Common Causes of Shoulder Pain

Your shoulder joint is like a ball resting on a golf tee. Because it's not tightly secured, the ball can easily move off the tee. This freedom lets you move your shoulder in a lot of different ways, in all different directions.

That flexibility, however, comes at a cost: Shoulders are notoriously unstable (like that golf ball on the tee). This means your shoulder and the structures around it may be more prone to injury.

“About 1 in 4 Americans has shoulder pain at some point in their life. If pain in your shoulder is affecting your life, there are many effective treatments that can help you feel like yourself again,” says says, Bassem T. Elhassan, a Mass General Brigham orthopedic surgeon and co-chair of the Shoulder Service at Massachusetts General Hospital. In this article, Dr. Elhassan describes common causes of shoulder pain, symptoms, and when to see a doctor to review your treatment options. 

What are the most common causes of shoulder pain?

There are many causes of shoulder pain. Here are the most common causes:

Shoulder arthritis

Shoulder arthritis is very common. Wear and tear over time can lead to arthritis (loss of protective cartilage) in your joints. Injuries that happen when you’re young can contribute to arthritis later in life. Arthritis causes a grinding feeling and a limited range of motion in your shoulder.

Nerve injuries, like brachial plexus injuries

The brachial plexus is a network of nerves that supplies nerve fibers to the chest, shoulder, and arm. It branches out of the spinal cord within the neck through a person’s armpit. Usually, trauma to the neck and shoulder causes brachial plexus injuries. These injuries typically result from motorcycle or car accidents, falls, lacerations, or medical conditions.

Dislocated shoulders

Shoulder instability causes your shoulder to dislocate (pop completely out of the socket). If you feel your shoulder slipping in and out of the socket, you may have injured your labrum (tissue that supports the shoulder joint). You can dislocate your shoulder for a range of reasons, from playing sports, to falling on your arm, to just taking part in activities of daily life.

Shoulder fractures

A fracture is a partial or total crack or break through a bone. It often occurs due to trauma.

Rotator cuff injuries 

Any part of the rotator cuff can get irritated, inflamed, or even tear. Pain with movement or in a certain position suggests a rotator cuff injury. Rotator cuff injuries can range from minor inflammation to complete tendon tears. They include:

• Torn rotator cuff. This happens when a tendon in your shoulder partially tears or fully separates from the bone. Most commonly they are a supraspinatus tear, which can be caused by a high-impact injury like falling on your arm while playing sports. Rotator cuff tears can also be caused by wear over time.
  
  
• Rotator cuff tendonitis. Tendonitis is inflammation of the tendons that connect the rotator cuff muscles to your shoulder bones. Often, tendonitis can cause the tendons to pinch and become a chronic issue.
  
  
• Bursitis. Repetitive motions can inflame the bursa sacs in your shoulder and cause them to fill with extra fluid, causing pain and swelling.

Tendon and cartilage tears

Progressive cartilage wear happens over time and causes arthritis. 

Symptoms of shoulder pain

“Shoulder pain can feel dull, sharp, or achy, and can be mild or severe,” explains Dr. Elhassan. “It may come on gradually, or start suddenly. It could be related to trauma or happen progressively. Normal activities can make shoulder pain worse, and rest might not make it better.” 

Other symptoms may include:

• Not being able to move your shoulder

• Muscle spasms

• Stiffness

• Swelling

• Weakness, numbness, or tingling 

When to see a doctor for shoulder pain

“If you have any of symptoms of shoulder pain, talk to your doctor,” Dr. Elhassan recommends. “You may benefit from treatment, physical therapy, or a combination of the two.”

Your doctor will help you understand what your pain is, where it’s coming from, and what to do about it. The first visit involves a conversation with your doctor to understand recent activities or issues that may cause your pain, a physical exam of your shoulder and surrounding muscles, and tests, like imaging of your shoulder, to diagnose the cause of your pain.

How is shoulder pain diagnosed?

Tests to diagnose shoulder pain include:

• An x-ray, MRI, or CT scan to evaluate the bones, ligaments, and tendons
  
  
• An electromyogram (EMG), which tests your nerve function
  
  
• An arthrogram, which is an x-ray that uses a special dye injection to get a more detailed view of the shoulder
  
  
• An arthroscopy, where your doctor inserts a tiny camera to look inside your shoulder

Preparing for your visit

The more you think about your shoulder pain before you see a doctor, the more you get out of your visit. 

Ask yourself some questions that will help your doctor understand your pain, including:

• Where is the pain and what does it feel like?

• When did the pain start?

• What causes the pain to worsen? What makes it feel better?

• Does the pain limit me from doing anything?

• Does the pain wake me up at night?

• Have I been taking any medicine for the pain?

• Does ice or heat help?

Nonsurgical shoulder pain treatment

“Whenever possible, we try alternatives to surgery first,” reassures Dr. Elhassan.

Most people with shoulder pain respond well to:

• Rest to give your shoulder time to heal
  
  
• Physical therapy to strengthen your shoulder and improve flexibility
  
  
• Medication to help with pain and swelling
  
  
• Steroids or numbing injections to reduce pain

If these don’t work — or if you have a serious injury — you may need surgery. Rotator cuff tears, for instance, don’t heal on their own. 

Surgery for shoulder pain

If you do need surgery, your doctor will explain your options. Here are the most common types: 

1. Minimally invasive arthroscopic surgery

Orthopedic surgeons use minimally invasive arthroscopic surgery to treat tendon, muscle, and ligament injuries, including rotator cuff tears. 

During this procedure, surgeons insert a small camera called an arthroscope into your shoulder. The images from the camera display on a monitor and guide the surgeon during the surgery. This procedure uses smaller incisions than traditional surgery and can mean less pain and a shorter recovery time.

2. Shoulder replacement surgery (arthroplasty)

Shoulder replacement surgery can replace your shoulder or parts of it with metal and plastic components. Shoulder replacement may be helpful if you have severe damage due to arthritis, a fracture, or other conditions.

Other surgical treatments can fix cartilage tears, repair shoulder dislocations, and reconstruct parts of the shoulder.

Getting shoulder pain care can help you return to the activities you love.

“We have many options for treating shoulder pain — and most of them don’t involve surgery,” says Dr. Elhassan. “If you’ve tried treatment and still don’t feel right, or you had a surgery that didn’t work the way you had hoped, get a second opinion. An experienced team of specialists can get you back to work, sports, and all the other activities you want to do.”