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Shoulder pain: causes, diagnosis, treatment, tips

by Josephine Andrews
Published: Last Updated on 308 views

Shoulder pain can be found in almost all age groups and in both sexes. Sometimes the pain in the shoulder occurs acutely, for example during sports or after lifting a heavy load. Other people suffer from chronic shoulder pain, for example due to joint wear and tear. Whatever the cause, shoulder pain can have a significant impact on everyday life. Read everything you need to know about the causes and treatment of shoulder pain here.

quick overview

  • Description: Acute or chronic pain in the shoulder region, possibly with other symptoms such as restricted mobility of the shoulder and arm
  • Causes: e.g. tendinitis or injury, bursitis, chronic muscle tension, broken bones, nerve damage, impingement syndrome, joint wear and tear (arthrosis), frozen shoulder, rheumatic diseases, fibromyalgia, carpal tunnel syndrome , neuroborreliosis, shingles, biliary colic, heart attack
  • Diagnostics: Collection of the medical history in the doctor-patient conversation, physical and orthopedic examinations, if necessary other examinations (neurological examination, blood tests, joint puncture, ultrasound , magnetic resonance imaging, computer tomography)
  • Therapy: depending on the severity and cause of the symptoms, eg painkillers, physiotherapy , cold/heat treatment, alternative healing methods (such as acupuncture, medicinal plants), targeted training of the shoulder area, surgery

Shoulder pain: description

Shoulder pain is discomfort in the shoulder region, sometimes radiating to the upper arm or neck. Doctors distinguish between acute and chronic shoulder pain:

  • Acute shoulder pain occurs suddenly, for example after an accident or a fall on the shoulder or arm. Reason is, for example, a biceps tendon tear, a dislocated shoulder or a broken upper arm.
  • Chronic shoulder pain develops gradually and can be very persistent. They are caused, for example, by joint wear and tear (arthrosis), a herniated disc in the cervical spine or a frozen shoulder.

Shoulder pain manifests itself in different ways – the symptoms vary depending on the cause. It can hurt when those affected spread their arm or lift it to the side. Pain often occurs when lying down, so that it is sometimes difficult for affected patients to find a comfortable and pain-free sleeping position. In some cases of shoulder pain, the mobility of the shoulder joint is also noticeably restricted and the joint stiffens (“frozen shoulder”).

Shoulder pain: causes and possible diseases

In about 85 percent of cases, the cause of shoulder pain is not in the shoulder joint itself, but in the area close to the joint (periarticular cause). For example, muscles, tendons, joint capsules and/or synovial fluid that are damaged by injury or illness can cause shoulder pain if muscles are too weak or misaligned. In addition, diseases of internal organs (gallstones, heart attack, etc.) or rheumatic diseases can also be associated with shoulder pain.

Overall, the following diseases and injuries are common causes of shoulder pain:

  • Chronic muscle tension : Chronic tension in the neck and shoulder muscles is often to blame for shoulder pain. It mostly affects people in sedentary jobs who work a lot with their head and upper body bent forward (e.g. at the computer). People who are generally prone to cramps, tension headaches or depression often develop tension- related neck and shoulder pain.
  • Joint wear : In the case of shoulder joint arthrosis (omarthrosis), the cartilage layer on the joint surfaces, which ensures smooth mobility of the shoulder joint, wears out more and more. The consequences are increasing shoulder pain over the years when moving the shoulder and restricted movement. The discomfort is most noticeable when the arm is rotated outward or raised to shoulder height (or higher). Possible causes of omarthrosis include age-related wear and tear, circulatory disorders in the head of the humerus, a tear in the rotator cuff, frequent dislocation of the shoulder or rheumatoid arthritis. If no cause for the painful joint wear and tear can be found, doctors speak of idiopathic (= without recognizable cause) shoulder joint arthrosis.
  • Bottleneck syndrome (impingement syndrome) : Bottleneck or impingement syndrome of the shoulder refers to functional disorders of the shoulder due to a narrowing between the acromion and upper arm bones: The space in the shoulder joint becomes too narrow due to irritation, calcification or wear and tear of the tendons and bursa. so that the head of the humerus hits the acromion and the tendon is literally pinched in the joint. The result is shoulder pain, especially under stress.

    If the arm is raised sideways or backwards (e.g. to pull something out of the back pocket of your pants), the shoulder pain can even become very severe. They can usually be felt on the outside of the upper arm. Nocturnal shoulder pain can also occur later.

