When they’re working as they should, no one gives their shoulders any thought. But when shoulder pain strikes, it’s hard to think about anything else.
When it comes to shoulder pain, there are many different kinds. Shoulder pain can be as mild as some unpleasant stiffness, or can cause you to be almost immobilized with pain. Shoulder pain can be as benign as muscle soreness from working out, or as serious as a dislocation. Shoulder pain can be fleeting, or it can be a source of chronic pain. Shoulder pain can be simple to relieve through over-the-counter and DIY treatments, or it can require the diagnosis and care of a specialist.
Whatever form your shoulder pain takes, you’ll want to know exactly what’s causing it, and exactly how to address it. Our list of the 21 most common causes of shoulder pain can help you better understand why you’re experiencing shoulder pain and where to get help.
1. Sprain
Every joint in your body where two or more bones meet is held together by ligaments: tough, fibrous bands of tissue. When one or more ligaments are stretched or torn, a sprain occurs. Sometimes, you may hear or feel a “pop” when the injury happens, other times the only signal that you’ve experienced a sprain is intense and sudden shoulder pain. This is followed by swelling and limited movement in the shoulder. Some sprains are extensive enough to require surgery to repair the damaged ligament. But most sprains can be treated at home. According to The Red Cross, the best approach is to treat the shoulder with: rest, ice, compression, and elevation (R.I.C.E.).
2. Tendonitis
Tendonitis is also called overuse tendinopathy. While ligaments connect bone to bone, tendons connect bone to muscle. Tendonitis occurs when a frequently repeated movement causes irritation or inflammation in a tendon. Tendonitis is sometimes referred to in terms of the joint affected by overuse; common terms include pitcher’s shoulder, tennis elbow, and jumper’s knee. Shoulder pain is common with tendonitis, as is pain in the heels, knees, wrists, and elbows. Tendonitis can be recognized by dull pain and tenderness occurring on the outside of a joint, especially when moving that joint. Treatment for tendonitis is the same as the treatment for sprains: R.I.C.E. Some studies have found that treatments like shock-wave therapy or growth-factor therapy are effective. Occasionally, a doctor may recommend injecting corticosteroids (anti-inflammatory drugs), otherwise aspirin can be used to manage shoulder pain and reduce inflammation in the tendon.
3. Tendon Rupture
Tendons are tough, fibrous cords, and are strong enough to withstand a great deal of movement and stretching. In fact, tendons can withstand pressure of up to five time’s one’s body weight! But occasionally, a tendon can become partially or completely separated from muscle to which it is attached. Tendons can also become torn within the tendon itself, either fully or partially. As with tendonitis, a tendon can be torn in any joint, but the heels (especially the achilles’ tendon), the knee (especially the ACL), and the shoulder (especially the biceps tendon and rotator cuff tendon). Middle-aged men are at highest risk for a tendon rupture. If you experience a sudden and severe shoulder pain as the result of a sharp movement or heavy lifting, followed by weakness in your shoulder, you’ve likely experienced a tendon rupture. Sometimes, a popping or snapping can be heard or felt when this takes place.
4. Rotator Cuff Injury
As we’ve noted above, tendonitis or tendon rupture in the rotator cuff is a common cause of shoulder pain. But other rotator cuff injuries can occur, including contusion or tearing of any of the tendons and muscles that hold the head of your humerus (upper arm bone) in your shoulder socket. A rotator cuff injury can result from overuse of the shoulders, as in repeatedly lifting during work or exercise, or it can result from a single injury, such as a sports tackle or fall. Symptoms include shoulder pain and discomfort, which may get worse when you sleep on that side of your body. Many rotator cuff injuries cause no shoulder pain or symptoms at all; a study conducted in Japan showed that almost 17% of symptom-free adults actually had some form of rotator cuff injury. Physical therapy is the usual treatment for rotator cuff injuries, though ones involving extensive damage or acute injury may require surgery. This can mean replacing the entire joint, repairing a muscle, or transferring a tendon from another part of the body.
