Shoulder pain can result from muscle, tendon, joint, cartilage, or nerve injuries. Common causes include rotator cuff problems, impingement, bursitis, labral tears, and neck-related conditions. Early assessment and targeted treatment help relieve pain and restore movement.
Shoulder pain can be the result of several causes including issues with the joints, muscles, or nerves from the neck. Some causes of shoulder pain are only temporary and will cause pain only for a short while.Unfortunately there are also other causes of shoulder pain that require further assessment by a health professional, such as a sports chiropractor, to help with pain management and prevention of further, more serious, shoulder injuries. Injures that are left untreated can be linked to osteoarthritis and rheumatoid arthritis.
Front shoulder pain is one of the most common complaints we receive and can be from damage to the cartilage or muscles in this area. Very rarely is it due to damage of the bone.
One of the most common causes of front shoulder pain is shoulder impingement (subacromial impingement). A shoulder impingement occurs when the rotator cuff muscles become pinched and there is increased friction, which results in inflammation and tendinopathy. Shoulder impingement often happens after excessive overhead movement (e.g. painting the ceiling or shoulder press at the gym) or poor shoulder biomechanics (e.g. rounding the shoulders with lifting).
Another cause of front shoulder pain is a shoulder labral tear. The labrum, which is a stretchy tissue that helps keep the joint in place, can tear due to impact injury or repetitive actions. A labral tear can also cause weakness, so it is important to keep the arm moving but decrease the load through the arm and not do anything too strenuous.
Front shoulder pain can also be due to rotator cuff tendinopathy. The rotator cuff muscles are a group of tendons that help the muscles move the arm and assist the ligaments and surrounding muscles to keep the shoulder in place to prevent dislocation or subluxation. These tendons can tear due to injuries such as a broken collar bone or as a part of aging. Depending on what has caused the tendinopathy, treatment may be required to increase the healing rate and help manage pain.
Lastly, frozen shoulders (adhesive capsulitis) is another cause of front shoulder pain but this injury is not nearly as common. Frozen shoulder is the result of scar tissue build up in the joint capsule and causes the muscles around the shoulder to ‘lock’ and restrict movement. The true cause of frozen shoulder is unknown but there are links to recent injuries causing the scar tissue build up, in addition to diabetes.
Back shoulder pain is usually the result of damage to the cartilage or referred pain from the rotator cuff muscles.
As described above, the shoulder labrum is a stretchy tissue that helps keep the shoulder joint in place. When there is a labral tear, this can cause pain both in the front and back of the shoulder. The location of the pain is dependent on where the tear has occurred.
The shoulder joint is also lined with cartilage on the joint surfaces. This cartilage is a smooth cushiony tissue that covers the ends of bones to allow for movement without excessive friction. Unfortunately, pain can arise when there is damage or wear-and-tear to the cartilage, and can ultimately lead to osteoarthritis.
Lastly, the rotator cuff muscles sit on the shoulder blade and they can also cause back shoulder pain. The rotator cuff muscles can tear from overuse but recent studies have also found tears to be a natural part of aging. Interestingly, tears do not always directly cause pain. In fact, many people have tears in their rotator cuff muscles and experience no pain at all. Nonetheless, rotator cuff muscles can also create referred pain as a result of triggerpoints.
Shoulder bursitis (subacromial bursitis) is the most common cause of shoulder tip pain or pain at the top of the shoulder. The shoulder bursa is a fluid-filled sac that sits under the tip of the shoulder. It acts as a cushion and gliding surface to minimise friction between tissues as the shoulder is moving. Shoulder bursitis is inflammation of this bursa, which may result from trauma or overuse. For more on bursitis, please read our full article on shoulder bursitis
Alternatively, shoulder tip pain can also be the result of an acromioclavicular (AC) joint sprain. High impact sports such as AFL, can lead to a direct blow to the shoulder, which results in trauma to the AC joint. The AC joint is the junction between the top of the shoulder blade found at the very top of the shoulder and the collar bone.
Neck pain with associated shoulder pain needs to be taken seriously as this can be the result of irritation to the nerves. This pain can vary depending on the nerves involved but it can refer down into the upper arm and shoulder, and even into the hands and fingers. It is most commonly felt on the back of the shoulder and outside of the upper arm.
Nerve irritation or damage can be caused by a variety of injuries including whiplash or impact injuries, which can last from 6 weeks to 18 months. Other causes include degenerative arthritis of the cervical spine, which can lead to more long-standing pain and requires appropriate diagnosis and management.
There are a few reasons that a shoulder might be in pain that aren’t discussed above. Sleeping positions such as sleeping on the side places additional stress on the shoulder because it is bearing most of the torso body weight. In fact, a study found that 67% of those who sleep on their side have a correlation with shoulder pain on the side they usually sleep on. This doesn’t directly mean that sleeping on a side causes shoulder pain, but it can add excessive stress that doesn’t help when trying to recover from an injury.
Shoulder pain from sleeping can indicate that there is a deeper underlying problem with the shoulder. Unfortunately, there are several causes as to why you may be experiencing shoulder pain from sleeping; therefore, it is highly recommended to have this properly assessed by a health professional to determine the underlying issue.
Shoulder pain after working out at the gym, particularly with weight lifting, could indicate that exercises are being performed incorrectly and placing stress on muscles and tendons in the shoulder such as the rotator cuff. In many cases, shoulder impingement is involved in addition irritation to the bursa or labrum.