    The cause of impingement syndrome is usually long-term stress on the shoulder, for example in athletes who perform a lot of overhead movements with their arms, such as handball players, volleyball players and swimmers (“athlete’s shoulder”). People who often have to raise their arms above their heads at work (such as painters, aircraft mechanics) often suffer from shoulder pain due to impingement syndrome.

  • Inflammation of the shoulder bursa (subacromial bursitis) : Inflammation of the shoulder bursa can also lead to shoulder pain and restricted movement of the shoulder joint. It usually develops as part of the impingement syndrome.
  • Rotator cuff tear (rotator cuff tear) : The rotator cuff is a strong “mantle” of muscles and tendons that holds the humeral head in the glenoid cavity while allowing arm movement in all directions (rotation). One or more of the rotator cuff tendons may partially or completely tear, resulting in sudden shoulder pain.

    The rotator cuff tear is usually the final stage of impingement syndrome. The tendons are already damaged by the constriction in the joint before they tear. On the other hand, an acute tear of the rotator cuff without previous damage to the tendons is rare, but can happen, for example, in the event of a fall on an outstretched arm.

  • Dislocated shoulder joint (shoulder dislocation): After a fall on the (outstretched) arm or a blow to the shoulder, the humerus can “jump” out of the socket. Such a dislocated shoulder can also be responsible for shoulder pain and reduced mobility of the shoulder and arm.

    When the shoulder first dislocates, ligaments or bony structures in the joint area can be injured. As a result, a shoulder dislocation can occur again and again later, even with relatively low loads. There are also people whose shoulder joints are generally unstable and jump out of the joint socket even with everyday movements (habitual shoulder dislocation). This can be recognized by sudden shoulder pain. Whatever the reason for frequent shoulder dislocations – it promotes shoulder joint arthrosis.

  • Upper arm fracture and collarbone fracture : Shoulder pain and painful limitation of movement of the shoulder can also be caused by a fracture of the upper arm in the area near the shoulder (proximal humerus fracture) or by a broken collarbone (clavicular fracture). An upper arm fracture is usually the result of a fall on an outstretched arm or elbow. A broken collarbone can also happen if you fall on your outstretched arm or if you fall on your shoulder.
  • Joint bleeding : A fall or hit to the shoulder or (outstretched) arm can also cause bleeding into the shoulder joint, especially in people with bleeding disorders. Symptoms include shoulder pain and limited shoulder and arm mobility.
  • Biceps tendon rupture : If you have a sudden, stabbing pain on the outside of your shoulder, it could be due to a biceps tendon rupture—a tear in one of the biceps tendons that attaches the arm flexor muscle to the shoulder area. Other signs of a biceps tendon rupture include bulging above the elbow and weakness in the arm when trying to bend it.
  • Frozen shoulder (“ frozen shoulder ”): The mobility of the shoulder is painfully restricted here due to a shrunken shoulder joint capsule – the shoulder is “frozen”, so to speak. The whole thing develops insidiously over several phases. In most cases, frozen shoulder occurs in the wake of another shoulder condition or injury (such as osteoarthritis of the shoulder, calcified shoulder, rotator cuff tear, or shoulder dislocation). The primary frozen shoulder is rarer than this secondary frozen shoulder, the cause of which remains unknown. The disease occurs primarily in women between the ages of 40 and 60. Diabetics also have an increased risk of frozen shoulder.
  • Calcified shoulder (tendinosis calcarea) : Here, calcium crystals have deposited on the tendon attachments of the rotator cuff (probably due to reduced blood flow). The calcium deposits cause shoulder pain with arm movements, especially with overhead movements. If calcium crystals are also deposited in the bursa of the shoulder joint, the shoulder pain becomes even worse and arm movements are further restricted. A calcified shoulder tends to develop between the ages of 30 and 50.
  • Polymyalgia rheumatica (PMR) : This inflammatory rheumatic disease causes muscle pain, especially in the shoulder and pelvic girdles. Shoulder pain, which increases with movement and is particularly pronounced in the morning, is characteristic. Pain in the neck, buttocks and thighs is also possible. Polymyalgia rheumatica tends to occur in the over 60 age group, especially in women.
  • Bacterial shoulder joint inflammation (bacterial omarthritis) : It is caused by bacteria that have either entered the joint via the blood or have infected the joint directly, for example during a joint puncture (removal of synovial fluid with a needle). The signs of bacterial shoulder joint inflammation are rapidly increasing, severe shoulder pain and fever . There may also be swelling and/or redness in the area of ​​the shoulder joint.
  • Fibromyalgia : Fibromyalgia is a mostly chronic pain disorder that is associated with persistent pain in many parts of the body (e.g. shoulder pain, neck pain, back pain and pain in the legs). Sleep disorders, fatigue, depressive moods and headaches or migraines often also occur. Fibromyalgia syndrome is quite common, primarily in women.
  • Shoulder-arm syndrome (cervicobrachial syndrome) : Shoulder-arm syndrome involves neck and shoulder pain that can radiate to the arm, hands, fingers and the back of the head. Due to the pain, the head can only be moved to a limited extent. The symptoms come from the middle and lower cervical spine, although the exact cause can be very different.

