Shoulder Pain

Medically Reviewed by Zilpah Sheikh, MD on June 19, 2024
12 min read

Shoulder pain is any type of pain or discomfort you feel in your shoulder. Your shoulder is called a ball-and-socket joint. It can move in many directions and it’s considered to be the most movable joint in the body. But it’s actually two joints (the acromioclavicular joint and the glenohumeral joint). 

Your shoulder joins with your upper-arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The humerus fits into the rounded socket of the scapula. Each shoulder is held in place by a group of four muscles and tendons, called a rotator cuff, which covers and protects the humerus and lets you raise and move your arm.

There are also ligaments that hold bone to bone, and a sac filled with fluid that cushions the humerus head inside the joint. Because there are so many parts to the shoulder, there are many reasons why your shoulder might hurt. You might injure it in a fall or accident, or you could have overdone a chore like painting. Sometimes, shoulder pain comes from a condition like arthritis. It can even stem from problems in other parts of your body, which is called referred pain.

Depending on what’s causing the pain, it can be sharp or achy. It can be sudden or come on gradually. It can also stop you from doing some of your regular activities. Using a painful shoulder could cause further damage, so it’s important to find out why your shoulder hurts and get treatment as soon as possible.

The shoulder's ball-and-socket joint gives you great range of motion, but it comes at the expense of stability. The shoulder joint gets dislocated more often than any other joint in the body. And repeated stress from the way you use your shoulders on the job or playing sports can lead to tears and other injuries.

Ask yourself some questions to help you decide if you have a shoulder injury:

  • Can you move your arm normally, or is your shoulder too stiff or painful?
  • Do you feel like your shoulder could pop out of the socket?
  • Is your shoulder strong enough for things you normally do?

You can treat some shoulder injuries at home for a few days with rest and ice. You can bandage it to hold it in place if necessary, and raise it above your heart. But some injuries need professional help. Here are signs that you need to see a doctor right away:

  • Your shoulder joint looks deformed.
  • You can’t use your shoulder at all.
  • The pain is intense.
  • Your shoulder swells suddenly.
  • Your arm or hand is weak or numb.
  • The pain comes with swelling, redness, or a fever. 
  • You have pain that lasts for more than 2 to 4 weeks.
  • The skin around your shoulder becomes discolored.

Because the shoulder is such a complicated and busy joint, it can be easy to hurt it. Most shoulder injuries are caused by overuse (repetitive use injuries), but they can also happen through force or falls.

Common shoulder injuries

  • Overuse. These injuries can happen when you move it the same way again and again. Overuse injuries are also called repetitive strain injuries. Reaching above your head, like when you’re swimming or washing or painting walls, or simply moving your arm back and forth, as when you are playing tennis or gardening, can cause overuse injuries. 
    • Bursitis is an overuse injury. The bursa (a fluid-filled sac that cushions in your joint) can get swollen and irritated if you repeat the same motions. If you have bursitis, you may notice the pain most when you move your shoulder.
    • A cartilage tear, called a SLAP tear when it’s in the shoulder, can also happen with overuse. You can injure the cartilage (the rubbery padding) that goes around the rim of your shoulder joint. With this type of injury, you might feel pain when you reach over your head, and your shoulder could seem weak. It might also feel like it’s catching, locking, or grinding.
    • Rotator cuff tear. Your rotator cuff is the group of muscles and tendons in your shoulder that hold your arm in place and let you lift your arm overhead. You can damage it through overuse. It also begins to show wear and tear as you age. Your shoulder may hurt at night and when you try to lift things. You might hear a crackling sound when you move it.
    • Impingement. This happens when the tendons of the rotator cuff get pinched in the bones of the shoulder. It can cause swelling and pain. If you lift your arms over your head a lot, it can set this off. 
    • Tendinitis. This is when the tendons that make up your rotator cuff get inflamed. It can happen slowly over time.
  • Nerve injury. A brachial plexus injury can happen when a group of nerves called the brachial plexus, which runs from your spinal cord through your shoulder to your arm, becomes stretched or squeezed. The nerves can even be torn away in rare cases. A minor nerve injury can cause a numbing feeling or weakness in the arm, as well as a feeling like an electric shock throughout the arm. A more severe nerve injury can cause such weakness in your arm that you can’t use it. It can also cause severe pain.
  • Trauma or fall. A car accident, a fall onto the ground, or getting struck by something are other ways you can hurt your shoulder.
    • Dislocation. If your shoulder is pulled back too hard or rotated too far, the top of your arm might pop out of its socket. You will feel pain and weakness in your shoulder. You may also have swelling, numbness, and bruising.
    • Separation. This injury affects the joint where your collarbone and shoulder blade come together. It’s called the acromioclavicular (AC) joint. A fall or hard blow tears the ligaments holding it together. If your collarbone gets pushed out of place, you’ll have a bump on top of your shoulder.
    • Fracture. A bone can break or crack if you fall or take a hard hit. The most common breaks are to the clavicle (collarbone) and the humerus (arm bone closest to your shoulder). You’ll have a lot of pain and may get a bruise. If your collarbone is broken, your shoulder can sag and you might not be able to lift your arm.
    • Cartilage tear
    • Rotator cuff tear
    • Bursitis. The bursa (a fluid-filled sac that cushions in your joint) can get swollen and irritated if you repeat the same motions over and over again. But bursitis can also be caused by a fall or another injury. If you have bursitis, you may notice the pain most when you move your shoulder.
    • Tendinitis
  • Frozen shoulder. This condition limits how much your joint will move. Abnormal bands of tissue (adhesions) build up in the joint and keep your shoulder from moving freely. Your shoulder might “freeze” because pain or surgery have made you use it less, allowing the adhesions to build up.
  • Bone spurs. Also known as “osteophytes,” these small, smooth pieces of bone rub up against and wear on your rotator cuff and keep your shoulder from moving the way it should. They can lead to tendinitis or a rotator cuff tear.
  • Poor shoulder posture and mechanics. How you stand and sit have an impact on how well you can move your arms. If you slouch, it can be harder for your shoulder joint to move. You might cause muscles to tighten and nerves to get pinched.