To properly carry out exercise to prevent further injury or shoulder pain, seeking help from a personal trainer, exercise physiotherapist or a sports chiropractor can help diagnose your shoulder biomechanics and determine the cause.
If the pain persists for more than two weeks, it typically indicates that an injury has occurred as muscle soreness from exercise only normally lasts 24-36 hours. In these instances, it is highly recommended to speak to a health professional to diagnose the injury. Once a proper diagnosis has been established, you can begin treatment, exercises, and rehabilitation to reduce pain and regain strength in the shoulder, neck and arm.
Although most of the causes discussed above can cause pain through the day and into the night, pain felt at night is most commonly caused by an inflamed bursa sac (bursitis) and/or sprained, inflamed or torn tendons. This causes more pain at night due to the lack to movement and mobility at night allowing the joint to stiffen and the pain to become more evident once movement is made again, like moving while asleep to reposition.
Think of it like sitting down for a long time and then standing up. Your legs hurt for a little bit until you start walking around. The pain doesn’t increase at night, the pain just becomes more evident because of all the surrounding muscles in the shoulder relaxing.
Bursitis is most commonly felt as a burning pain in the shoulder joint. It occurs when one of the bursae sacs in your shoulder becomes inflamed. A bursa sac is a capsule filled with synovial fluid which acts as a cushion between the bones in the shoulder to prevent bone on bone pain.
There are several bursae sacs in a shoulder, although the subacromial sac in the shoulder is the one that is most likely to become inflamed and thus painful. The main cause of the pain is due to the loss of low-friction gliding capabilities. The swelling bunches up under the bone and adds more friction in the confined joint space.
Shoulder pain with lifting the arm is typically the result of shoulder bursitis or shoulder impingement, or both can happen together.
The shoulder bursa is a fluid-filled sac that sits under the tip of the shoulder. It acts as a cushion and gliding surface to minimise friction. Shoulder bursitis is inflammation of this bursa, which may result from trauma or overuse.
Shoulder impingement occurs when the rotator cuff muscles become pinched and there is increased friction, which results in inflammation and tendinopathy.
Referred shoulder pain can be difficult to diagnose as there are several causes. Referred shoulder pain typically means that the pain is from a source that is outside of the shoulder.
For example, referred shoulder pain that follow a specific pattern in the arm can be due to irritation or damage to nerves in the neck.
Alternatively, more vague shoulder pain can also indicate that the issue lies elsewhere in the body and can be a more serious issue such as; abdominal problems, pelvic problems, heart or blood vessel issues, lung problems, and other conditions.
If you believe you have referred shoulder pain, please seek immediate professional medical help.
Symptoms of shoulder pain are quite varying due to the different issues that can cause pain in and around the shoulder. The pain could be felt deep in the joint either toward the front or back of the shoulder and can be described as a catching pain.
Muscle pain typically feels more of a background ache but can vary in severity. The pain is generally more diffuse and spread across a larger area, as opposed to concentrated on a specific spot. There could be a sensation of weakness in the shoulder or upper arm which may feel like the arm is sliding in or out of the socket. This can be linked to issues with the rotator cuff or ligaments in the shoulder.
The general identification of bursitis is localised pain, swelling or/and tenderness when moving a joint area, such as a shoulder or hip. Tenderness of the inflamed shoulder joint will occur with bursitis, as well as a pinching pain or impingement when moving the arm away from the body.
A pinched nerve in the shoulder happens where a nearby muscle or bone irritates or places pressure on the nerve. The pain can be sharp and can drastically range from minor to severe pain. There can also be associated pins and needles or numbness. This is generally felt only in one shoulder and feels sharp compared to the dull ache of muscles and bursa sac irritation.
Exercise and stretches may or may not be encouraged for different shoulder pain causes. It is important to speak to a health professional to clarify the exact exercises and/or stretches that are targeted for specific pain causes.
Lightweight exercises that continue load and mobility while having shoulder pain are encouraged. Exercises such as guided yoga is an excellent way to continue mobility without putting too much load through an effected shoulder.
Here is a great shoulder exercise to help build stability in the shoulder joint:
Corner pec stretch
Here are a list of shoulder of gentle shoulder stretches that can help alleviate shoulder pain and improve shoulder flexibility:
Pain management in the beginning of a shoulder injury is important to address. The faster we are able to reduce the pain, the faster we can begin with exercises and rehabilitation of the shoulder. However, under the correct guidance, it is important to note that you do NOT need to completely eliminate the shoulder pain before beginning rehabilitation exercises. In fact, rehabbing even while experiencing some low levels of shoulder pain may actually help speed up the healing process.
Health professionals such as sports chiropractors can provide hands-on treatment to reduce nociceptive input (essentially calming the nerves) around the shoulder joint capsule and assist in reducing pain. This can be done using a variety of techniques.
Dry needling and acupuncture can be done in conjunction with soft tissue muscle releases to reduce nociceptive input and reduce pain in the shoulder joint. These modalities can also assist to increase blood flow to the affected area and promote healing of the soft tissue surrounding the joint capsule. In more severe cases, medical intervention, such as Non-Steroidal Anti-Inflammatory medications (NSAIDs) or cortisone injections, may also assist with pain management.
