What can cause shoulder pain?
The shoulder comprises three bones:
- the humerus, which is the upper arm bone
- the scapula, which is the shoulder blade
- the clavicle, which is the collarbone
The top of the upper arm fits in to the glenoid, a round socket in the shoulder blade. A set of muscles and tendons called the rotator cuff keep the shoulder joint in place and provide mobility and stability.
In this article, we look at some common causes of shoulder pain and their treatments. We also cover when to see a doctor, diagnosis, and self-care.
Tendinitis causes pain around the shoulder joint.
In the shoulder, tendinitis typically affects the tendons of the rotator cuff or those that connect the shoulder blade to the bicep. Inflammation of these tendons can cause pain around the shoulder joint, and the skin in this area may appear flushed and swollen.
Tendinitis can be either acute or chronic. Acute tendinitis usually results from injuries or overuse of the shoulder joint. Conditions that affect the bones, such as arthritis, can lead to chronic tendinitis.
Resting the joint is an important step in treating tendinitis. Applying an ice pack to the area for 20 minutes several times per day can also help soothe the pain. It is important to wrap the ice pack in a towel rather than use it directly on the skin.
Bursitis refers to inflammation of the bursae, which are small, fluid-filled sacs that act as cushions between bones and soft tissues in joints.
Bursitis typically results from injuries, overuse, and repetitive movements of the joints. However, infections and inflammatory conditions such as arthritis and gout can also cause inflammation of the bursae.
Inflammation of the bursae between the rotator cuff and the shoulder blade is called subacromial bursitis. In the rotator cuff, bursitis can sometimes develop at the same time as tendinitis.
Bursitis in the shoulder can cause tenderness and pain, which can restrict the movement of the arm and make daily activities difficult.
People can often treat bursitis at home by resting, applying an ice pack, and taking OTC medications, such as ibuprofen, naproxen, or aspirin.
For people with severe bursitis, a doctor may recommend having steroid injections or undergoing a procedure to remove the fluid from inside the bursae. If the bursitis is due to an infection, a doctor may prescribe antibiotics.
In rare cases, a person may require surgery to remove the affected bursae.
Tendons can sometimes split or tear. This damage may be partial, or the tendon may completely detach from the bone.
A tendon tear can result from injuries, persistent overuse, and general wear and tear to the shoulder as a person gets older.
In the shoulder, tears typically affect the tendons of the rotator cuff and biceps. Tendon tears can cause pain, swelling, and weakness or reduced mobility in the arm.
People can usually treat tendon tears in the shoulder at home by:
- resting the shoulder and avoiding activities that may aggravate symptoms
- applying an ice pack to the area for 20 minutes several times each day
- taking OTC medications, such as ibuprofen and naproxen
A doctor may also suggest trying strengthening exercises or physical therapy. If the tendon tear does not get better with these treatments, a doctor may recommend steroid injections or surgery.
Shoulder impingement refers to when the top of the shoulder blade, or the acromion, rubs on the rotator cuff tendons and bursae when a person lifts their arm.
Impingement can limit movement, cause pain and weakness in the arm, and lead to bursitis and tendinitis.
Treatment for shoulder impingement typically involves resting, taking NSAIDs, and trying physical therapy or occupational therapy. However, it may take several weeks or months for the symptoms to improve.
If a person's symptoms do not respond to the treatments at all, a doctor may recommend steroid injections or surgery.
If a person thinks they have dislocated their shoulder, they should go to the emergency room for treatment.
Shoulder dislocation occurs when the upper arm bone slips out of the shoulder socket.
A complete dislocation occurs when the bone comes fully out of the socket. A subluxation refers to when the bone only partially comes out of the socket.
Shoulder dislocations can be very painful and usually prevent movement of the affected arm. The shoulder may also appear misshapen, or there may be a bulge underneath the skin where the bone has come out of place.
Shoulder dislocation usually occurs due to an injury, such as from playing contact sports. Dislocation can damage the joint and surrounding connective tissues, which can make a person more vulnerable to future dislocations.
Doctors refer to repeated dislocations of the shoulder as chronic shoulder instability.
Anyone who suspects that they have dislocated their shoulder should go to the emergency room. A person should not try to pop the shoulder back into place themselves, as this may damage the joint or the surrounding tissues.