    Painful muscle tension in the neck, for example due to frequent desk work or psychological stress, herniated discs in the area of ​​the cervical spine, congenital vertebral malformations, vertebral fractures, bacterial infections of the spine , osteoporosis and tumors in the spine are possible.

  • Tendonitis : When the tendons in the shoulder area wear down, chronic inflammation can develop. When moving, it then hurts in the shoulder area – locally on the side and above as well as on the upper arm bone.
  • Herniated disc in the cervical spine : Sudden shooting, electrifying pain in the shoulder, upper arm and neck indicate a herniated disc in the lower cervical spine. In addition, the pain often radiates to individual fingers and increases when the head is turned.
  • Shoulder girdle compression syndrome (thoracic outlet syndrome) : The term includes various rare complaints in the shoulder area. What they all have in common is that they are triggered by a narrowing of the blood vessel-nerve cord leading to the arm in the upper chest area. The consequences are alternating shoulder pain, tingling and numbness on the outside of the shoulder.
  • Carpal tunnel syndrome : In carpal tunnel syndrome , the middle arm nerve (medial nerve) is damaged in the area of ​​the carpal tunnel. The carpal tunnel is a narrow passageway in the wrist formed by the forearm and carpal bones and ligaments. The middle arm nerve and the flexor tendons of the fingers run through it.

    The nerve damage causes pain and numbness or tingling in the first three fingers (sometimes also in the ring finger). The symptoms initially only appear at night and in the early morning, later also during the day. The pain can also radiate to the forearm and shoulder. The cause of carpal tunnel syndrome remains unclear in most cases. The disease occurs primarily in middle-aged women.

  • Neuroborreliosis : Borreliosis (Lyme disease) is a bacterial inflammation of the joints. It is caused by bacteria (Borrelia burgdorferi) that ticks transmit to humans. The disease can also spread to the nervous system and is then called neuroborreliosis . Sufferers sometimes develop shoulder pain.
  • Shingles : This painful rash is caused by the same virus that causes chickenpox, variella-zoster virus. It usually extends in the shape of a belt and on one side of the trunk from the spine to the front. In addition to severe back pain, shingles can also cause shoulder pain.
  • Heart attack : If the pain suddenly occurs in the left shoulder and behind the breastbone, a heart attack could be the cause. This is especially true if the patient also develops chest tightness, shortness of breath, and fear of death. However, these symptoms can also have other causes, such as chest tightness (angina pectoris) or a panic attack. In any case, an immediate visit to the doctor is advisable!
  • Biliary colic : If the shoulder pain occurs on the right side and the affected person simultaneously feels increasing and decreasing colic-like pain in the upper and middle abdomen, it is probably a case of biliary colic . It is caused by either inflammation of the gallbladder or a gallstone lodged in the duct between the gallbladder and the small intestine. If you suspect biliary colic, you should consult a doctor immediately!
  • Embolism in the lungs : In a pulmonary embolism , a blood vessel in the lungs is blocked by a blood clot that has been deposited. Symptoms depend on the size of the blocked vessel. Possible symptoms include chest pain that radiates into the shoulder or abdomen, shortness of breath or rapid breathing, coughing (possibly coughing up blood), rattling noises when breathing, outbreaks of sweating, tachycardia, anxiety, dizziness or fainting.
  • Lung tumor (Pancoast tumor) : Pancoast tumor is a rare form of lung cancer that develops at the top of the lungs. In addition to back pain, it can also cause shoulder pain.

Shoulder Pain: When Should You See a Doctor?

