What's Causing My Shoulder Pain?

Shoulder pain can make even simple tasks feel difficult, from brushing your hair to reaching into a cabinet. But what causes that pain? And when should you see a doctor?

“It’s a complex joint, and because we use it so often, it’s vulnerable to both overuse and wear-and-tear,” said Ryan Nixon, MD, an independent knee and shoulder orthopedic surgeon who chooses to practice at Franciscan Health.

Here’s what you should know about the most common causes of shoulder pain, how to recognize the symptoms and the treatment options that may help you feel better.

6 Common Causes Of Shoulder Pain

There are several common reasons why your shoulder might hurt. In many cases, pain develops slowly and worsens with certain movements:

Rotator cuff injuries

“The rotator cuff is a group of muscles and tendons that helps lift and rotate your arm. When it’s torn or inflamed, you lose strength and mobility,” said Dr. Nixon.

Rotator cuff tears can happen from injury or wear over time.

“These are common in people who have done repetitive shoulder work over the years, like tradespeople or athletes," Dr. Nixon said. "Sometimes the tear is partial, sometimes full.”

Shoulder tendonitis

Shoulder tendonitis, or irritation or inflammation of the tendons in your shoulder, often comes from repetitive, overuse motion.

“We see this a lot in people who do overhead activities, whether it’s sports or certain types of work,” Dr. Nixon said. “A lot of times, these patients come in with pain that flares up when they lift their arm or work out. It’s not always a tear, just inflamed tissue that can respond well to rest and physical therapy.”

Arthritis in the shoulders

As you age, the cartilage in your shoulder can wear down, resulting in arthritis  in your shoulder.

“You may have deep aching pain and stiffness that gradually gets worse,” Dr. Nixon said. “Many patients say they can’t reach overhead anymore, or their range of motion is gone. On imaging, we’ll see a narrowing of the joint space or bone spurs.”

Bursitis

Bursitis happens when the fluid-filled sac that cushions your shoulder joint becomes inflamed. It’s often linked to overuse or injury.

“It can overlap with tendonitis, and it’s common for them to show up together,” Dr. Nixon said. “People may feel a sharp pain on the outside of their shoulder when they lift their arm.”

Frozen shoulder

Also called adhesive capsulitis, frozen shoulder causes stiffness and pain that slowly gets worse over time.

“It can be limiting for months or even years if not treated early,” Dr. Nixon said. “It often comes on after a period of immobility, like after surgery or an injury. The joint capsule tightens, and patients lose both motion and comfort.”

Labrum tears

“In younger patients, especially those who have dislocated their shoulder, a torn labrum is more common,” Dr. Nixon said. “These patients often feel a catch or click in the shoulder, or a sense that it will slip out of place.”

Common Symptoms Of Shoulder Pain

Shoulder pain symptoms differ depending on the cause, but many people describe similar patterns. They can include:

• Pain that wakes you up at night
• Pain when you reach behind your back, like to grab a bag from the back seat
• Discomfort when you lift weights or reach overhead
• No previous treatment, but pain that’s gotten worse over time
• Full range of motion, but pain during specific movements

“These are the types of things I hear from patients during their first visit,” Dr. Nixon said. “And often, they haven’t had any evaluation or imaging done yet.”

When To See A Doctor For Shoulder Pain

Some shoulder soreness goes away with rest and time. But Dr. Nixon said if the pain sticks around or interferes with daily life, you should get it evaluated.

“Shoulder pain that lingers or gets worse may need imaging or a treatment plan to prevent more damage,” he said.

You should see a doctor right away if:

• You can’t lift your arm
• Your shoulder looks deformed
• There’s swelling or bruising that doesn’t go away
• You heard a pop or felt a tear when the pain started

How Shoulder Pain Is Diagnosed

“When somebody comes in with shoulder pain, it could be one of dozens of things,” Dr. Nixon said. “My job is to ask the right questions, do a physical exam, order imaging to narrow down the most likely causes and come up with a plan that makes sense.”

A typical evaluation includes determining:

• How long the pain has been going on
• Whether the pain started after a specific injury or developed gradually
• What kind of treatments or surgeries you had in the past
• How much the pain interferes with daily life
• What physical demands or activities you typically do
• Any ongoing health issues, like diabetes, that may affect healing
• Whether you have family or social support at home (important if we consider surgery).

After this conversation and a physical exam, imaging typically comes next.

“We usually start with an X-ray. If we need to see soft tissue or suspect a tear, we may order an MRI,” he said.

Treatment Options For Shoulder Pain

The best treatment for your shoulder pain depends on the cause, your age and how much the pain affects your life. Many people start with nonsurgical options like:

• Rest and avoid activities that make it worse
• Anti-inflammatory medications
• Physical therapy
• Cortisone injections

“We see good results with steroid injections for things like tendonitis or bursitis,” Dr. Nixon said. For calcific tendonitis, he sometimes recommends a procedure called needle lavage. “We use a needle and ultrasound guidance to break up the calcium deposits, which can help avoid surgery.”

“Most people don’t need surgery right away,” he added. “If the pain gets better and function improves, that’s a win.”

But shoulder surgery can help in more serious cases.

“If there’s a full-thickness rotator cuff tear or the shoulder is unstable, surgery can restore strength and reduce pain,” he said. Labral tears in younger, active patients may also benefit from surgery.

Getting The Right Care For Shoulder Pain

Most shoulder procedures are elective.

“You don’t have to rush into anything.  We base decisions on how much it affects your quality of life,” Dr. Nixon said. “If you can live with it, great. If you can’t, we’ll talk about the next step.”

Being open about your goals is key.

“We’re here to help you get back to what matters most to you, whether that’s to work, golf, lift your grandkids or just sleep through the night,” he said.

If shoulder pain slows you down, Franciscan Health is here to help.

Schedule an appointment. Learn more about our orthopedic services to find the care that’s right for you.