Your shoulders are the joints where your upper-arm bones (humerus), shoulder blades (scapula), and collarbone (clavicle) meet. The humerus fits into the rounded socket of the scapula on each side of your body. 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.
Pain in your shoulder can have many causes. 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.
What Are the Symptoms of a Shoulder Injury?
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 elevate it above the 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.
- The shoulder is swelling suddenly.
- Your arm or hand is weak or numb.
What Are Shoulder Pain Causes and Risk Factors?
Common shoulder injuries:
- 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 it may bruise. If your collarbone is broken, your shoulder can sag and you might not be able to lift your arm.
- Cartilage tear. You can injure the cartilage (the rubbery padding) that goes around the rim of your shoulder joint. It can happen after doing the same motion over and over. You can also hurt it in a fall or anytime your shoulder absorbs a lot of force. 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 or in a fall. 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.
- 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.
- 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.
- 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 it 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.
Other causes of shoulder pain:
- Osteoarthritis. Also called degenerative joint disease, this is the most common form of arthritis. It can affect any joint, including your shoulders. The cartilage between bones breaks down, and they rub together. This can cause pain and stiffness.
- Rheumatoid arthritis. This is a disease that causes your body’s immune system to attack the protective lining in your joints. It can also cause pain and stiffness in your shoulders.
- Referred pain. Sometimes your shoulders hurt when there’s nothing wrong with them. This can be a sign of trouble with your gallbladder, liver, or another organ.
- Heart attack. If your shoulder hurts and you have trouble breathing or your chest feels tight, you might need emergency medical help right away.
- Tendinitis. This is when the tendons that make up your rotator cuff get inflamed. It can happen slowly over time or as the result of a fall or a direct hit to your shoulder.
- 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.
How Is Shoulder Pain Diagnosed?
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. Your doctor may also recommend an arthrogram, which involves a shot of dye to make the details show up more clearly.
- 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 is a surgical procedure that 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.
What Are Shoulder Pain Treatments and Home Remedies?
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.
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 shoulder 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.
How Can I Prevent Shoulder Pain ?
OrthoInfo: “Shoulder Pain and Common Shoulder Problems,” “Rotator Cuff and Shoulder Conditioning Program.”
Cleveland Clinic: “Rotator Cuff Tendonitis,” “Bone Spurs,” “Shoulder Tendinitis.”
American Society for Surgery of the Hand: “Shoulder Pain.”
American Academy of Family Physicians: “Shoulder Pain.”
Mayo Clinic: “Shoulder Pain,” “Rotator Cuff Injury,” “Arthroscopy.”
National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Shoulder Problems.”
Arthritis Foundation: “Shoulder Injuries,” “Arthritis and Diseases That Affect the Shoulders.”
American Academy of Orthopaedic Surgeons: “Common Shoulder Injuries,” “Dislocated Shoulder,” “Clavicle Fracture,” “Shoulder Joint Tear,” “Rotator Cuff Tears,” “Shoulder Impingement/Rotator Cuff Tendinitis.”
Stanford Medicine: “Approach To The Exam of The Shoulder.”
Johns Hopkins Medicine: “Electromyography (EMG).”
Texas Department of Insurance: “Shoulder Injury Prevention Fact Sheet.”
University of Iowa Hospitals and Clinics: “Shoulder Injury Prevention.”
Merck Manual Home Edition.
American Orthopaedic Society for Sports Medicine.