SHOULDER PAIN CAUSES - WHERE IS THE PROBLEM?
Your shoulder pain causes are very likely in the muscles and joints of your neck and upper back, or in your shoulder blade muscles.
Pain between your neck and shoulder is most likely from your neck, or tension and posture affecting the Trapezius muscle here.
Pain in the upper arm is often from your shoulder itself.
Finding tender spots in appropriate muscles or limitation of movement of particular joints, helps one decide.
This does not exclude problems in your heart, lung or upper abdomen. These areas can also send pain to your shoulder.
Remember always, common things will coincide purely by chance. You could have both orthopedic and internal problems at the same time.
Have you any chest or abdominal complaints which came on at about the same time as your shoulder pain? Your doctor may order a chest X-ray or liver test to help sort it out.
Shoulder examination for your range of movement
You can quickly check your shoulder movement with 3 actions, comparing your range of movement on the two sides, which should be pretty much the same. Also note if any of the movements is more uncomfortable.
Reach back over your opposite shoulder and then behind your neck. Put your hand up behind your back.
If you have a recently painful shoulder, and find that all these movements are equally restricted, you may be developing
This is one of the shoulder pain causes that needs relatively urgent attention.
Examining yourself for a painful arc, during adduction
One very simple test will show up tenderness in the rotator cuff , provided that you can put your arm straight up above your head.
Start from this position and lower your arm down sideways, taking about five seconds , keeping it straight, and as far back as possible.
Do you get pain in your shoulder or upper arm, only in the middle part of this movement, not at the top nor bottom.
The painful part of the movement is experienced while some tender part of the rotator cuff mechanism, is passing under the edge of the coraco acromial arch.
The other reason for the painful arc is that during the first part of the action of lowering your arm sideways from fully elevated, the Supraspinatus muscle is not contracting.
This muscle's part of the rotator cuff is that most commonly damaged.
The position where it starts to contract, is about the same as when a painful arc commonly starts, with one's arm about 30 degrees above horizontal.
Finding the reason for a painful arc
Finding that you have a painful arc only indicates tenderness of your rotator cuff mechanism.
This tenderness may have multiple causes, from a joint stuck in your neck to a full thickness rotator cuff tear.
Examine your shoulder to pinpoint the tender spots.
Start by identifying your acromion. The back corner is a reliable landmark. It is a bony point at the end of the ridge across your shoulder blade.
Move your finger forward along the edge of your acromion, which you can identify with small up and down movements of your fingertip.
Note how tender this bone is.
Now return to the back corner and then move down off the acromion, so you are pushing through your deltoid muscle onto the humerus and rotator cuff.
Push in firmly as you move your finger forward, running parallel to the edge of your acromion but just below it. Make little forwards and backwards movements as you press inwards.
Compare the tenderness here with that of the acromion.
If your rotator cuff is more tender, the trouble may be in that mechanism.
If the acromion is more tender, it is likely the trouble is in your neck or upper back joints.
A series of excellent short videos on further tests of scapular muscles, can be viewed on
the explore physical therapy site.
The Biceps tendon and Popeye the Sailor Man
Your biceps is the bulge on the front of your upper arm, popularized by the guy with the pipe.
It is a double muscle, one side having a very long tendon which passes up into your shoulder joint and can wear or get sore.
This is called biceps tendinitis, and causes a deep, throbbing ache in the front of the shoulder, triggered or aggravated by repetitive overhead work with your arm. .
If you suspect this, test yourself by standing with your hand by your side, then moving your hand back as far as you can, keeping your arm straight.
This should produce the pain.
Bicipital groove point tenderness is felt by pressing into the front of your shoulder joint, where the tendon can be inflamed.
Imaging is very valuable for sorting out shoulder pain causes
Modern ultrasound machines and magnetic resonance imaging can provide detailed pictures of these shoulder pain causes.
Dynamic US can show the rotator cuff tendons rippling against edge of the acromion as they pass under it when the arm is raised. This abnormality is called impingement. It can hurt.
This is more likely if your acromion bone is bent or beaked downwards, or if the tendons are riding high due to weakness of two other muscles from the shoulder blade.
Plain X-ray is used to examine the shape of the acromion and the width of the gap between the humerus (and tendons) and the acromion.
The x-ray may also show calcification in the tendons. This can also hurt - in fact quite badly!
MRI can demonstrate splits and tears in the tendons. These can also hurt.
MRI or US can show sub acromial bursitis to be partly responsible for your shoulder pain.
A bursa is a bag with very smooth walls and containing a little fluid, placed between moving structures to reduce friction. Here the bursa lies between the rotator cuff and the acromion and deltoid muscle.
Cervical disc disease can cause nerve pain in your shoulder and arm, like sciatica from lumbar disc disease. MRI is the best imaging to show this, as well as rarities such as cancer or sarcoidosis compressing nerves.
Important blood testing for shoulder pain causes
The sedimentation rate (ESR) is a valuable test for inflammation severe enough to produce systemic disturbance.
This is particularly to pick up
, which often presents with shoulder pain, usually of both shoulders - compared with rotator cuff and mechanical disorders which are usually one sided.
Now what to do about these shoulder pain causes.
From shoulder pain causes back to shoulder anatomy