Why Does Your Shoulder Hurt? Common Causes of Shoulder Pain
Shoulder pain is most often caused by rotator cuff problems (tendinitis, impingement or tears), frozen shoulder, bursitis, arthritis, injuries such as dislocation, or pain referred from the neck. The location of the pain, the movements that trigger it and whether it is worse at night all give clues to the cause. Shoulder pain that lasts more than two weeks, limits movement, disturbs sleep or follows an injury should be examined by a doctor. Left shoulder pain with chest discomfort or breathlessness needs emergency care.
This guide explains how the shoulder works, the common causes of shoulder pain, how it is assessed and what treatment options may be considered.
How the Shoulder Works
The shoulder is a ball-and-socket joint and the most mobile joint in the body. A group of four muscles and their tendons, called the rotator cuff, holds the ball in the socket and helps lift and rotate the arm. A small fluid-filled sac called the bursa reduces friction between the tendons and the bone above. Because the shoulder moves so freely, it depends heavily on these soft tissues, which makes them prone to strain and wear.
Common Causes of Shoulder Pain
Rotator cuff tendinitis and impingement
When the rotator cuff tendons get irritated or pinched under the bony arch of the shoulder, pain appears when lifting the arm overhead, reaching behind the back or lying on the affected side. Repetitive overhead work, sports and posture can contribute.
Rotator cuff tear
Tendons can tear after a fall or gradually with age. Symptoms include pain, weakness when lifting the arm and difficulty with daily tasks such as combing hair.
Frozen shoulder (adhesive capsulitis)
The capsule around the joint becomes thick and tight, causing pain and progressive stiffness. It is more common between 40 and 60 years of age and in people with diabetes or thyroid problems. Read our guide on exercises to avoid with frozen shoulder.
Bursitis
Inflammation of the bursa causes pain on the outer shoulder, often with tenderness and pain when lying on that side.
Arthritis
Osteoarthritis or rheumatoid arthritis can affect the shoulder joint or the small joint at the tip of the shoulder (acromioclavicular joint), causing pain, stiffness and a grinding feeling.
Injuries
Dislocations, fractures of the collarbone or upper arm, and labral tears can follow falls, accidents or sports injuries.
Calcific tendinitis
Calcium deposits can form in the rotator cuff tendons and cause sudden, intense pain in some people.
Pain from the neck
A pinched nerve in the neck (cervical radiculopathy) can cause pain in the shoulder and shoulder blade, often with tingling or weakness in the arm.
Referred pain from other organs
Heart problems, gallbladder conditions and some lung conditions can cause pain felt in the shoulder. This is why new shoulder pain with other symptoms should never be ignored.
What the Location of Pain Can Suggest
- Outer side of the shoulder: rotator cuff or bursa
- Front of the shoulder: biceps tendon or joint problems
- Tip of the shoulder: acromioclavicular joint
- Shoulder blade and neck: neck or muscle related
- Deep, all-round stiffness: frozen shoulder or arthritis
These are general patterns only. A clinical examination is needed to confirm the cause.
How Is Shoulder Pain Diagnosed?
A doctor will ask about how the pain began, which movements trigger it and whether it affects sleep. They will examine the shoulder’s range of movement, strength and tender points, and may also check the neck. Depending on findings, tests may include:
- X-ray to look at bones, arthritis and calcium deposits
- Ultrasound to assess tendons and the bursa
- MRI for a detailed view of soft tissues
- Blood tests in selected cases, such as suspected inflammatory arthritis
Treatment Options for Shoulder Pain
Treatment depends on the diagnosis. Many shoulder conditions are first managed without surgery.
Rest and activity changes
Reducing overhead and repetitive activities for a short time allows irritated tissues to settle. Complete immobilisation is usually avoided, as it can increase stiffness.
Physiotherapy and exercise
A guided programme to improve range of movement, strengthen the rotator cuff and shoulder blade muscles and correct posture is central to recovery for many conditions. Learn more about physical therapy for shoulder pain.
Medicines
Pain-relieving and anti-inflammatory medicines may be prescribed for a short period after medical review.
Other non-surgical options
Depending on the condition, a pain specialist may consider therapies such as TENS, IFT, therapeutic ultrasound, shockwave therapy or image-guided injections. Suitability is decided after assessment. You can read about shockwave therapy for shoulder pain.
Surgery
Surgery may be considered for significant tendon tears, recurrent dislocations or severe arthritis that does not respond to other treatment. This decision is made with an orthopaedic surgeon.
Everyday Tips to Protect Your Shoulders
- Keep your workstation at a height that avoids hunching
- Take breaks from repetitive or overhead tasks
- Warm up before sports or gym workouts
- Lift objects close to your body
- Do not ignore pain that keeps returning
Frequently Asked Questions
What is the most common cause of shoulder pain?
Rotator cuff problems, including tendon inflammation (tendinitis), impingement and tears, are among the most common causes of shoulder pain in adults. Frozen shoulder, bursitis and arthritis are also frequent causes.
Why does my shoulder hurt more at night?
Lying on the affected side increases pressure on the tendons and bursa. Rotator cuff problems and frozen shoulder often cause night pain. Sleeping on your back or the other side with a pillow supporting the arm may help.
How do I know if my shoulder pain is from my neck?
Pain that spreads from the neck to the shoulder blade or down the arm, with tingling, numbness or weakness in the hand, may come from a nerve in the neck. A doctor can examine both the neck and shoulder to find the source.
Can shoulder pain be a sign of a heart problem?
Yes, in some cases. Pain in the left shoulder or arm with chest discomfort, breathlessness, sweating or nausea can be a sign of a heart attack and needs emergency care immediately.
When should I see a doctor for shoulder pain?
See a doctor if the pain lasts more than two weeks, disturbs sleep, limits movement, follows an injury or fall, or comes with weakness, swelling, fever or numbness.
Is frozen shoulder more common in people with diabetes?
Yes. Frozen shoulder is more common in people with diabetes and thyroid disorders. It typically causes gradual pain followed by stiffness that limits both active and assisted movement.
Visit Painmedic Pain Clinic in Pune
If shoulder pain is affecting your work, sleep or daily tasks, a consultation can help identify the cause and discuss suitable non-surgical options. Painmedic Pain Clinic is led by Dr. Kauser Mujawar (M.B.B.S, D.N.B Anaesthesiology, FIPM). See our shoulder pain treatment page for more information.
- Address: 202, KD Plaza, Timber Market Rd, near Seven Loves Chowk, Ekbote Colony, Mahatma Phule Peth, Swargate, Pune, Maharashtra 411042
- Phone: +91 86863 13147
- Timings: Monday to Saturday, 8 AM to 8 PM; Sunday closed
You can also send an enquiry through our contact page.