After a medical professional has relocated the bone back into its socket, a dislocated shoulder can take several months to fully heal.
Treatment options typically include resting, taking NSAIDs, and engaging in physical therapy to strengthen the shoulder muscles. It may require surgery, especially if it is recurrent.
Osteoarthritis is a degenerative condition in which the cartilage in joints gradually breaks down. Osteoarthritis commonly affects the knees, hips, and hands but can affect any joint in the body, including the shoulder.
Symptoms of osteoarthritis tend to get worse over time and include swelling, pain, stiffness, and reduced movement of the joint.
A person may also notice a grinding sensation as they move their shoulder.
Previous injuries and general wear and tear as a person gets older can lead to osteoarthritis.
There is currently no cure for osteoarthritis, so treatment focuses on relieving symptoms, improving mobility, and slowing condition progression.
Treatment options include:
- modifying daily activities to reduce pain
- engaging in physical therapy or occupational therapy to strengthen and stretch the muscles that support the shoulder
- applying an ice pack or heat pad for 20 minutes two or three times per day to help relieve pain and inflammation
- using OTC medications, including NSAIDs and pain-relieving creams and ointments
- taking prescription drugs to relieve pain
- having an injection of a steroid into the shoulder joint
- undergoing a type of surgery called total shoulder arthroplasty, which replaces the affected shoulder joint
Forceful impacts to the shoulder can fracture, or break, the bones. Fractures typically cause severe pain, swelling, and bruising.
Falls, sports injuries, and motor vehicle accidents are common causes of shoulder fractures.
People who suspect that they have fractured a bone in their shoulder should see a doctor right away or go to the emergency room if it is severe.
Treatment for a shoulder fracture may involve wearing a sling for several weeks while the bone heals.
People with severe fractures may require surgery to repair the bone using plates, screws, or wires. They may even need a total shoulder arthroplasty.
Doctors will usually prescribe a course of physical therapy or occupational therapy to aid recovery.
When to see a doctor
A person should see a doctor for shoulder pain that does not improve after a few days of resting the affected arm. Also, see a doctor if the pain is severe, recurring, or occurs following an injury.
People with a dislocated shoulder or a severe injury should go to the emergency room.
A doctor will typically start by asking the person about their symptoms and medical history. They may then carry out a physical examination of the affected shoulder and test its range of movement.
Such tests create an image of the complicated structures inside the shoulder and allow the doctor to identify issues such as osteoarthritis and fractures.
The first step to treating shoulder pain is usually resting, which may require a person to alter their activities for a few days to avoid overexerting the joint and aggravating the symptoms.
Taking OTC pain relievers, such as ibuprofen and naproxen, can help manage the pain and reduce swelling. Acetaminophen can help with pain relief.
Gently stretching and exercising the shoulder can also help people get back to their everyday activities as quickly as possible following an injury.
The American Academy of Orthopaedic Surgeons recommend performing the pendulum and crossover arm stretches, if such movement is possible, on 5 or 6 days per week until the shoulder has fully healed.
To do the pendulum stretch:
- Lean forward and place one hand on a table, with the other arm hanging freely at the side. Keep the knees soft and the back straight.
- Gently swing the free arm forward and backward.
- Then swing the arm from side to side.
- Finally, swing the arm in a circular motion.
- Do 10 of each type of swing, then switch to the other arm and repeat.
Performing the crossover arm stretch each day can aid recovery following an injury.
To do the crossover arm stretch:
- Relax the shoulders.
- Bring one arm up and stretch it horizontally across the chest, pulling it as far as it will go.
- Hold the upper arm, not the elbow, with the other arm.
- Hold this stretch for 30 seconds.
- Do four repetitions on each side.
The shoulder is a very complicated joint, which makes it particularly vulnerable to damage. Causes of shoulder pain can include injuries, general wear and tear, and inflammatory conditions such as osteoarthritis.
The treatment of shoulder pain will very much depend on the cause of the problem. However, a person can usually treat mild shoulder pain at home by resting, applying ice packs, and taking OTC medications.
People with severe pain or pain that does not get better with home treatment should see a doctor. Also, see a doctor straight away for shoulder dislocations and other serious injuries.