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Shoulder pain

  • Definition
    • Shoulder pain is any pain in or around the shoulder joint.

      Test Your Shoulder Pain Knowledge

      1. The shoulder is the most movable joint in the human body.

        1. A. True
        2. B. False

        The correct answer is true. Tendons are a type of tissue that connect muscle to bone. A group of four tendons in the shoulder, called the rotator cuff, give the shoulder a wide range of motion.

      2. Rotator cuff problems are the most common cause of shoulder pain.

        1. A. True
        2. B. False

        The correct answer is true. Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or moving it forward or behind your back. Arthritis and bone spurs can also cause shoulder pain.

      3. Which of the following can cause rotator cuff problems?

        1. A. Keeping your arm in the same position for a long time, such as doing computer work
        2. B. Sleeping on the same arm each night
        3. C. Playing sports that use your arm in an overhead motion such as tennis, baseball, swimming, and lifting weights
        4. D. Working with your arm overhead (such as painting and carpentry)
        5. E. Falling on your arm while it is stretched out
        6. F. All of the above

        The correct answer is all of the above. Poor posture over many years and normal wear and tear related to age may also lead to rotator cuff problems. Sometimes self-care can treat shoulder pain. If you injure your shoulder from a sudden fall, talk with your doctor.

      4. Symptoms of rotator cuff problems include:

        1. A. Pain when lifting your arm overhead or to the side
        2. B. Pain in the front of the shoulder
        3. C. Pain when lying on your shoulder
        4. D. Weakness and loss of motion of your shoulder
        5. E. All of the above

        The correct answer is all of the above. Your shoulder can feel stiff when you try to lift with your arm or move your shoulder. It may become harder to place your arm behind your back. Most people with rotator cuff tendon tears have pain at night. If you notice that shoulder pain makes you want to avoid using your arm, call your doctor.

      5. If you have shoulder pain from rotator cuff problems, self-care involves using:

        1. A. Heat
        2. B. Ice
        3. C. Acetaminophen (Tylenol)
        4. D. Ibuprofen (Motrin) or Naproxen (Aleve)
        5. E. B and D
        6. F. All of the above

        The correct answer is B and D. Ice and ibuprofen or naproxen help reduce pain and swelling. Acetaminophen treats pain, but won't reduce swelling. Apply ice packs 20 minutes at a time, 3 - 4 times a day. Avoid activities that cause pain. Call your doctor if symptoms don't get better. A steroid injection in your shoulder may help.

      6. Changing your posture can help relieve shoulder pain.

        1. A. True
        2. B. False

        The correct answer is true. Your posture during the day and night can help relieve some of your shoulder pain. Sleep on your back or the side that is not painful. Putting pillows under your shoulder may help. When sitting, keep your shoulders back, a rolled towel or pillow behind your lower back, your feet flat on the floor or on a low stool.

      7. Other ways to ease the strain on your shoulder include:

        1. A. Avoid carrying a backpack or purse over just one shoulder.
        2. B. Lift and carry objects close to your body. Try not to lift heavy loads away from your body.
        3. C. When reaching for something with your arm, point your thumb up.
        4. D. Wear a sling.
        5. E. All of the above.
        6. F. A, B, and C

        The correct answer is A, B, and C. Consider making some changes around your home so it is easier for you to take care of yourself. Store everyday items you use in places you can reach easily. Keep things with you that you use a lot, like your phone.

      8. Physical therapy can help treat shoulder pain.

        1. A. True
        2. B. False

        The correct answer is true. Your doctor may refer you to a physical therapist (PT) to treat shoulder pain. After testing and examining you, your PT will know which muscles are too weak or too tight. You will then start a program to stretch out your muscles and make them stronger.

      9. If you have a rotator cuff tear, you will need surgery.

        1. A. True
        2. B. False

        The correct answer is false. Rest and exercise may help someone with a partial rotator cuff tear who does not normally put a lot of demand on the shoulder. You may need surgery to repair the tendon if the rotator cuff has a complete tear, or if the symptoms continue after types of treatment.

