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Shoulder injuries can be caused by sudden acute trauma, or can come on gradually over time or following an acute injury which has not healed properly.
If you are not sure what is causing your shoulder pain why not try our shoulder pain symptom checker?
Below we outline the more common causes of shoulder pain, the less common causes as well as some important conditions that should not be missed.
Most common shoulder injuries
Rotator cuff strain is a tear or strain of any of the four muscles which stabilize the shoulder joint and are known as the rotator cuff. These muscles are important in rotating the upper arm bone or humerus and lifting the arm up to the side. Because of the wide range of movement required in the shoulder joint these muscles are susceptible to injury. Rotator cuff tears can occur when falling onto an outstretched arm or as a result of a sudden powerful movement such as in throwing or paddling a kayak. Symptoms include sudden shoulder pain at the time of injury with possibly a tearing feeling in the shoulder. Severe pain is likely to continue for a few days depending on severity of the injury and moving the arm out to the side is likely to be difficult.
Rotator cuff tendinitis - If a rotator cuff tear has not healed properly or has not fully rehabilitated then it can become chronic. Symptoms of a chronic rotator cuff injury will develop gradually over time and can be from overuse or degeneration of the tendon. Chronic rotator cuff injuries are more commonly seen in athletes over the age of 40 years involved in shoulder intensive sports. Impingement syndrome is one form of chronic rotator cuff injury where the tendon of the supraspinatus muscle becomes pinched and inflammed in the shoulder joint.
Dislocated shoulder is a traumatic and painful shoulder injury where the humerus bone pops out of the shoulder joint causing severe pain and damage to various ligaments and tendons which help hold the shoulder joint in place. A dislocated will cause severe shoulder pain and requires immediate medical attention and should never be popped back in place by anyone who is not qualified and experienced to do so. A full rehabilitation program if the athlete is essential to avoid re-injuring the shoulder.
Shoulder instability can occur following a dislocated shoulder or other traumatic injury. With an unstable shoulder the humerus bone may partially dislocate or sublux out of the shoulder joint. Recurrent full dislocations can also occur if the shoulder joint is unstable.
Glenoid labrum tear is a tear to the fibrous ring of tissue which covers the inside of the socket that the ball of the humerus bone sits. Symptoms of a glenoid labrum tear include pain in the shoulder joint which cannot easily pinpointed. The pain is made worse by overhead activities or when the arm is held behind the back.
Broken collar bone is a fracture of the prominent clavicle bone which runs across the front of the shoulder to the breast bone or sternum. A broken collar bone will usually happen by falling onto the shoulder or onto an outstretched arm. Symptoms include pain on the collar bone at the time of impact which may be severe. There may be also be swelling over the area and a bony deformity may be felt.
AC joint sprain is a sprain or tear to the ligaments which hold the acromioclavicular joint together. It is usually caused by a fall onto an outstretched arm and can vary in severity from very minor to a complete rupture where the clavicle bone is displaced poking up out of the shoulder. Symptoms include shoulder pain at very end of the collar bone on top of the shoulder joint. Often a swelling or lump can be seen on top of the shoulder.
Long head of biceps strain is a tear to the biceps muscle tendon at the front of the shoulder. Symptoms include a sudden sharp pain at the front of the arm at the time of injury. There may be swelling over the front of the shoulder and contracting the biceps muscle will be painful.
Referred shoulder pain is where an injury or problem elsewhere in the body causes pain to appear as if it is in the shoulder. The more common causes of referred pain in the shoulder include problems in the cervical spine or neck, upper back as well as myofascial referred pain which involves the tissue which surrounds muscles.
Less common causes of shoulder pain
Pec major strain is a strain or tear of the large pectoralis major muscle at the front of the shoulder. It is most likely to rupture at the point of attachment to the arm or humerus bone at the shoulder. Symptoms include a sudden sharp pain at the front of the arm at the time of injury with rapid swelling over the front of the upper arm or shoulder. If the injury is severe enough a gap of lump may be visible in the muscle and a complete rupture will require surgery.
Frozen shoulder or adhesive capsulitis to give it its medical name is a condition which significantly affects the range of movement in the shoulder. A frozen shoulder will go through three phases; a freezing phase which is painful as the patient gradually loses movement in the shoulder, a stiff phase which is often less painful but with most loss of mobility, and a thawing phase where pain reduces and movement of the shoulder is restored.
Thoracic outlet syndrome is compression of the nerves and / or blood vessels which travel from the neck to the armpit. Symptoms include pain, tingling, numbness and weakness in the neck and throughout the arm.
Axillary nerve compression usually occurs from a direct impact or trauma to the outer arm although it can occur following a shoulder dislocation. Symptoms are numbness over the deltoid muscle on the outer upper arm. The patient will have difficulty raising their arm out to the side and if the injury has been sustained for a long period of time then wasting away of the deltoid muscle in the shoulder can be seen.
Fracture to the neck of humerus is a fracture to the top of the arm bone or humerus. It is seen more often in young adults, adolescents and the elderly and is usually caused by a fall onto an outstretched arm or impact to the shoulder. This injury will cause severe shoulder pain and needs urgent medical assistance.
Scapular fracture is a fracture to the shoulder blade at the back of the shoulder. This type of injury is very rare. Symptoms include sudden pain at the back of the shoulder over the bone. The athlete will have difficulty moving the arm and in particular raising the arms above the head. Tenderness and swelling will be seen. Seek medical attention.
Stress fractures of bones in the shoulder joint are rare but a stress fracture of the coracoid process can occur in clay pigeon shooting or trap shooting. Symptoms include tenderness over the caracoid process which is a prominent point at the front of the shoulder blade.
Levator scapular syndrome is inflammation of the insertion of the levator scapula muscle as it inserts into the top inside edge of the scapula or shoulder blade. This is often caused and made worse by poor posture and sitting a computer all day. Deep tissue massage is an effective treatment although a steroid injection can be indicated in prolonged cases.