislocate again. Ice and over the counter pain relievers may help with the pain. You will also likely need physiotherapy. A physiotherapist will help you move your arm so that your shoulder does not get too stiff. Therapy also helps strengthen the muscles around your shoulder to protect it. If a closed reduction does not work, you may need surgery to put it back into place.
Separated Shoulder
Usually, the only treatments needed for a separated shoulder are a sling to keep you from moving it, ice packs, and pain relievers. You will also likely need physiotherapy, and your doctor will tell you when you can start lifting above your head or heavy weights. Surgery for a separated shoulder is not common, but you might need it if your separation is severe.
Shoulder Fracture
In many cases, a shoulder fracture (a broken shoulder) will heal if you keep your arm in a sling. But sometimes shoulder fractures need surgery to put the bones back together and repair any other damage. If your fracture is severe, your doctor may recommend a joint replacement, also called arthroplasty.
Rotator Cuff Tears
Rotator cuff tears can only be repaired with surgery, but not all rotator cuffs need to be repaired. If your tear is minor, your doctor will likely recommend a sling, nonsteroidal anti inflammatory drugs (NSAIDs), physiotherapy, or steroid shots.
Most Other Injuries
The first line treatment for most other shoulder injuries usually includes resting your shoulder, taking NSAIDs, and doing physiotherapy. Your doctor may recommend a cortisone shot. If these do not work, you may need surgery.
If your shoulder does not improve after these first steps, your doctor may try injecting a corticosteroid (an anti inflammatory medicine) straight into the joint to relieve swelling and pain. With any problem in your shoulder, your treatment plan will probably include exercises to help you stretch and strengthen the joint and to improve your range of motion.
Shoulder Pain Home Remedies
You can relieve mild shoulder pain at home by following the RICE method, though newer evidence suggests updated strategies for acute injury management that emphasise controlled movement over prolonged rest. RICE stands for:
- Rest
- Ice
- Compression
- Elevation
This includes:
- Taking NSAIDs (nonsteroidal anti inflammatory drugs) for pain and inflammation as directed, or taking paracetamol for pain.
- Applying an ice pack to your shoulder. Do not apply heat to your shoulder if you have swelling because heat can make it worse. Also, do not put ice directly on your skin. Make sure there is fabric between the ice and skin to prevent damage to the skin.
- Stretching your muscles.
- Massaging your shoulder.
- Resting.
Using a sling to keep your shoulder from moving can help relieve shoulder pain and also keeps the weight of your arm from pulling on your shoulder. It is important not to use a sling for too long without your doctor’s advice, as keeping your arm immobile for too long can cause other complications, like muscle weakness.
Unless you have been told not to do exercises that work your shoulder, using your shoulder could help ease the stiffness and pain of some types of shoulder injuries. Check with your doctor or physiotherapist first, because depending on the injury, exercise could make things worse.
Can Shoulder Pain Be Prevented?
Not all cases of shoulder pain are preventable, especially if they are the result of an accident, injury or underlying condition. You can reduce your risk of injuring your shoulder by:
- Wearing protective equipment
- Stopping an activity if you feel pain
- Giving your body time to rest and recover after activities
- Stretching, warming up and cooling down before and after playing sports or exercising
When to See a Doctor for Shoulder Pain
Visit a healthcare provider if you:
- Have severe shoulder pain and swelling
- Experience pain for longer than a couple of days
- Experience worsening pain
- Have limited movement and function of your arm
Signs that you need to see a doctor straight away:
- Your shoulder joint looks deformed
- You cannot use your shoulder at all
- The pain is intense
- Your shoulder swells suddenly
- Your arm or hand is weak or numb
- The pain comes with swelling, redness, or a fever
- You have pain that lasts for more than 2 to 4 weeks
- The skin around your shoulder becomes discoloured
If you have shoulder pain and any other signs of a possible heart attack (chest pain, tightness in your chest, pain radiating to the jaw, sweating, a hard time breathing), call Triple Zero (000) straight away. This is a life threatening emergency.
Takeaways
You use your shoulders a lot, and they allow you to move your arms many different ways. Because you use them so much, it is easy to injure one or both. Most shoulder injuries, especially if they are caused by overuse, can be managed at home as long as the symptoms do not get worse. But some, like a shoulder dislocation or fracture, need medical attention. Also, shoulder pain does not always mean there is something wrong with your shoulder. It is sometimes a sign of a more serious condition, like a heart attack.