5. Brachial plexus injury
Just as a rotator cuff injury can cause shoulder pain, a brachial plexus injury can also cause serious shoulder pain or discomfort. The brachial plexus is the name for the network of nerves between the spinal cord and the hand, arm, and shoulder. These nerves can be damaged through compression, stretching, or tearing. Minor injuries to the brachia plexus occur frequently in contact sports like football and hockey, and athletes refer to these as “burners” or “stingers.” Infants can also receive brachial plexus injuries through compression when being born. A study published in the journal, Neurosurgery, found that the large majority of people suffering brachial plexus injuries were young and male, and many were admitted after motorcycle or snowmobile accidents. When severe, a brachial plexus injury can result in paralysis of the shoulder or arm. Treatment can include surgery, such as a nerve transfer, nerve graft, or muscle transfer.
6. Osteoarthritis
The most common form of arthritis is Osteoarthritis. In this condition, the cartilage that protects and cushions the ends of your bones in joints becomes gradually worn down. A broad survey of people affected by osteoarthritis has found that as many as 25% of the adult population in the US will have some form of osteoarthritis by 2020. With all forms of arthritis, people over 40, women, and those with a family history of the condition are more likely to be affected. Other risk factors include excessive weight and low physical activity. Osteoarthritis usually occurs in the knees, hands, hips and spine, but can also strike the shoulders, causing shoulder pain. Other symptoms include joint stiffness, swelling, tenderness, and reduced range of motion. You may find that your joints make a cracking or popping sound, or a grating sensation, and bone spurs (lumps of bone around the affected joint) can also develop.
7. Septic Arthritis
Like osteoarthritis, septic arthritis is a painful joint condition. But instead of occurring due to the breakdown of joints’ cartilage, septic arthritis results from an infection of the joint. In this condition, bacteria, fungi, or viruses can enter the joint by traveling from another part of the body through the bloodstream. In some cases, a penetration injury can introduce pathogens directly into the joint. Septic arthritis usually affects infants and older adults, though it can happen to anyone. Likewise, the knees are most commonly affected, but any joint, including the shoulder or elbow, can contract septic arthritis. Fortunately, septic arthritis is not very common; studies have found that only about 6 people per 100,000 contract the condition in developed countries. Shoulder pain, swelling, redness, and fever can be symptoms of septic arthritis in the shoulder joint. Treatment consists of antibiotics and/or drinking the fluid from the joint with a needle.
8. Rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory condition that affects the joints, along with other parts of the body. In some people, the skin, blood vessels, lungs, heart, or eyes are affected. Rheumatoid arthritis is an autoimmune disorder, meaning it involves the body’s natural defense system attacking the body’s own tissues. In the case of rheumatoid arthritis, the immune system attacks the lining of the joints, which causes serious swelling, joint erosion, and, eventually, bone deformity. Like other forms of arthritis, joint pain and stiffness are common, but the inflammation response means that fever and fatigue may be present as well. The joints most affected are the small joints of the hands, wrists, and feet, but shoulder pain and stiffness can be present as well. About 1% of the population has this condition. Pain medications can be used to manage the pain of rheumatoid arthritis, and newer drugs like Disease-modifying antirheumatic drugs (DMARDs) and biologic response modifiers can slow the disease’s progress.
9. Bursitis
Like rheumatoid arthritis, bursitis involves inflammation of the joints, and can be an unexpected cause of shoulder pain. In this condition, the inflammation occurs in the bursae, the small sacs of fluid that cushion the joints’ bones, muscles, and tendons. Along with shoulder pain, bursitis can use knee, hip, or elbow pain. It has been found to be especially common in joints that are subject to repetitive pressure, such as frequent sitting or kneeling for work. Fortunately, bursitis usually clears up in a few weeks when properly treated, though it’s likely to recur in the same joint in the future. Rest and ice are usually enough to clear up bursitis, but physical therapy or corticosteroid injections may be used if the bursitis persists.
10. Polymyalgia rheumatica
Yet another inflammatory condition that can cause shoulder pain is Polymyalgia rheumatica. This condition is commonly seen in individuals with giant cell arteritis, a condition in which blood vessels are narrowed by inflammation in the scalp, neck and arms, reducing blood flow to these areas. In polymyalgia rheumatica, inflammation causes stiffness and muscle pain in the shoulders. The onset of the syndrome is usually very rapid, and the stiffness and shoulder pain it causes are usually worse in the morning. Fatigue and mild fever are also common. A 2016 research survey conducted in Israel found that women are 2-3 times more likely to be affected by polymyalgia rheumatica and giant cell arteritis than men, and that the disease is almost exclusively found among people ages 60 and older. Low doses of oral corticosteroids are the most popular treatment, along with magnesium and vitamin D. In some cases, immunosuppressant medication, methotrexate (Trexall), may be added as well to treat more severe shoulder pain.
