Why does your shoulder hurt?

The shoulder is the most complex, mobile joint in the body, making it especially vulnerable to injury for people of all ages.

“Shoulder pain is a common issue that’s generally related to aging and everyday wear and tear, but acute traumatic injuries can also occur,” says Ilya Voloshin, chief of the Shoulder and Elbow Division in University of Rochester’s orthopaedics department.

Here, Voloshin offers advice on protecting your shoulders from injury and when to seek treatment:

Why does your shoulder hurt?

As tendons get older, they become more vulnerable to injury, commonly from overuse. Repetitive or strenuous activity without proper conditioning, stretching, and warm-up can lead to inflammation and pain.

In people of all ages, shoulder pain can result from acute injuries such as:

Falling
Hoisting heavy objects (like a grocery bag)
Yardwork
Athletic activities such as tennis or golf

Shoulder pain can also be nerve-related. Conditions like neck arthritis or carpal tunnel syndrome in the wrist can cause pain to radiate down or up the arm, respectively, to the shoulder and shoulder blade.

Some pain might occur without overuse, injury, or related conditions. Certain everyday habits could be the cause of your shoulder pain.

Habits that can cause shoulder pain

Sleep position: Some sleep positions, such as sleeping on your side, put extra pressure on the shoulder joint. Try a different position that doesn’t compress it and reduces pain.
Lifting: Lifting heavy objects improperly can strain the shoulders. Bend your knees and keep your arms close to your side when lifting.
Desk posture: Sitting at a desk in front of a keyboard all day can cause problems, especially for people who hunch their shoulders. Stooping narrows the rotator cuff space, which can lead to painful impingement, or “pinching,” of the tendons and muscles. Upright posture gives the shoulder joint room to move freely.

Common shoulder injuries and what they feel like

Rotator cuff: Rotator cuff disease is the most common shoulder problem. Almost everyone will experience this at some point. Symptoms include:

Sharp pain, especially when reaching the arm backward or to the side
Dull aching that worsens at night

Nighttime pain is very common with shoulder rotator cuff injury: When you’re upright, gravity helps to stabilize the ball of the shoulder in the socket; when you recline, the ball of the rotator cuff-deficient shoulder is harder to stabilize in the socket, which can cause pain during the night. Sleeping in a more upright position or in a reclining chair can help.

Frozen shoulder: This happens when people stop moving their arm and scar tissue forms around the joint, making movement excruciating. But 80% percent of frozen shoulder cases improve without surgery.

“If you have any kind of shoulder pain that isn’t caused by a fracture or dislocation, keep moving it!” says Voloshin. “Once it gets frozen, the recovery process takes a lot longer. Physical therapy is the first step, and cortisone injections may help.”

Shoulder impingement: There are two types of shoulder impingement:

External impingement: occurs above the rotator cuff and happens due to increased pressure between the rotator cuff tendon and acromion bone (a flat, bony projection of the shoulder blade at the highest point of the shoulder). Bone spurs can form on the acromion due to this increased pressure and can worsen the impingement.
Functional impingement: can be nerve-related, from poor posture, or some aspect of shoulder or spine anatomy that functionally narrows the subacromial space—the space between the rotator cuff and the acromion. Both cause painful friction between tendons and bony structures.

Shoulder tendonitis: Tendonitis occurs when overuse or repetitive overhead motions inflame the rotator cuff tendons, leading to pain, weakness, stiffness, and nighttime discomfort.

How to relieve shoulder pain and when to seek care

Shoulder braces and support—do they help? Braces immobilize a fractured, dislocated shoulder or post-surgical shoulder but do not necessarily help with other issues.

It’s important to keep painful shoulders moving (except in setting a fracture or dislocation); over-the-counter anti-inflammatory medicines plus physical therapy is a good first step to try at home.

Physical therapy for shoulder pain: A physical therapist will assess your injury and recommend stretches and low-resistance exercises to strengthen the muscles and tendons that support the shoulder joint.

For those who are aging and want to remain active, physical therapy can help you strengthen your shoulder before an injury occurs.

There are easy exercises that boost shoulder strength and stability; a session or two with a physical therapist ensures you do the movements properly and safely to get the full benefit.

When to see a doctor: Seek care if you have had an acute injury and suddenly can’t raise your arm.

After injury: A medical evaluation can check for injuries such as fractures, dislocations, or a full-thickness rotator cuff tear, in which the muscle and tendon have completely separated from the bone. Checking for tears immediately can improve surgical outcomes.
Long-term pain or concerns: If your shoulder function is slowly declining, the first likely treatment would be anti-inflammatory medication and physical therapy, which can be prescribed by a medical provider. If the problem persists over 4-6 weeks, then obtaining an MRI and referral to a surgeon is reasonable.

Do you need shoulder surgery or replacement?

Some patients can function well even with reduced shoulder mobility and avoid surgery. For others, full recovery is the goal. When weighing treatment options, providers consider a patient’s age, functional status, and activity level.

Shoulder surgery can be a good option for:

Patients with persistent concerns, even after non-operative treatment
Patients with a full-thickness rotator cuff tear

Shoulder replacement is an option for:

Patients who have suffered a devastating injury
Patients who have an anatomical issue that is not repairable due to poor tissue quality or the size of the tear

Generally, joint replacement is best for older patients with a severe rotator cuff tear. A shoulder replacement surgery can: