Shoulder pain is common in sport and injuries can be either acute (sudden onset) or chronic (gradual onset), caused by overuse. Here we explain the common and less common causes of shoulder pain.
Is your shoulder pain sudden onset (acute) or gradual onset (chronic)?
Acute shoulder pain
Sudden onset or acute shoulder injuries often occur from a fall onto an outstretched arm, from a direct impact, overstretching or overloading.
Rotator cuff strain
A rotator cuff strain is a common cause of acute shoulder pain in sport, especially in throwing and racket sports. It is a tear to any of the four ‘rotator cuff’ muscles in the shoulder. Symptoms include:
- Sudden shoulder pain which may radiate down into the arm.
- You may have a feeling that something has torn.
- Rotator cuff strains can be mild or very severe.
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Acromioclavicular joint sprain
An AC joint separation or AC joint sprain is a tear to the ligament that joins the acromion and clavicular bones at the top of the shoulder.
- You can injure your AC joint by falling onto an outstretched arm.
- Injuries range from mild to a complete tear of the ligament. Initially, you will feel severe pain which may radiate throughout the shoulder.
- Later pain will be localized to the bony bit on the top of your shoulder.
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A dislocated shoulder is a very traumatic and painful injury. It occurs when the head of the humerus (upper arm bone) pops out of the shoulder joint.
- Most injuries are caused when your arm is forced upwards and outwards.
- As a result, the humerus bone pops out of the front of your shoulder.
- If you have dislocated your shoulder your will feel severe pain and rapid swelling.
It is essential you seek medical attention immediately. DO NOT attempt to pop your shoulder back in because this can cause permanent injury to nerves and blood vessels.
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Long head of biceps rupture
A rupture of the long head of biceps muscle is a tear or strain of the long tendon of the biceps muscle which originates from the shoulder. It is more common in older athletes.
- A sudden sharp pain is felt at the front of the upper arm/shoulder.
- There may be pain and swelling over the front of the shoulder joint.
- Contracting the biceps muscle against resistance is likely to be painful.
- In particular, lifting a straight arm up forwards against resistance will reproduce symptoms.
Broken collar bone (Clavicle fracture)
A Clavicle fracture is also known as a broken collarbone. You can fracture your collar bone by falling onto an outstretched arm or your shoulder.
- You will feel severe pain in the collar bone with swelling.
- If you suspect you have a broken collar bone seek medical attention immediately.
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Pec major tendon strain
A pectoralis major tendon strain is a strain or tear of the powerful pectoralis major muscle at the front of the chest. The pectoralis muscle rotates the arm inwards and is at its weakest where it attaches to the humerus (arm) bone. Symptoms include shoulder pain and swelling at the front of the shoulder.
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Chronic shoulder pain
Gradual onset shoulder pain or chronic shoulder pain develops over a period of time. You may not have known the exact time of injury and put up with a ‘niggle’, or discomfort for some time.
Rotator cuff tendinopathy (tendonitis)
Rotator cuff tendinopathy is a degenerative condition affecting one or more of the rotator cuff tendons in the shoulder.
- Pain is often present when resting.
- It is made worse by lifting things, especially above your shoulder.
- The tendon will probably feel tender and there may be a creaking feeling when the shoulder moves.
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Shoulder impingement syndrome
Impingement of the shoulder, sometimes called swimmer’s shoulder or thrower’s shoulder, is caused by the tendons of the rotator cuff muscles becoming trapped or impinged. Symptoms include:
- Shoulder pain with develops gradually over a period of days or weeks.
- Pain may be located to the front and/or outside of your shoulder joint.
- Symptoms are worse during overhead movements such as in throwing, racket sports, and swimming.
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Frozen shoulder causes pain and restricted movement in the shoulder joint. It is normally only seen in older people, with no specific cause. There are three phases to this injury.
- Initially, the shoulder will ache, with the pain becoming more widespread and worse at night.
- The joint will then start to stiffen and the pain may limit daily activities.
- Eventually, with treatment, your shoulder will begin to loosen up and pain will ease.
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Glenoid labrum tear
Glenoid labrum tear occurs when the tissue lining the shoulder joint socket tears. It is more common in sports which involve repetitive movements such as overhead throwing.
- Weakness and pain in your shoulder joint.
- Resisted flexion (bending) of the elbow and moving the arm behind your back may reproduce symptoms.
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Subacromial bursitis has similar symptoms to Supraspinatus tendinitis. A bursa is a small sack of fluid found between tendon and bone. The bursa can become impinged or trapped in the shoulder.
- This results in pain and weakness in the arm, particularly when it is lifted sideways through a 60-degree arc.
- Pain may also be felt when you press in at the inside front of the upper arm.
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A winged scapula is a symptom of another condition, rather than an injury itself.
- It is where the shoulder blade protrudes out on the back, rather than lying flat against the back of the chest wall.
- A winged scapula can be painful.
- It may be linked to poor posture, which is quite common with many people sitting at desks all day!
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Shoulder pain assessment and diagnosis
In order to thoroughly assess any injury, a sound knowledge of the anatomy of the area is required. These examples are for information purposes only. We highly recommend seeing a sports injury professional or doctor to receive a full and accurate assessment of your injury. The assessment is split into subjective and objective. Subjective assessments gather information about the injury history, whilst objective assessments examine the shoulder itself.
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Exercises for shoulder pain
After an injury, shoulder rehabilitation exercises usually begin with mobility exercises. Then, when pain allows, isometric or static shoulder exercises are used to begin strengthening. These then progress to dynamic ones with a resistance band or dumbbell weights. Exercises to stabilize the shoulder girdle, including the shoulder blade, as well as any deficit in spine function, is important to prevent future injury. Later on, more sports-specific or functional exercises are done in preparation for returning to full training.
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References & further reading
- Seitz AL, McClure PW, Finucane S et al. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech (Bristol, Avon) 2011;26(1):1–12
- Wilk KE, Obma P, Simpson CD et al. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther 2009;39(2):38–54.