11. Frozen shoulder
Many people have never heard of frozen shoulder, but this condition is very real, and can cause shoulder pain and related problems. Frozen shoulder often occurs after a person has had their arm immobilized due to an injury, such as a broken arm, or surgery, such as a mastectomy. Rheumatology studies have shown that people with diabetes also have a higher risk for frozen shoulder. The problem has three phases. In the “freezing phase,” shoulder pain occurs whenever the shoulder is moved, and mobility becomes functionally limited. In the “frozen phase,” the shoulder is immobilized. In the “thawing phase,” movement gradually returns to the shoulder. Physical therapy is the usual treatment for the mobility issues and shoulder pain related to this condition. Most recover on their own within 12 to 128 months, though surgery is also an option.
12. Dislocated shoulder
If a frozen shoulder comes about from too little shoulder movement, a dislocated shoulder occurs in the opposite way- from a movement outside the joints natural range of motion. In a dislocated shoulder, the ball-shaped top of the humerus (upper arm bone) pops out of the cup-shaped shoulder socket, where it’s normally held in place by muscles, tendons, and ligaments. This type of injury usually occurs as the result of the arm being pulled out of place, as in a sports injury or fall. The dislocation is usually accompanied by a sound or sensation of popping, along with severe pain and swelling. The joint may be visibly out of place as well. All dislocations require a doctor to move the bone back into place, usually following an X-ray. Surgery may be needed, and the joint will likely need to be immobilized with an arm sling while it heals. A shoulder that has been dislocated will be less stable in the future, meaning it’s somewhat more likely to suffer a second dislocation. Rehabilitative exercises can strengthen the joint and improve mobility.
13. Separated shoulder
A separated shoulder can also occur after a fall or contact injury. This happens when the ligaments that hold the clavicle (collarbone) to the shoulder blade are damaged. In mild cases, the ligaments are stretched, but they may be fully torn in severe cases. Shoulder pain, swelling, and mobility limitation following a blow may indicate a separated shoulder. Some 30-50% of people who have sustained a shoulder separation have some residual pain, making this the most common complication. Those whose injury requires surgery may also develop arthritis in the shoulder. In most cases, the R.I.C.E treatment and pain relievers are sufficient, as this type of shoulder injury, properly managed, can heal on its own within a few weeks.
14. Broken arm
If you break your upper arm bone (humerus), you may experience severe pain in the shoulder where it connects. Other symptoms can include swelling and tenderness. A break can be a small crack (fracture) or a complete break of the bone. A doctor will need to examine and X-ray the area, and pain relievers and ice will be needed to reduce swelling. A small broken bone can heal on its own if the joint is immobilized in a sling and treated with ice. A severely broken bone may require surgery to implant screws or wires fro reinforcement. A broken arm usually results from a fall or vehicular accident, and is more common in active children, athletes and people with weaker bones (such as older adults).
15. Broken collarbone
It may not come as a surprise that a broken collarbone can also cause pain in your shoulder. The collarbone (aka clavicle) forms the front of the shoulder, and many of the shoulder’s muscles, tendons, and ligaments attach to it. The collarbone is slender and, unlike the arm bones, is not embedded in a protective layer f muscle, so broken collarbones are quite common. One epidemiologic study of over 500 patients found that broken collarbones accounted for about 44% of all fractures in the shoulder girdle. A snapping sensation or sound usually accompanies a collarbone fracture, along with pain in the front of the chest or shoulder. The usual treatment is ice, pain relievers, and immobilizing the area by placing the arm in a sling.16. Torn cartilage
Cartilage is the tough, rubbery tissue that holds bones together and supports other tissue, like muscles. The elastic and tough cartilage of the shoulder is a type called Hyaline cartilage. Cartilage can be torn, usually through a strong impact, which will result in pain and possibly a crunching noise or sensation. Shoulder pain, stiffness, and limited mobility can indicate torn shoulder cartilage, but a doctor will need to perform an MRI or arthroscopy to make the diagnosis. The good news is that torn cartilage can heal, and usually does so with the help of physical therapy, anti-inflammatory and pain-relieving medications, and possibly steroid injections.
