Dr. Mersad Alimoradi 09 Dec 2021

Pain in your shoulders can develop in various ways. You might have taken a fall or recently been in an accident that impacted your shoulder. Or you might have experienced a painful shoulder suddenly and don’t know why.

Chronic shoulder pain can stem from a range of painful causes, such as rotator cuff tendinitis, shoulder dislocation, and even a torn shoulder cartilage.

With that being said, shoulder pain isn't a condition you should overlook. After all, our shoulders have a wide range of motion, and if something goes wrong, it can hamper our ability to go about daily life.

We’ve put together a guide to help you find your way around the common causes of shoulder pain.

An Insight Into Chronic Shoulder Pain

The shoulder joint is right between your upper arm bone, shoulder blades, and collarbone. Together with surrounding muscles and tendons, it facilitates various arm movements that allow you to perform your daily activities.

As we age, the degradation of tissues and gradual wear and tear are the most common causes of pain in your shoulder. However, other painful conditions that affect your shoulder joint, muscles, and tendons can cause chronic shoulder pain.

Accidents, overuse, sporting injuries, and workplace injuries. These are only a few risk factors that lead to a wide range of conditions that cause shoulder pain.

If you’ve noticed any of these symptoms, a shoulder condition is most likely causing your shoulder pain.

  • Stiffness in your shoulder
  • Pain when you move your shoulder
  • Swelling in the shoulder area
  • Weakness or numbness of your hand or arm
  • Inability to move your shoulders

Let’s take a look at the common causes of shoulder pain.

1. Rotator Cuff Tendinitis

Rotator cuff tendinitis is also known as shoulder impingement, biceps tendonitis, or shoulder bursitis. Although it has many names, they have a similar meaning - inflammation in the shoulder tendons.

Your rotator cuff comprises shoulder muscles and their tendons surrounding the bursa of the shoulder joint. The bursa is a fluid-filled sac that cushions your joints. Tendinitis occurs when your shoulder tendons become inflamed, typically because of rotator cuff injury.

Rotator cuff tendinitis doesn't occur suddenly. It can result from:

  • Keeping your shoulder muscles stagnant for a long time (frozen shoulder)
  • Repeatedly engaging in intense overhead activities, like swimming, baseball, or painting
  • Placing all your weight on the affected shoulder when you go to bed
  • Bad posture
  • Sudden force when using your shoulder

Repeatedly stressing the painful shoulder can cause the pain to worsen. If it persists for too long, you may have to resort to surgical treatment to cure your rotator cuff tendinitis.

Here is what to look out for in rotator cuff tendonitis:

  • Pain when you move your rotator cuff muscles or shoulder joint
  • Swelling around your shoulder bursa
  • Weakening overtime

2. Rotator Cuff Tears

A rotator cuff tear is a painful shoulder condition wherein injury causes your tendons to tear and detach from your arm bone. These internal tears can be partial or complete. A complete rotator cuff tear completely removes your rotator cuff tendons away from your bone. A partial rotator cuff tear can leave it attached to the bone to a certain degree.

Chronic rotator cuff tear is the other type of rotator cuff tendinopathy, affecting about 2 million Americans every year. Tendinopathy is tendon injury because of overuse.

Aside from overuse, other causes of rotator cuff tears involve:

  • Degeneration from aging
  • Shoulder dislocation
  • Broken collarbone
  • Bone spurs, extra growth along bony edges
  • Reduced blood flow

If you notice intense shoulder pain during a planned shoulder movement, you may have rotator cuff tendinopathy. Here are a few signs that your shoulder pain is a rotator cuff tear:

  • Arm pain when you move your arm over your head
  • A popping or crackling sound when you move your arm
  • Your painful shoulder worsens at night
  • Difficulty carrying heavy objects

3. Shoulder Dislocation

Shoulder dislocation occurs when too much force is applied to your shoulder socket and, when pulled, your arm pops out. It’s a common cause of shoulder pain, often seen in sports injuries, accidents, and when you fall on your shoulder or outstretched arms.

Shoulder dislocation isn't only limited to your joint but also the connective tissue, muscles, and tendons of your shoulder. When you have a dislocated shoulder, you may experience the following symptoms:

  • Total or partial restriction in range of movement
  • Swelling
  • Muscle spasms
  • Tingling and numbness in the area
  • Redness
  • Bruising
  • Pain with or without moving the shoulder

When you dislocate your shoulder, severe pain, weakness, numbness, and swelling appear almost immediately. But when treated early, a shoulder dislocation doesn’t cause any permanent damage.

4. Shoulder Separation

Shoulder separation affects the acromioclavicular joint, the joint that connects your collarbone and shoulder blade. When the ligaments holding these bones together tear, it results in a shoulder separation.

Shoulder separation ranges from mild, where the ligaments are only stretched, to severe, when a strong force can entirely tear the ligaments. Severe shoulder separation can affect your shoulder’s function and hamper your normal activities.

A shoulder separation creates a bulge above the back of your shoulder from where the separated bone protrudes. Other symptoms of shoulder separation include:

  • Swelling or protrusion in the shoulder area
  • Intense shoulder pain
  • Weak shoulder
  • Restricted movement or loss of motion in the affected shoulder

The non-surgical treatment options can be limited if you have shoulder separation, so you’ll likely need surgery to repair your shoulder.

