Shoulder pain

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 26, 2015
StartSymptomsShoulder pain

Shoulder pain can be acute or chronic. It is number three in the top patient complaints of musculoskeletal related pain. Recurrence of pain after treatment is also quite common. The shoulder is the most mobile joint in the body, creating the capability to move the arms and hands in all directions. Climbing a ladder, mopping a floor, screwing in a light bulb, driving a car, playing golf and myriad other daily work chores and recreational activities all involve movement of the shoulder joints.


Definition & Facts

The clavicle, scapula, and proximal humerus make up the three bones of the shoulder area. These bones are surrounded by muscular structures that control movement of the shoulder. Pathways for blood vessels and nerves that serve the shoulder, arm, hand and fingers travel through narrow openings in the shoulder area.

Trauma or chronic conditions can lead to complex pain issues that can be difficult to diagnose. Acute injuries that involve dislocation of the shoulder, torn ligaments and other issues that are obvious upon visual examination or from imaging results are more easily diagnosed. Shoulder pain associated with muscular problems, or pain, numbness or coldness in hands or fingers due to circulation and nerve conduction issues caused by impingement in the thoracic outlet area may be more difficult to diagnose.


One of the most common causes of shoulder pain is trauma to the joint and surrounding tissue. A dislocated shoulder is when the ball of the humerus (upper arm bone) is pulled from the socket. A separated shoulder involves tearing of the ligaments at the clavicle (collar bone) and scapula (shoulder blade). Rotator cuff inflammation or tears are another common cause of shoulder pain. They are common among athletes. The rotator cuff is tendons and muscles attaching to the humerus and scapula, which permit the shoulder joint to rotate.

Frozen shoulder is another common cause of shoulder pain. It can come on gradually or suddenly. It can be extremely debilitating, causing pronounced loss of range of motion. Frozen shoulder can be a result of different causes, but rheumatic arthritis or deposits of glycosylated end products due to uncontrolled diabetes are common sources.

High blood glucose levels of uncontrolled diabetes result in end products from the glucose acting like a glue on muscle fibers, restricting their movement. This capsule of muscle tissue becomes thickened and tight. Frozen shoulder is also called adhesive capsulitis. Another cause of frozen shoulder is lack of movement during recovery from injury or surgery.

Osteo- and rheumatoid arthritis can also cause shoulder pain. Osteoarthritis is caused by wear and tear on the joints in the body. Rheumatoid arthritis is an immune system response that attacks the joints of the body, causing inflammation. Arthritis literally is joint inflammation. Typically, osteoarthritis causes pain and stiffness that is more pronounced when a person gets out of bed and lessens with movement. Rheumatoid arthritis in the shoulder will likely continue to be as stiff and painful as it was upon rising.

When to see a doctor

Sudden radiating shoulder pain without injury may be a symptom of a heart attack. It should not be ignored. Immediate emergency medical intervention should be sought. Some people with worsening heart disease have reported radiating pain, usually in the left arm or shoulder area, that led to a diagnosis of heart disease.

The heart does not have nerves that sense pain, and left arm and radiating shoulder pain are two of many symptoms associated with those having a heart attack. Falls, pulls, overextension, impact and other injuries to the shoulder that cause any loss of range of motion or anything more than mild temporary discomfort should be evaluated by a physician. If the symptoms persist, an osteopathic specialist should be consulted.

Anyone suffering from a shoulder dislocation or separation should seek immediate medical intervention. Severe damage to blood vessels and nerves can occur when a shoulder is dislocated or separated. Chronic pain that persists, or loss of range of motion that does not fully resolve due to mild trauma, should also be evaluated by a physician.

Shoulder pain, stiffness or weakness that affects the performance of daily activities from work to recreation should be evaluated as soon as possible to reduce the chance of further injury to the joint and the surrounding tissue, blood vessels and nerves. Any shoulder related issues that cause pain, weakness, tingling, a pins-and-needle sensation or burning in the arms, hands or fingers needs to be evaluated quickly as well.

Treatment & Therapy

Treatment plans for mild, acute and even chronic pain commonly involve the use of non-steroidal anti-inflammatory drugs(NSAID) such as ibuprofen and naproxen sodium. More severe pain may be treated with stronger NSAIDs and possibly the addition of a narcotic pain reliever.

The goal is resolution of pain through other therapies to not require the need for prescription or over-the-counter drugs. Other pharmacological treatments include the use of oral or injectable steroids to reduce inflammation that then reduces pain. Shoulder pain caused by fatigued muscles may benefit from over-the-counter muscle rubs.

Standard muscle rubs are menthol, methyl salicylate or capsaicin based. Menthol provides a cooling sensation, and methyl salicylate provides a warming sensation. Capsaicin, the resin from hot peppers, provides a pronounced warming sensation. Each provides relief by irritating nerve endings in the skin to reduce the perception of the pain coming from the shoulder joint.

Surgery is indicated in trauma and other anatomical issues where there are tears or malformation in tissues of the shoulder joint or blood vessel and nerve issues that could be relieved due to surgical intervention. Rotator cuff tear repair is a common surgical procedure. Compression of blood vessels and nerves at the thoracic outlet that are causing pain, coldness, weakness and tingling/burning of the hands and fingers may need to be relieved with surgery if other therapies cannot resolve it.

Prevention & Prophylaxis

Preventing shoulder pain requires a multifaceted approach. Athletes and workers who are at a higher risk of shoulder injury due to their job duties should always wear the latest safety gear. For example, football players wear shoulder pads for protection. Maintaining sufficient muscle mass to support the functioning of the shoulder joint throughout a lifetime requires regular exercise. Good nutrition promotes strong muscles and lean bodies. Maintaining a proper weight reduces the chance of acquiring Type 2 diabetes that can lead to one form of frozen shoulder.

Some causes of joint inflammation have been directly associated with diet as well. Red meat is known to cause joint inflammation, and may mimic arthritis in some people. Shoulder pain is common. It can be anywhere along a spectrum of slightly annoying to utterly disabling. It can be caused by trauma, arthritis, diabetes, congenital defects such as glenoid dysplasia, or even be referred pain from liver, gallbladder or heart disease.

The first step to dealing with it is to know the source of the pain. Once the source is understood, then the appropriate medical treatments can be sought to resolve the issues causing the pain.