Other causes of shoulder pain

  • Arthritis. As with any joint, your shoulder can get arthritis.
    • Osteoarthritis is called the wear-and-tear arthritis because it usually affects the joints that do the most work, like your shoulder. After a while, the cartilage can start to break down. When the cartilage breaks down enough, it can’t keep the bone from rubbing against bone anymore, which causes the pain.
    • Rheumatoid arthritis usually affects more than one joint at a time. This type of arthritis causes swelling in the shoulder lining, which can trigger pain and stiffness.
    • Posttraumatic arthritis. If you’ve broken or dislocated your shoulder, you can be at risk of posttraumatic arthritis.
  • Referred pain. Sometimes, your shoulder hurts when there’s nothing wrong with it. This can be a sign of trouble with your gallbladder, liver, or another organ.
  • Heart attack. If you have shoulder pain in your left arm up to your jaw, have a hard time breathing, or your chest feels tight, you might need emergency medical help right away.

Your doctor will start with a physical exam to check for any structural problems and rule out anything that might involve your spine or neck. Next, they’ll test your range of motion to see how strong and flexible your shoulder is. That will involve moving your arms in various ways, like above your head, across your body, or behind you, and rotating it 90 or 180 degrees.

Your doctor also might recommend one or more imaging tests to get a closer look:

  • X-rays. These can help your doctor find bone spurs, arthritis, and other bone-related causes of your shoulder pain.
  • MRI scan. This uses radio waves and a powerful magnet to make detailed images of your shoulder.
  • CT scan. This is a series of X-rays taken from different angles. When they’re put together, they can give your doctor a better look at what’s happening with your shoulder.
  • Electromyography (EMG). This measures the electrical activity in your muscles to see if there are any problems with your nerves.
  • Arthroscopy. This surgery lets a tiny fiber-optic camera show your doctor high-definition images of your shoulder. In some cases, your doctor may also be able to treat the problem during the procedure.
  • Arthrogram. This is an imaging test (CT, fluoroscopy, MRI, or ultrasound) done with an injected dye. First, the dye is injected into your joint, where it is absorbed to make it easier for the radiologist to see any problems in your shoulder’s tissues.

For dislocations, separations, and fractures, you need a doctor’s help to get your shoulder back in the right position and then a sling to hold it in place while it heals.

For many other issues, your doctor may suggest rest, heat or ice, and a medicine like aspirin or ibuprofen to reduce the pain and swelling.

If your shoulder doesn’t improve after these first steps, your doctor may try injecting a corticosteroid (an anti-inflammatory medicine) straight into the joint to relieve swelling and pain.

Sometimes, cartilage tears, rotator cuff tears, and frozen shoulders don’t improve with rest and medicine. Your doctor may recommend surgery.

With any problem in your shoulder, your treatment plan will probably include exercises to help you stretch and strengthen the joint and to improve your range of motion.

There isn’t any one particular shoulder pain treatment because the type of help you need depends on what type of shoulder injury you have.