5. Cartilage Tear

Cartilage is a connective tissue component of your bones. In your shoulder, it acts as a cushion that protects your shoulder joint against impact. Your cartilage can tear because of trauma and overuse, resulting in a painful shoulder.

A cartilage tear is a common cause of shoulder pain in athletes and physically active young people. Repetitive and forceful rotation often seen in sports like baseball and tennis can lead to cartilage tears.

Here are a few other causes of cartilage tears in your shoulder:

  • Degeneration of cartilage with aging
  • Wear and tear
  • Falls
  • Accidents that impact your shoulder

When you have a cartilage tear, you may feel a painful catching or grinding when you attempt to use the affected shoulder. Signs and symptoms to watch out for with cartilage tears comprise:

  • Shoulder inflammation
  • Joint locking, your joint cannot move freely
  • Joint pain
  • Joint grinding or clicking

6. Frozen Shoulder

A frozen shoulder results from long periods of shoulder inactivity due to injury or inflammation. It leads your shoulder joint socket to develop a build-up of adhesions, bands of soft tissue.

When you immobilize your shoulder for a long time because of shoulder surgery or injury, a frozen shoulder can cause shoulder pain and significantly restrict your movement.

If you have a frozen shoulder, you may notice that your shoulder appears to lock. This is because of the inflammation and thickening of your shoulder tissues, causing stiffness and pain when you try to move it.

If you notice a few of these symptoms, a frozen shoulder maybe the cause of your shoulder pain:

  • Pain in the shoulder that’s worse at night
  • Difficulty sleeping due to shoulder pain
  • Excruciating pain when you put weight on the affected shoulder
  • Stiff shoulder joint
  • Inability or difficulty moving the shoulder

7. Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune, inflammatory disease that can cause chronic shoulder pain. It occurs when your immune system attacks the protective lining surrounding your shoulder joint socket, leading to inflammation.

If it progresses, it can spread to both shoulder joints. Aside from pain in your shoulder, you may notice some tenderness and weakness with movement.

If you have rheumatoid arthritis, you may note the following symptoms:

  • Joint pains (usually several joints)
  • Fatigue
  • Weight loss
  • Fever
  • Swelling in the joints
  • Stiffness in the affected shoulder
  • Shoulder pain worsens in the morning

8. Calcific Tendonitis

Calcific tendonitis is the build-up of calcium in your rotator cuff, contributing to subacromial impingement or inflammation in your shoulder. Calcific tendinitis is one of the most painful causes.

Calcific tendonitis can disrupt the normal function of your rotator cuff by filling the space between the shoulder blade and rotator cuff with calcific deposits. The calcium deposits add pressure on your shoulder tendons, resulting in irritation and pain.

If calcific tendonitis is the cause of your shoulder pain, here are a few symptoms to look out for:

  • Stiffness in the affected shoulder
  • Pain when you move the affected shoulder
  • Difficulty sleeping on the painful shoulder
  • Limited range of motion for the shoulder
  • Tender rotator cuff  

9. Shoulder Labral Tear

Your shoulder labrum is a cartilage that helps keep your shoulder joint in place. A complete tear occurs when the labrum is removed from your bone. But it can also be an internal tear within your labrum or a bicep tendon tear, where the biceps tendon connects with the labrum.

If your labrum is completely torn off, it can cause pain in your shoulder, and you’ll likely have to undergo arthroscopic surgery to repair the labrum.

A shoulder labral tear is a common cause of shoulder pain in athletes and professions with repetitive overhead movement, like baseball pitchers.

If you have a shoulder labral tear, you’ll notice pain in your shoulder when you perform overhead motions. You might also experience these symptoms with a shoulder labral tear:

  • Shoulder pain at night
  • Restricted or total loss of range of motion
  • Popping or grinding sensation in the shoulder socket
  • Limited flexibility of the affected shoulder

Frequently Asked Questions (FAQs)

Does physical therapy work for shoulder pain?

Physical therapy is an excellent non-surgical treatment for certain types of shoulder pain. However, if the cause of your shoulder pain is a severe condition, you may need to resort to surgical treatment.

How does heart disease affect shoulder pain?

So far, there's no medical connection between heart disease and shoulder pain. However, a weakened heart prevents adequate blood flow to your body, including your shoulders, and may slow down your normal healing process.

Does cortisone injection work on shoulder pain?

Yes. Cortisone or corticosteroid injection is one of the most common non-invasive and effective treatment options for treating shoulder pain.

Why are people with diabetes susceptible to painful shoulder conditions?

When you have diabetes, the high blood sugar levels allow sugar molecules to attach to collagen, making it adherent and sticky. It restricts the range of movement in your shoulder and often leads to painful shoulder conditions.

When should I worry about shoulder pain?

It’s best to contact your healthcare provider if the primary cause of your shoulder pain is a shoulder injury. If you experience intense pain, swelling, or deformation in the shoulder area, seek medical attention as soon as possible.

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About the Author:
Dr. Mersad is a medical doctor, author, and editor based in Germany. He's managed to publish several research papers early in his career. He is passionate about spreading medical knowledge. Thus, he spends a big portion of his time writing educational articles for everyone to learn.