What Causes Shoulder Pain? Questions to Ask and How Doctors Diagnose It

Shoulder pain can make everyday activities like reaching overhead, getting dressed, sleeping or lifting objects surprisingly difficult. But just like knee pain, shoulder pain isn’t a diagnosis. Several different structures can cause shoulder symptoms, and determining the source of the pain is an important first step toward treatment.

What Can Cause Shoulder Pain?

The shoulder is one of the body’s most mobile joints. That mobility also makes it vulnerable to injuries and conditions affecting the bones, cartilage, muscles, tendons and ligaments.

Common causes of shoulder pain include:

• Rotator cuff problems: The rotator cuff is a group of muscles and tendons that helps stabilize and move the shoulder. Tendinitis, inflammation or a tear can cause pain and weakness, particularly with overhead movements.
• Shoulder impingement: Certain movements can cause structures in the shoulder to become irritated or compressed, often resulting in pain when reaching overhead.
• Arthritis: Cartilage loss within the shoulder joint can cause pain, stiffness and reduced range of motion.
• Labral injuries: The labrum is cartilage that helps stabilize the shoulder. Injuries can occur from trauma, repetitive overhead activity or certain sports.
• Shoulder instability: A shoulder that repeatedly feels like it is slipping, shifting or coming out of place may have an instability problem.
• Bursitis: Inflammation of a fluid-filled sac that helps reduce friction around the shoulder can contribute to pain and tenderness.
• Frozen shoulder: Also called adhesive capsulitis, this condition can cause significant stiffness and progressively limit shoulder movement.
• Pain from another area: Shoulder pain can sometimes originate outside the shoulder itself, including the neck or upper back.

What Should You Tell Your Doctor?

The details of your symptoms can help your doctor determine which structures may be involved. Be prepared to discuss:

• When did the pain begin?
• Did it happen after an injury or develop gradually?
• Where exactly does it hurt?
• Does the pain travel down your arm or into your neck?
• Which movements make it worse?
• Does reaching overhead cause pain?
• Is it difficult to reach behind your back?
• Do you have weakness in the arm?
• Does the shoulder click, catch or feel unstable?
• Does the pain wake you up at night?
• Have you lost any range of motion?

It can also be helpful to tell your doctor about your work, exercise and sports activities, particularly if they involve repetitive overhead movements.

How Is Shoulder Pain Diagnosed?

Diagnosis typically begins with a conversation about your symptoms and a physical examination.

Your doctor may evaluate your shoulder’s range of motion, strength and stability and perform specific movements designed to help identify the source of your pain. Your neck and other areas may also be examined when appropriate, since problems outside the shoulder can sometimes cause shoulder symptoms.

Imaging may be recommended depending on your symptoms and examination.

X-rays can help identify arthritis, fractures, bone abnormalities and other changes involving the bones and joint. An MRI can provide more detailed information about soft tissues such as the rotator cuff, labrum and other tendons and ligaments.

In some situations, additional imaging or diagnostic tests may be appropriate.

Importantly, an imaging finding doesn’t always explain a person’s symptoms. Your doctor will consider your history, physical examination and imaging together to determine the most likely cause of your pain.

Questions to Ask Your Doctor

If you’re being evaluated for shoulder pain, consider asking:

1. What do you think is causing my shoulder pain?
2. Could the pain be coming from my neck or another area?
3. What did you find during my physical examination?
4. Do I need an X-ray, MRI or another test?
5. What are my treatment options?
6. What activities should I avoid or continue?
7. Could physical therapy help?
8. What symptoms would indicate that I need to be reevaluated?

Shoulder pain can have many causes, and the treatment that works for one condition may not be appropriate for another. A thorough evaluation can help identify what’s actually causing your symptoms and guide the next step in treatment.

This information is for educational purposes only and is not a substitute for evaluation and medical advice from a qualified healthcare professional.

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