Shoulder pain, which is not a condition, but rather a symptom, refers to pain located anywhere in or around the shoulder. Shoulder pain can come from the shoulder joint or any of the ligaments, muscles and tendons surrounding the joint. In some cases, shoulder pains are actually referred pain coming from an issue with a nearby organ, such as the heart or gallbladder.
Shoulder pain symptoms are varied and depend on the cause. The pain can be dull or sharp and range from mild to severe. In most cases, the pain is the result of shoulder injuries or a defect in the joint’s bone.
Depending on the cause, shoulder pain symptoms may be accompanied by:
- Limited range of motion
- Numbness or tingling
- Weakness in the shoulder or arm
Referred pain from another part of the body felt in the shoulder may also be accompanied by chest pain, nausea or vomiting, pain under the rib cage, or back pain.
There are several possible causes of shoulder pain. The following are the most common:
Acute or chronic tendinitis happens when tendon connecting to the shoulder wears down, either due to repetitive wear and tear from aging or certain activities or because of a degenerative disease, such as arthritis.
This painful condition occurs when the bursae, which are fluid-filled sacs that cushion the bones, muscles and tendons in the joints, become inflamed. This can happen as a result of overuse and is often happens with rotator cuff tendinitis.
- Tendon tears.
Degenerative changes from aging or overuse and injuries can cause the tendons in the shoulder to partially or completely split or tear.
- Instability or dislocation.
Shoulder instability happens when the muscles and ligaments that hold the ball and socket joint of shoulder stretch or get injured, causing the shoulder to become unstable or dislocate. The most common cause is injury resulting from a fall or accident, but it can also happen from repetitive physical activities or even a genetic predisposition.
This is also known as shoulder impingement syndrome. Impingement occurs when the rotator cuff tendon, which runs through a narrow passage, called the subacromial space, becomes trapped or “impinged”, causing it to scrape against the bone with movement.
Shoulder fractures most often involved the collarbone (clavicle), scapulae (shoulder blade) and the upper arm bone (humerus) and are usually the result of trauma from an accident, sports injury, or a fall.
Different types of arthritis can cause shoulder pain, though it is most often osteoarthritis that affects the shoulder. Arthritis can result from wear and tear throughout our lives, shoulder injuries, or inflammation depending on the type.
Due to the many possible causes, anyone is at risk for shoulder pain. The following increase the risk of shoulder pains:
- Aging, because of degenerative changes and increased risk of other diseases as we age
- Participating in contact sports
- Occupations involving repetitive motion or pressure on the shoulder
- Sports, such as baseball, gymnastics, and tennis
- Medical conditions, such as arthritis
In order to diagnose the cause of your shoulder pain symptoms, the doctor will first conduct a thorough examination, which will include your medical history and a physical examination. You will be asked to describe your pain and how long you’ve had it. You may also be asked what activities cause or worsen the pain, as well as which, if any, shoulder pain relief treatments you have tried.
A physical examination will allow the doctor to check for any abnormalities, such as swelling, redness, bruising, or muscle weakness. The doctor may also manipulate your arm to check your range of motion.
The following tests may be ordered to help diagnose the cause of your shoulder pains:
X-rays are often the first imaging test used in patients presenting with shoulder pain to look for fractures, bone spurs and other bone abnormalities. X-rays are not able to show most issues with the tendons, cartilage or muscles.
Ultrasounds use high-frequency soundwaves to produce real-time images of the muscles, tendons and other tissues using a transducer on the shoulder.
- Magnetic Resonance Imaging (MRI).
MRI is considered the imaging test of choice for diagnosing shoulder issues. An MRI uses radio waves and a magnetic field to produce detailed images. Sometimes a special dye is given either through intravenous or injected directly into the shoulder to enhance certain details.
- Computed tomography scan (CT scan).
This type of scan uses a series of X-rays taken from different angels to create cross-sectional images that show bones, soft tissues and blood vessels in detail.
This type of imaging test may be used to look at the joint structure. A long, thin needle is used to inject a special dye directly into the joint and a series of x-rays are taken with your shoulder joint in different positions. Arthrography can be used to diagnose most shoulder injuries and conditions.
In some cases, arthroscopy may be recommended to help diagnose the cause of shoulder pain that couldn’t be identified using other tests. Arthroscopy is a minimally invasive surgical procedure in which a fiber-optic camera at the end of a thin tube is inserted into the shoulder joint through a small incision. This allows the doctor to visualize the inside of the joint. This procedure may also be used to repair any damage found.
There are various options available to treat shoulder pain. Though treatment will depend on the specific cause of your shoulder pain symptoms, most often treatment will include one or more of the following, beginning with the least invasive:
- Altering your activity.
This can include resting your shoulder and avoiding activities that aggravate your symptoms in order to try to prevent pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain relievers may be prescribed to help relieve pain and inflammation.
- Physical therapy.
Special conditioning exercises may be recommended to help you regain strength and flexibility, and regain your range of motion after shoulder injuries to help you return to your regular activities.
- Occupational therapy.
If your shoulder problem was caused by your job, you may be referred to an occupational therapist who evaluate your work environment and duties and help you make modifications to help you continue with your daily activities safely.
- Injectable treatments.
Corticosteroid injections, which are a combination of cortisone and numbing agent, are injected into the shoulder joint to provide quick relief of shoulder pain.
According to the American Academy of Orthopedic Surgeons, 90 percent of patients who experience shoulder pain find relief using nonsurgical treatments. Surgery may be recommended for those who’ve failed to get sufficient relief from other treatment options, or for those with extensive damage or advanced osteoarthritis. Surgical options include arthroscopic surgery or traditional open surgery, such as shoulder replacement.