In the following cases of shoulder pain, a doctor’s visit is advisable:

  • very bad shoulder pain
  • persistent shoulder pain
  • recurring shoulder pain
  • Shoulder pain after a fall on your shoulder or arm, or after an accident
  • Significant restriction of movement of shoulder and arm
  • The pain radiates to other parts of the body such as the neck or arm
  • Accompanying symptoms such as numbness or tingling

A doctor should be alerted as soon as possible in the following situations :

  • very strong, wavy pain in the right shoulder and upper right abdomen, often accompanied by nausea and vomiting (biliary colic suspected)
  • Severe pain in the right shoulder and upper right abdomen with fever and chills (suspected gallbladder infection)
  • Sudden left shoulder pain and pain behind the breastbone, tightness in the chest, shortness of breath, fear of death, often dizziness and/or nausea (suspected heart attack or angina pectoris)
  • Sudden chest pain radiating to the shoulder, possibly accompanied by symptoms such as shortness of breath or rapid breathing , tachycardia, sweating, coughing or coughing up blood, dizziness, fainting (pulmonary embolism suspected)

Shoulder pain: diagnosis

If you have shoulder pain, the doctor will first ask you about your medical history (anamnesis). It is important, for example, when and how often the pain in the shoulder occurs, whether it is only noticeable when the arm or shoulder is moved or also at rest, and whether there are other complaints in addition to the shoulder pain, such as loss of strength in the arm or numbness in the fingers appear.

This is followed by a physical examination (clinical function tests, palpation of trigger points, tendons and joints, movement testing). Based on the medical history and the physical examination, the doctor can usually make assumptions about the possible cause of the shoulder pain. Further investigations bring clarity:

  • Orthopedic examination : It is standard for shoulder pain and can, for example, provide indications of arthrosis of the shoulder joint, impingement syndrome, calcified shoulder, fibromyalgia and broken bones (collarbone or upper arm fracture).
  • Neurological examination : Here the functional and conduction status of nerve tracts is checked if a herniated disc in the cervical spine is possibly causing the shoulder pain.
  • Blood tests : If neuroborreliosis or shingles could be behind the shoulder pain, a blood sample from the patient can be tested for antibodies against the respective causative agent of the disease. If a heart attack is suspected, the heart enzymes are determined in the blood sample. Coagulation disorders as a possible cause of joint bleeding can also be determined via a blood analysis.
  • X-ray examination : X-rays are taken if the trigger for the shoulder pain is, for example, calcified shoulder, polymyalgia rheumatica. a broken bone or a dislocated shoulder joint.
  • Ultrasound examination : By means of ultrasound (sonography), for example, frozen shoulder, biceps tendon rupture, gallbladder inflammation and gallstones can be identified as the cause of shoulder pain.
  • Joint aspiration : If the doctor suspects a bacterial infection in the shoulder joint, they will take a sample of the synovial fluid with a thin needle (joint aspiration) to create a bacterial culture. If bacteria can actually be grown from the synovial fluid, this confirms the doctor’s suspicion.
  • Lumbar puncture : If neuroborreliosis is the cause of shoulder pain, a sample of the cerebrospinal fluid ( liquor ) is taken from the lumbar spine using a thin needle . In the laboratory, the sample is examined for Borrelia – the causative agent of neuroborreliosis.
  • Magnetic resonance imaging (MRI) : Magnetic resonance imaging or magnetic resonance imaging is indicated when shoulder pain is possibly due to shoulder impingement syndrome, joint wear, rotator cuff tear, or shoulder girdle compression syndrome.
  • Computer tomography (CT) : If the cause of shoulder pain is, for example, a lung tumor (Pancoast tumor), a pulmonary embolism, shoulder-arm syndrome or a herniated disc in the cervical spine, this can be clarified using computer tomography.
  • Electrocardiogram ( ECG ) : A recording of the electrical heart activity reveals whether a heart attack may have caused the pain in the shoulder.
  • Cardiac catheter examination : An examination using a cardiac catheter is always carried out for shoulder pain if a heart attack could be the trigger for the pain.
  • Lung endoscopy : In this examination, also known as bronchoscopy , a small camera attached to the tip of a thin tube or metal tube is inserted through the mouth or nose into the windpipe and its main branches (main bronchi). This allows the doctor to examine these airways from the inside. This is mainly done if a lung tumor is suspected.

Shoulder pain: therapy and exercises

The treatment of shoulder pain depends on the type and extent of the symptoms.

Treatment by the doctor and physiotherapist

If an injury or medical condition is behind the shoulder pain, the doctor will treat it appropriately. For example, he will use a lever technique to set a dislocated shoulder joint (shoulder dislocation) and then immobilize it in a bandage for a while. The shoulder is then slowly accustomed to movement again with physiotherapy exercises.