Dislocated shoulder. If you have a dislocated shoulder, it must be put back into the socket as quickly as possible to prevent complications. The most common treatment is called a closed reduction or manipulation. This must be done in the emergency department because it’s easy to cause more injury if you try it yourself. The doctor, with help from another health care professional, physically moves your arm and shoulder back into the right position. It is a painful procedure, so you will likely need sedation beforehand.

Once the shoulder is back in place, you’ll need to wear a sling to keep it there and to keep your arm from pulling on your shoulder, so it doesn’t dislocate again. Ice and over-the-counter pain relievers may help with the pain. You will also likely need physical therapy. A physical therapist will help you move your arm so that your shoulder doesn’t get too stiff. Therapy also helps strengthen the muscles around your shoulder to protect it.

If a closed reduction doesn’t work, you may need surgery to put it back into place.

Separated shoulder. Usually, the only treatments needed for a separated shoulder are a sling to keep you from moving it, ice packs, and pain relievers. You will also likely need physical therapy, and your doctor will tell you when you can start lifting above your head or heavy weights.

Surgery for a separated shoulder isn’t common, but you might need it if your separation is severe.

Shoulder fracture. In many cases, a shoulder fracture – a broken shoulder – will heal if you keep your arm in a sling. But sometimes, shoulder fractures need surgery to put the bones back together and repair any other damage.

If your fracture is severe, your doctor may recommend a joint replacement, also called arthroplasty.

Rotator cuff tears. Rotator cuff tears can only be repaired with surgery, but not all rotator cuffs need to be repaired. If your tear is minor, your doctor will likely recommend a sling, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, or steroid shots.

Most other injuries. The first-line treatment for most other shoulder injuries usually include resting your shoulder, taking NSAIDs, and doing physical therapy. Your doctor may recommend a cortisone shot. If these don’t work, you may need surgery.

Home treatments may help you manage many types of shoulder pain, from overuse to arthritis. But if the pain gets worse, you lose function of your arm or hand, or you get other symptoms, contact your doctor as soon as possible because you don’t want the injury to worsen.

Ice. Icing the painful area can help reduce inflammation (swelling) and relieve pain. But do not put ice directly on your skin. Make sure there is fabric between the ice and skin to prevent damage to the skin.

Over-the-counter (OTC) pain relievers. Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and pain. Follow the directions, and if the drugs don’t help relieve the pain, speak with your doctor because you may need higher doses or a different type of pain medicine.

Immobilization. Using a sling to keep your shoulder from moving can help relieve shoulder pain. It also helps keep the weight of your arm from pulling on your shoulder. But it’s important to not use a sling for too long without your doctor’s advice. Keeping your arm immobile for too long can cause other complications, like muscle weakness.

Exercises/physical therapy. Unless you’ve been told not to do exercises that work your shoulder, using your shoulder could help ease the stiffness and pain of some types of shoulder injuries. Check with your doctor or physical therapist first, though, because, depending on the injury, exercise could make things worse.

If you have shoulder pain and any other signs of a possible heart attack (chest pain, tightness in your chest, pain radiating to the jaw, sweating, a hard time breathing), call 911 right away. This is a life-threatening emergency.

If you have shoulder pain along with any of these problems, contact your doctor as soon as possible because the injury could be serious:

  • Your shoulder looks abnormal or deformed.
  • You can’t move your arm or use your shoulder.
  • The pain is intense or unbearable, or is getting worse.
  • There is sudden swelling.
  • Your shoulder is red, warm, or tender to the touch.
  • You were able to use your shoulder, but it is getting hard to.

You use your shoulders a lot, and they allow you to move your arms many different ways. Because you use them so much, it’s easy to injure one – or both. Most shoulder injuries, especially if they’re caused by overuse, can be managed at home as long as the symptoms don’t get worse. But some, like a shoulder dislocation or fracture, need medical attention. Also, shoulder pain doesn’t always mean there is something wrong with your shoulder. It is sometimes a sign of a more serious condition, like a heart attack.

What causes sudden shoulder pain without injury?

You may not always realize your shoulder is injured, especially if you have an overuse injury. Rotator cuff injuries are a common example of that. But you could also get sudden shoulder pain if you are having a heart attack, so when in doubt, seek medical help.

What are the symptoms of a serious shoulder injury?

The most obvious signs of a serious shoulder injury include not being able to move your arm or use your shoulder or getting an obvious deformity, such as if you break or dislocate your shoulder. But if you have a hard time breathing or chest pain with your shoulder pain, this may be very serious, because they are signs of a heart attack.