Disclaimer: Shoulder pain is complex but rarely harmful. However, the following section is meant for educational purposes only and not to diagnose any conditions. You should always consult a medical professional before attempting any treatments when experiencing pain.
Our goal is to simplify your understanding of why your shoulder hurts so you can make the best decision moving forward. There are a few common causes of painful shoulders.
Assuming there’s no serious condition to worry about, a painful shoulder can fall into three categories.
Definition: you have a significant limitation of range of motion compared to your other side, whether you are trying to move it or someone is moving it for you.
What causes stiffness of the shoulders?
Definition: you feel as if your shoulder is unstable or will “pop out of place” if you move in a certain direction, which makes you nervous.
What causes loose (or wobbly) shoulders?
Definition: you feel pain with or without weakness when you move your shoulder when doing different tasks or activities, but you don’t have a significant loss of range of motion (~50% compared to the other side). It could be as simple as raising your arm overhead or bench pressing 225 lb.
Sometimes, this category of painful shoulders is actually very strong, but it’s hard to produce force if you’re hurting. We call those strong and painful shoulders. Think of an athlete who is able to play their sport at a high level but is having shoulder pain during or after.
What causes weak (or strong) painful shoulders?
Disclaimer: We want to be clear that shoulder pain is complex but rarely harmful. The following section is meant for educational purposes and not to diagnose any conditions. You should always consult a medical professional before attempting any treatments if you’re experiencing pain.
One of the most common causes of pain at the top of your shoulder is the acromioclavicular joint (AC joint), which is where your collarbone (clavicle) meets your shoulder blade (acromion of the scapula).
Some causes of AC joint pain include age-related changes and too much activity that your shoulder is not ready to handle. We see this type of shoulder pain in athletes and gym-goers who are pushing too hard with not enough time to recover or individuals who have manual labor occupations.
One risk factor for this type of shoulder pain is being under 25 years old and being able to bench press more than 1.5x your body weight (strong!). In those cases backing off training for a while is the way to go.
Sometimes, top of the shoulder pain is caused by a traumatic event, such as a fall on an outstretched hand or falling/being hit directly on the side of the shoulder.
The good news is that this type of shoulder pain responds very well to conservative management that incorporates strategic load management and progressive rehab, but it’s important to notice that it may take 6-9 months for a full recovery.
There are too many causes of front shoulder pain to mention here, so to avoid getting in the weeds, we've listed the most common cause below.
Subacromial Pain Syndrome (may sound scarier than it is)
Formerly referred to as Subacromial Impingement, this is the most common musculoskeletal shoulder condition and is an umbrella term used to describe shoulder pain at the front and/or side.
Subacromial pain syndrome typically develops gradually over time and is associated with a history of relative shoulder overuse.
Some structures that may contribute to subacromial pain syndrome include a bursa, rotator cuff muscles, labrum, and long-head biceps tendon. It is important to note that pinpointing the exact structure that's causing your pain with absolute certainty is impossible during a physical exam. A good physical therapist will instead focus on what motions are painful and limited and improve those with their treatments instead of "treating a specific structure."
Typical findings include pain with overhead movements, such as reaching an object on a high shelf, pressing motions, such as bench pressing, and moving one's arm as if one were making a snow angel in the air.
Patients sometimes may complain of increased pain at night or weakness with certain motions, such as resisted external rotation - like swinging a door open with your forearm while your upper arm stays in place against your body.
Scientific research recommends exercise as the first choice of intervention for subacromial pain syndrome with comparable outcomes, but at a lower cost and with fewer risks, than surgery. Exercise is also more effective than just resting in reducing pain and function if this condition is present.
Posterior shoulder pain (posterior means “at the back”) is most commonly related to internal impingement or posterior instability.
We suggest also reading the “shoulder blade pain” section as your shoulder blade sits at the back of your rib cage.
Internal Impingement
Posterior Instability (also see the section on Loose and Painful Shoulders)
In certain cases, pain felt around the shoulder blade can be of cervical origin (coming from the neck). Different structures in the neck, such as the discs, joints, muscles, or nerve roots, could cause this.
Additional symptoms that may lead us to suspect that the neck is involved in causing pain around the shoulder blade include:
In the majority of cases, however, shoulder blade pain originates from structures either surrounding the shoulder blade or attached to it. This includes muscles or bony structures (thoracic spine/ribs). There are 17 muscles that originate or are attached to your shoulder blade! Based on your activity levels and lifestyle, some muscles may be “overworked” while others are “underworked”, which may cause lack in capacity and tolerance to movement causing discomfort or pain in the region.
To be able to tell with more certainty what is causing your shoulder pain, we recommend an assessment from a licensed medical professional or book a call with one of our licensed Doctors of Physical Therapy.