In some cases, the cause of shoulder pain cannot be treated: The wear and tear of a shoulder joint (omarthrosis) cannot be reversed. But you can at least try to relieve shoulder pain with conservative measures. Patients with shoulder osteoarthritis receive anti-inflammatory and pain-relieving medication (e.g. as tablets or as injections into the shoulder joint). Physiotherapy (physiotherapy, heat applications, etc.) can also have a pain-relieving effect.

In very severe cases, i.e. severe shoulder pain due to advanced arthrosis, an artificial shoulder joint can be used.

In general, there are the following therapy options, depending on the cause and severity of the shoulder pain:

  • pain or anti-inflammatory drugs
  • immobilize
  • Physiotherapy (physiotherapy, heat/cold treatment, etc.)
  • alternative healing methods
  • surgical interventions (e.g. suturing torn tendons, setting up a complicated fracture of the upper arm, inserting an artificial shoulder joint)
  • alternative/complementary healing methods (such as acupuncture)

You can do that yourself

  • Cold/warmth : In the case of acute or suddenly worsening shoulder pain (e.g. due to bursitis, biceps tendon rupture, rotator tendon rupture or calcified shoulder), cold is generally beneficial – for example in the form of ice, cold packs or damp cool compresses. In the case of chronic shoulder pain, on the other hand, heat is usually felt to be more pleasant.
  • Ergonomic workplace : Important if the shoulder pain is due to muscle tension from frequent desk work. Because an ergonomic workplace prevents uneven strain on the muscles in the shoulder, neck and back and thus painful muscle tension. For example, pay attention to the correct height of the table and chair, the correct distance from the keyboard and palm rests in front of the keyboard.
  • Acupuncture, cupping & Co .: The World Health Organization (WHO) expressly recommends acupuncture for shoulder-arm syndrome. Massages, cupping and arnica ointments can also relieve the shoulder pain of those affected.
  • Targeted training : In order to prevent a painful “athlete’s shoulder”, a complex chronic overload, the shoulder muscles should be built up in a targeted and even manner and the muscles and ligaments in the rear shoulder area should be regularly stretched. A sports doctor or experienced trainer will show you suitable exercises.
    The stretching exercises for the rear shoulder area are also advisable in combination with physiotherapy if someone already suffers from an “athlete’s shoulder”: moderately pronounced shoulder pain can often be relieved with it (severe shoulder pain is operated on). Regular shoulder exercises are recommended to prevent recurrence of the problem.
    In the case of chronic shoulder pain (e.g. due to arthrosis or calcified shoulders), those affected often get used to a relaxed posture, which causes the shoulder muscles to shorten over time. To counteract this, the muscles should be stretched regularly. Have a sports doctor or physiotherapist show you suitable stretching exercises for the shoulder area.
    In general, regular measures are recommended for chronic shoulder pain to improve shoulder mobility and strengthen the muscles in the shoulder area – especially in the painful areas. For example, specific exercises for the shoulder girdle, massages, Feldenkrais or physiotherapy are suitable. Especially with arthrosis, the shoulder should be moved regularly despite the pain. Otherwise it will become increasingly stiff over time.
  • Relaxation techniques : Stress, tension and everyday worries are often (partly) responsible for shoulder pain. Relaxation methods can provide the necessary relief for muscles, tendons, ligaments and the soul. For example , progressive muscle relaxation according to Jacobson, autogenic training and yoga are suitable. Such relaxation methods are often used in combination with alternative healing methods such as acupuncture, magnet therapy or biofeedback to treat chronic shoulder pain.
  • Medicinal plants : If the shoulder pain is due to arthrosis, you can do a lot with medicinal plants against the symptoms. In the case of acute painful joint inflammation, for example, compresses with arnica blossoms or rubs with arnica ointment or gel are suitable. Circulation-boosting baths with hay flowers or rosemary oil (together with eucalyptus oil) can be used as beneficial heat therapy in times of minor symptoms (non-activated arthrosis). Anti-inflammatory tea made from devil’s claw root is also recommended for shoulder pain caused by osteoarthritis.
  • You should talk to your doctor or pharmacist about the use of over-the-counter painkillers and anti-inflammatory drugs (such as ibuprofen ) for shoulder pain : He will advise you on the selection, dosage and duration of use of a suitable preparation.

Alternative medical concepts and their specific effectiveness are sometimes controversial and not clearly proven by studies. If your symptoms worsen, consult your doctor.

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