Painful Shoulder Conditions

Find about common shoulder pain problems

Common Shoulder Conditions

Shoulder Osteoarthritis:

Osteoarthritis (OA) is a wear and tear condition that is one of the most common causes of shoulder pain with age. Osteoarthritis is caused by wearing down of the cartilage that lines the bones of a joint. Healthy cartilage is smooth and slippery. After trauma, such as surgery or injury, or just as part of the natural process of aging, the smooth surface of the cartilage can become rough, irregular, and thin. This process can cause inflammation and is often associated with swelling and bony outgrowths on the sides of the joint called “bone spurs.” Osteoarthritis can cause pain with movement and a decreased range of motion. The joints in the shoulder affected by osteoarthritis include:

  1. Glenohumeral joint arthritis symptoms:
    1. Decreased range of motion
    2. Pain with shoulder movement
    3. Popping/grinding of the shoulder joint with movement
    4. Deep pain in the joint
  2. Acromioclavicular (AC) joint
    1. Pain in the top or front of the shoulder
    2. Pain with pressing movements, such as bench pressing or pushups
    3. Popping in the front/top of the shoulder

Inflammatory Arthritis

Arthritis caused by inflammation from another disease process, such as rheumatoid arthritis or gout, can also affect the shoulder joint. These conditions are diagnosed by a rheumatology doctor and require specific lab tests and imaging to diagnose. Symptoms of inflammatory arthritis in the shoulder include:

1. Pain

2. Warmth

3. Swelling

4. Redness

5. Decreased range of motion

Shoulder Osteoarthritis - Oklahoma Doctor Treatment

Tendon Injuries and Rotator Cuff Tears

Tendon injuries are a common cause of pain in the shoulder, particularly in one of the rotator cuff tendons. Rotator cuff tears or biceps tendon tears can occur due to injury from increased stress on the shoulder. They can also become degenerated with overuse.

Rotator cuff tear symptoms:

  • Pain with overhead movement
  • Pain radiating down the outside of the arm
  • Weakness of the shoulder
  • Pain with reaching into a back pocket
  • Swelling 
  • Decreased range of motion

Labrum Injury

The labrum can tear in multiple locations. One common type of tear is at the top portion of the labrum, known as a “SLAP” tear, which stands for superior labrum anterior and posterior.” Labrum injuries can occur from trauma, such as a shoulder dislocation, motor vehicle accident, sports injury, or any other forceful movement of the shoulder joint. Tearing can also be degenerative, meaning the cartilage gets frayed and worn down over time from normal activity. Symptoms of labrum tears include:

  • Pain with shoulder movement
  • Popping, catching, or clicking with movement
  • Decreased range of motion
  • Weakness
  • Swelling

Joint Capsule and Ligament Instability

Because the shoulder is such a mobile joint, much of its support comes from the ligaments around the joint and the capsule of the joint. These structures can become stretched out or torn from injury or overuse, which causes the shoulder to become unstable. This means the bones can move too excessively within the joint, which can cause inflammation and pain. Repeated shoulder dislocations can cause also cause shoulder instability by stretching the capsule or damaging the ligaments. 

Symptoms of shoulder instability include:

  • Decreased range of motion in specific directions
  • Popping or clicking in the joint
  • Pain with movement or after movement
  • Repeated episodes of shoulder dislocation
  • A sliding or loose feeling in the joint

Painful Shoulder Joint Conditions

Frozen Shoulder or “Adhesive Capsulitis”

Frozen shoulder, also known as adhesive capsulitis, is a condition in which the shoulder becomes painful and limited in the range of motion. The cause is excessive inflammation and scarring of the joint capsule. Frozen shoulder can occur due to diabetes and can be associated with thyroid problems. Symptoms of frozen shoulder progress in stages, last for several months to two years, and include:

1. The first phase is notable for severe shoulder pain with decreased range of motion

2. The second phase generally includes decreased pain, but worsened range of motion

3. The third phase includes improvement in pain and improvement in range of motion

Acromioclavicular (AC) Joint Separation or “Shoulder Separation”

Shoulder separation, or acromioclavicular (AC) joint, typically occurs with direct trauma to the shoulder. Symptoms of AC separation can include:

1. Visible deformity on the top portion of the shoulder

2. Pain with movement

3. Decreased range of motion

AC Joint Osteolysis or “Weightlifters Shoulder”

Weightlifters shoulder, or AC joint osteolysis, is an overuse injury that can occur with repetitive pushing movements, such as occurs with bench pressing. Strain on the joint can cause small fractures at the end of the clavicle that cause the joint’s degradation resulting in pain. Symptoms of AC joint osteolysis include:

1. Pain over the front/top of the shoulder at the site of the AC joint

2. Pain after weight lifting

3. Mild shoulder weakness

Loose Body

Loose bodies are small fragments of bone, cartilage, or hard deposits from crystalized synovial fluid floating around in the shoulder joint. They can get caught in other structures and cause pain, clicking, catching, or locking. Sometimes they are seen on x-ray or MRI imaging, but do not cause a problem and would be considered “incidental,” meaning they are noticed but not relevant. 

Nerve Pinching 

In addition to the mechanical structures of the shoulder discussed above, there are a few nerves that can be responsible for shoulder pain: 

• Pinching of nerves in the neck, or cervical spine, can cause pain and/or numbness that radiates to the shoulder and down the arm

• Thoracic outlet syndrome is a condition in which nerves near the first rib become crowded and pinched, causing pain and/or numbness in the shoulder and arms. 

-This can also be due to pinching of blood vessels that can cause similar symptoms, known as vascular thoracic outlet syndrome.

• Suprascapular nerve pinching

o This nerve runs through a portion of the shoulder blade and controls two muscles of the rotator cuff: the infraspinatus and the supraspinatus. This nerve can be pinched due to a cyst that compresses it, which can sometimes be associated with swelling from a tear in the labrum. Symptoms include pain and weakness in the shoulder.

• Parsonage-Tuner Syndrome

o This is a rare disorder due to inflammation of any part of the brachial plexus, a bundle of nerves starting in the neck that controls the shoulder and arm. The cause is not well understood, but has been associated with autoimmune reactions, vascular problems, and viral infection. Symptoms include sudden severe pain in the shoulder followed by severe weakness.

Cervical Spine Osteoarthritis

The facet joints are small joints in the neck that prevent excessive rotation. When these joints become arthritic or inflamed, they can cause pain that radiates to the shoulder. 

Biomechanics

Because the shoulder is so mobile and involves several different bones that move in multiple directions, the muscles involved with these movements are extensive. When there is muscle imbalance, tightness, or weakness, the joints’ mechanics become altered and cause pain. Therefore, it is essential to work on proper shoulder, neck, and shoulder blade mechanics with movement. 

Are You a Regenexx Candidate?

Find Out