17. Cervical radiculopathy
The many nerves that emerge from the spinal cord in the neck and shoulder region can become damaged in a number of ways, potentially causing cervical radiculopathy. The term simply means nerve root damage in the cervical (upper spine) region resulting from the compression of one or more vertebrae. This can happen in middle age as the result of normal age-related degeneration or in younger people as the result of an impact trauma. Cervical radiculopathy causes loss of sensation in the shoulder, arm, and hand, as well as arm and shoulder pain, or pain in the chest. Treatment consists of symptom management through pain medication, steroids (as oral drugs or epidural injections), and physical therapy. Avascular necrosis (death of bone tissue due to limited blood flow)18. Shoulder Impingement Syndrome
The single most common cause of shoulder pain leading to shoulder specialist visits is shoulder impingement syndrome. This condition comes about when the tendons or bursa in the shoulder are impinged (pushed) upon by the bones of the shoulder. Repeatedly lifting the arm and shoulder, as in house painting or tennis, can lead to shoulder impingement syndrome. In this condition, the shoulder pain is constant and interferes with daily activities involving motion of the shoulder and arm. Rest of the shoulder and arm, along with anti-inflammatory pain medications and gentle daily stretching, are usually sufficient to heal Shoulder Impingement Syndrome.
19. Thoracic outlet syndrome
Just as the nerves of the shoulder region can become compressed by the cervical vertebral discs, the blood vessels and nerves just between the collarbone and the first rib (the thoracic outlet) can become compressed. This condition is known as thoracic outlet syndrome, and it is characterized by neck and shoulder pain and numbness in the fingers. Thoracic outlet syndrome usually results from a physical trauma, but shifting of the ribs during pregnancy or congenital bone abnormalities can also cause it. The Journal of the American Academy of Orthopedic Surgeons reports that this condition is especially difficult to diagnose because there is such variety in the symptoms that can present, including neck, hand, and shoulder pain, tingling, weakness, numbness, and vasomotor problems. Treatment for Thoracic outlet syndrome consists of pain management with medication along with physical therapy. This is usually sufficient to relieve the shoulder pain associated with the syndrome, but surgery is also an option in more persistent cases.
20. Avascular necrosis
Also called osteonecrosis, Avascular necrosis happens when bone tissue dies as the result of diminished blood flow. A dislocated joint or broken bone can block the flow of blood to part of the bone. Alcohol abuse or high-dose, long-term steroid medication can also cause Avascular necrosis. It’s most common in people ages 30-50, and usually occurs in the knee, hand and foot, or in one or both shoulders. There are usually no symptoms in the early stages, but as the condition becomes worse, pain occurs when weight is put on the joint. This usually becomes more severe and persistent over time. X-rays, bone scans, and MRIs can be used to diagnose Avascular necrosis. There is no way to restore bone tissue that has been lost, but the condition can be treated with the goal of preserving remaining bone tissue. Osteoporosis drugs, blood thinners, cholesterol-lowering medications, and non-steroid anti-inflammatory drugs are usually prescribed.
21. Heart attack
You may picture a heart attack as a dramatic and sudden pain in the chest accompanied by weakness or fainting. But most people, especially women, experience a heart attack as a sensation of pressure, squeezing, tightness, or pain, which may be centered in the chest, back, jaw, shoulder, or arm. Other signs of heart attack include nausea, stomach pain, heartburn, cold sweat, weakness, dizziness, and shortness of breath. A heart attack is caused by a blockage of blood flow to the heart, usually caused by a clot of plaque composed of arterial fat and cholesterol. The resulting blockage can damage or destroy the heart muscle. Treatment for heart attacks has improved enormously in recent years; research from Harvard shows that only about 10% of heart attacks today are fatal. Emergency treatment is essential, however. People at risk for a heart attack can take nitroglycerin or aspirin at the start of a heart attack if their doctor has made the recommendation. People who have experienced a heart attack will be closely monitored for heart health and given medication such as beta blockers, ACE inhibitors, and statins. Surgical procedures like Coronary artery bypass surgery or Coronary angioplasty and stenting may be needed, and Cardiac rehabilitation will be essential to recovery as well.