      10. Sudden shoulder pain can be a sign of a heart attack.

        1. A. True
        2. B. False

        The correct answer is true. Call 911 if you have sudden pressure or crushing pain in your shoulder, especially if the pain runs from your chest, jaw, or neck, or occurs with shortness of breath, dizziness, or sweating.

  • Alternative Names
    • Pain - shoulder

  • Considerations
    • The shoulder is the most movable joint in the human body. A group of 4 muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion.

      Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or moving it forward or behind your back.

  • Causes
    • The most common cause of shoulder pain occurs when rotator cuff tendons become trapped under the bony area in the shoulder. The tendons become inflamed or damaged. This condition is called rotator cuff tendinitis or bursitis.

      Bursitis of the shoulder

      Shoulder pain may also be caused by:

      • Arthritis in the shoulder joint
      • Bone spurs in the shoulder area
      • Bursitis, which is inflammation of a fluid-filled sac (bursa) that normally protects the joint and helps it move smoothly
      • Broken shoulder bone
      • Dislocation of the shoulder
      • Shoulder separation
      • Frozen shoulder, which occurs when the muscles, tendons, and ligaments inside the shoulder become stiff, making movement difficult and painful
      • Overuse or injury of nearby tendons, such as the bicep muscles of the arms
      • Tears of the rotator cuff tendons
      Shoulder joint dislocation

      Sometimes, shoulder pain may be due to a problem in another area of the body, such as the neck or lungs. This is called referred pain. There is usually no pain when moving the shoulder.

  • Home Care
    • Here are some tips for helping shoulder pain get better:

      • Put ice on the shoulder area for 15 minutes, then leave it off for 15 minutes. Do this 3 to 4 times a day for 2 to 3 days. Wrap the ice in cloth. Do not put ice directly on the skin because this can result in frostbite.
      • Rest your shoulder for the next few days.
      • Slowly return to your regular activities. A physical therapist can help you do this safely.
      • Taking ibuprofen or acetaminophen (such as Tylenol) may help reduce inflammation and pain.

      Rotator cuff problems can be treated at home also.

      • If you have had shoulder pain before, use ice and ibuprofen after exercising.
      • Learn exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. A doctor or physical therapist can recommend such exercises.
      • If you are recovering from tendinitis, continue to do range-of-motion exercises to avoid frozen shoulder.
      • Practice good posture to keep your shoulder muscles and tendons in their right positions.
  • When to Contact a Medical Professional
    • Sudden shoulder pain can sometimes be a sign of a heart attack. Call 911 if you have sudden pressure or crushing pain in your shoulder, especially if the pain runs from your chest to the left jaw, arm or neck, or occurs with shortness of breath, dizziness, or sweating.

      Heart attack symptoms

      Go to the hospital emergency room if you have just had a severe injury and your shoulder is very painful, swollen, bruised, or bleeding.

      Call your health care provider if you have:

      • Shoulder pain with a fever, swelling, or redness
      • Problems moving the shoulder
      • Pain for more than 2 to 4 weeks, even after home treatment
      • Swelling of the shoulder
      • Red or blue color of the skin of the shoulder area
  • What to Expect at Your Office Visit
    • Your provider will perform a physical exam and closely look at your shoulder. You will be asked questions to help the provider understand your shoulder problem.

      Blood or imaging tests may be ordered to help diagnose the problem.

      Your provider may recommend treatment for shoulder pain including:

      • Nonsteroidal anti-inflammatory drugs (NSAIDs)
      • Injection of an anti-inflammatory medicine called corticosteroid
      • Physical therapy
      • Surgery if all other treatments do not work

      If you have a rotator cuff problem, your provider will likely suggest self-care measures and exercises.

  • References
    • Martin SD, Thornhill TS. Shoulder pain. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelly's Textbook of Rheumotology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 46.

      Matzkin EG, Hampton DM, Gill TA. Shoulder diagnosis and decision making. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 43.