Shoulder Pain

The shoulder has a wide and versatile range of motion. When something goes wrong with your shoulder, it hampers your ability to move freely and can cause a great deal of pain and discomfort.

The shoulder is a ball-and-socket joint that has three main bones: the humerus (long arm bone), the clavicle (collarbone), and the scapula (also known as the shoulder blade). These bones are cushioned by a layer of cartilage. There are two main joints:

• the acromioclavicular joint, which is located between the highest part of the scapula (also called the acromion) and the clavicle.
• the glenohumeral joint, made up of the top, ball-shaped part of the humerus bone and the outer edge of the scapula. This joint is also referred to as the shoulder joint.

The shoulder joint is the most mobile joint in the body. It moves the shoulder forward and backward and also allows the arm to move in a circular motion, and to move up and away from the body.

Shoulders get their range of motion from the rotator cuff, which is made up of four tendons. Tendons are the tissues that connect muscles to bone. If the tendons or bones around the rotator cuff suffer damage or swelling, you may find it painful and difficult to lift your arm up over your head.

The shoulder can be injured by performing manual labor, playing sports, or even by repetitive movement. Certain diseases can bring about pain that travels to the shoulder, such as disease of the cervical spine of the neck, as well as liver, heart, or gallbladder disease.

You are more likely to have problems with your shoulder as you grow older, especially after age 60. This is because the soft tissues surrounding the shoulder tend to degenerate with age.

In many cases, shoulder pain can be treated at home. Depending on the cause, physical therapy, medications, or surgery may be necessary.

A number of factors and conditions can contribute to shoulder pain. The most prevalent cause is rotator cuff tendinitis, a condition where the tendons are inflamed.

Sometimes shoulder pain is the result of injury to another location in your body — usually the neck or bicep. This is called referred pain. Referred pain generally does not get worse upon movement of the shoulder.

Common causes of shoulder pain include, but are not limited to:

• arthritis, osteoarthritis, rheumatoid arthritis, septic arthritis
• bursitis (swelling of the bursa sacs, which protect the shoulder)
• tendinitis (swelling of tendons)
• bone spurs (bony projections that develop along the edges of bones)
• torn cartilage
• torn rotator cuff
• pinched nerves
• broken shoulder bone
• broken arm
• frozen shoulder (when tendons, ligaments, and muscles stiffen and become difficult or impossible to move)
• repetitive use or overuse injury of nearby areas, such as the bicep
• shoulder separation (when ligaments that hold the collarbone and shoulder blade together are torn, causing the collarbone to be out of place)
• dislocated shoulder (when the ball of the humerus is pulled out of the shoulder socket)
• spinal cord injury
• heart attack

Some minor shoulder pain can be treated at home. Icing the shoulder for 15 to 20 minutes, three or four times a day for two to three days can help reduce pain. Use an ice bag or wrap ice in a towel (putting ice directly on your skin can cause frostbite).

Other home treatments include:

• resting the shoulder for several days before returning to normal activity and avoiding any movements that might cause pain

• using over-the-counter nonsteroidal anti-inflammatory medications to help reduce pain and inflammation

• compressing the area with an elastic bandage to reduce swelling

If you’ve never experienced shoulder pain before and your pain is not related to an injury, sudden shoulder pain can be a sign of heart attack. If shoulder pain continues to your neck, jaw, or chest, and you also experience trouble breathing, tightness in the chest, dizziness or excessive sweating, call 9-1-1 immediately.

If you injured your shoulder and it is bleeding, swollen, or you see exposed bone, tissue or tendons, go to an emergency room or urgent care center as quickly as possible.

Additionally, you should contact your doctor if you experience:

• fever
• inability to move your shoulder
• lasting bruising
• heat and tenderness around the joint
• pain that persists beyond a few weeks of home treatment

Your doctor will want to find out the cause of your shoulder pain. Your doctor will conduct a physical examination, feeling for injury, and assessing your range of motion and joint stability. Imaging tests, such as an X-ray or MRI, can produce detailed pictures of your shoulder to help with the diagnosis.

Your doctor may also ask questions to determine the cause. Be prepared to answer the following questions:

• Is the pain in one shoulder or both?
• Did this pain begin suddenly? If so, what were you doing?
• Does the pain move to other areas of your body?
• Can you pinpoint the area of pain?
• Does it hurt when you are not moving?
• Does it hurt more when you move in certain ways?
• Is it a sharp pain or a dull ache?

Treatment will depend on the cause and severity of the shoulder pain and may include:

• physical therapy
• use of a sling or shoulder immobilizer
• nonsteroidal anti-inflammatory medications (NSAIDs)
• corticosteroids (powerful anti-inflammatory drugs that are injected into the shoulder)
• surgery
• arthroscopic surgery, which is performed through a tiny incision

If you’ve had surgery on your shoulder, follow after-care instructions carefully. 

Simple shoulder exercises can help to stretch and strengthen muscles and rotator cuff tendons. A physical therapist can show you how to do them properly.

If you’ve had previous issues with your shoulders, use ice for 15 minutes after exercising to prevent future injuries.

After a bout of bursitis or tendinitis, performing simple range-of-motion exercises every day can keep you from getting frozen shoulder.