Shoulder Pain

Shoulder pain is a common problem that can affect people of all ages. It can be caused by a variety of factors, from a simple muscle strain to a more serious underlying medical condition. Understanding the cause of your shoulder pain is the first step towards finding the right treatment and getting back to your daily activities without discomfort.

This article will explore the common causes of shoulder pain, how it can be treated, and when you should seek medical advice. We will also answer some frequently asked questions about shoulder pain.

How does the shoulder work?

The shoulder is the most mobile joint in the body, allowing you to lift, rotate, and extend your arms in multiple directions. It is a complex ball-and-socket joint, where the head of the upper arm bone (humerus) fits into a shallow socket (glenoid) in the shoulder blade (scapula). This joint is surrounded by a group of muscles and tendons called the rotator cuff, which keeps the head of the humerus in the socket and allows you to move your arm.

The shoulder's incredible range of motion, however, comes at the cost of stability, making it prone to injury. Problems with any part of the shoulder, including the bones, muscles, tendons, ligaments, and cartilage, can cause pain.

Causes of shoulder pain?

Shoulder pain can be caused by a number of conditions, including:

• Rotator cuff problems: These are the most common cause of shoulder pain. The rotator cuff can be damaged through overuse, injury, or age-related wear and tear. This can lead to conditions like tendinopathy or a rotator cuff tear.
• Frozen shoulder: Also known as adhesive capsulitis, this condition causes pain and stiffness in the shoulder joint. It occurs when the flexible tissue that surrounds the shoulder joint, called the capsule, becomes inflamed and thickened.
• Shoulder instability: This happens when the head of the upper arm bone is forced out of the shoulder socket. This can be a partial dislocation (subluxation) or a full dislocation. Once a shoulder has been dislocated, it is more likely to happen again.
• Arthritis: The most common type of arthritis to affect the shoulder is osteoarthritis, which is caused by wear and tear on the joint cartilage over time. Rheumatoid arthritis, an autoimmune disease, can also affect the shoulder.
• Bursitis: This is the inflammation of a bursa, a small fluid-filled sac that cushions the bones, tendons, and muscles near your joints.
• Fracture: A broken bone in the shoulder, such as a fractured collarbone or humerus, can cause severe pain.
• Referred pain: Sometimes, pain felt in the shoulder can be coming from another part of the body, such as the neck or heart.

What causes shoulder and neck pain?

Pain that is felt in both the shoulder and neck is often due to a problem in the neck itself. This is known as referred pain. The nerves that supply the shoulder originate in the neck, and if these nerves are irritated or compressed, it can cause pain that radiates down into the shoulder and arm. This can be caused by conditions such as a herniated disc or cervical spondylosis (age-related wear and tear of the neck).

If you are experiencing both shoulder and neck pain, it is important to see a doctor to determine the underlying cause.

Causes of shoulder pain at night

Shoulder pain that is worse at night is a common complaint. This can be due to a number of factors:

• Sleeping position: Lying on the affected shoulder can put pressure on it and cause pain.
• Inflammation: When you lie down, the effects of gravity are reduced, which can cause inflammatory fluids to collect in the joint, leading to increased pain and stiffness.
• Rotator cuff injuries: These injuries are often worse at night because the tendons are more likely to be pinched when you are lying down.

Sudden shoulder pain without injury

Sudden shoulder pain that occurs without any apparent injury can be alarming. Possible causes include:

• Frozen shoulder: The pain from a frozen shoulder can come on suddenly and for no apparent reason.
• Calcific tendonitis: This is a condition where calcium deposits build up in the rotator cuff tendons, causing sudden and severe pain.
• Infection: Although rare, a bacterial infection in the shoulder joint can cause sudden and severe pain, along with swelling and fever.
• Referred pain: As mentioned earlier, pain from other parts of the body can be felt in the shoulder.

If you are experiencing shoulder pain and are unsure of the cause, it is always best to err on the side of caution and seek medical advice.

How to tell if shoulder pain is muscular or heart related

In some cases, shoulder pain can be a sign of a heart attack. It is important to be able to distinguish between muscular shoulder pain and pain that may be heart-related.

Muscular shoulder pain:

• Is usually a dull, aching pain that is localized to the shoulder area.

• Is often made worse by movement.

• May be accompanied by weakness or stiffness in the shoulder.

• Usually improves with rest and over-the-counter painkillers.

Heart-related shoulder pain:

• Is often described as a feeling of pressure, tightness, or squeezing in the chest that spreads to the shoulder, arm, neck, jaw, or back.

• May be accompanied by other symptoms such as shortness of breath, sweating, nausea, or light-headedness.

• Is not usually affected by movement.

• Is a medical emergency and requires immediate attention.

If you are experiencing shoulder pain and are unsure of the cause, it is always best to err on the side of caution and seek medical advice.

Shoulder pain treatment

The treatment for shoulder pain will depend on the underlying cause. In many cases, simple self-care measures can be effective. For more information visit our pain management page.

Exercise & physiotherapy for shoulder pain

Gentle exercises can help to reduce stiffness and improve the range of motion in your shoulder. A physiotherapist can develop a personalised exercise program for you, as well as provide other treatments such as manual therapy and advice on how to modify your activities to avoid further injury.

Painkillers for shoulder pain

Over-the-counter painkillers such as paracetamol and ibuprofen can help to relieve mild to moderate shoulder pain. If your pain is more severe, your doctor may prescribe stronger painkillers.

Steroid injections

Steroid injections can be used to reduce inflammation and relieve pain in the shoulder. They are often used to treat conditions such as rotator cuff problems and frozen shoulder.

Surgery for shoulder pain

In some cases, surgery may be necessary to treat shoulder pain. This may be recommended if other treatments have not been effective, or if there is a structural problem with the shoulder that needs to be repaired. 
Common surgical procedures for the shoulder include:

• Shoulder arthroscopy 

• Total shoulder replacement 

• Rotator cuff surgery 

When to call your doctor: How to tell if shoulder pain is serious

You should see a doctor if:

• Your shoulder pain is severe.
• You are unable to move your arm.
• Your shoulder is swollen or abnormal shape.
• You have a fever or feel generally unwell.
• The pain does not improve after a few weeks of self-care.
• Unexpected weight loss.

You should call for an ambulance or go to the nearest emergency department if you have shoulder pain that is accompanied by chest pain, shortness of breath, or other signs of a heart attack.

Shoulder Pain at Ramsay Health Care

Shoulder pain is very common and understanding the cause of your shoulder pain is the first step towards finding the right treatment and getting back to your daily activities without discomfort.

Ramsay Health Care offers expert diagnosis and treatment for shoulder pain, including fast access to consultations and surgery if required. Contact us today to book an appointment today with a shoulder pain specialist.

Shoulder Pain FAQs