Shoulder pain

and Carola Felchner, science journalist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Shoulder pain is found in almost all age groups and in both sexes. Sometimes the shoulder pain is acute, for example, during exercise or after lifting a heavy load. Other people suffer from chronic shoulder pain, for example due to joint wear and tear. Regardless of its cause, shoulder pain can have a significant impact on everyday life. Read everything you need to know about the causes and treatment of shoulder pain here.

Brief overview

Description: acute or chronic pain in the shoulder region, possibly with further symptoms such as limited mobility of the shoulder and arm
Causes: e.g. tendinitis or injury, bursitis, chronic muscle tension, bone fracture, nerve damage, impingement syndrome, joint wear (osteoarthritis), frozen shoulder, rheumatic diseases, fibromyalgia, carpal tunnel syndrome, neuroborreliosis, shingles, biliary colic, heart disease
Diagnostics: recording of the medical history in the doctor-patient conversation, physical and orthopedic examinations, possibly other examinations (neurological examination, blood tests, joint puncture, ultrasound, magnetic resonance imaging, computed tomography)
Therapy: depending on the severity and cause of the symptoms, e.g. painkillers, physiotherapy, cold / heat treatment, alternative healing methods (such as acupuncture, medicinal plants), targeted training of the shoulder area, surgery

Shoulder pain: description

Shoulder pain is a discomfort in the shoulder region that sometimes radiates to the upper arm or neck. Doctors differentiate between acute and chronic shoulder pain:

Acute shoulder pain occurs suddenly, for example after an accident or a fall on the shoulder or arm. The reason is, for example, a biceps tendon tear, a dislocated shoulder or a broken arm.
Chronic shoulder pain develops slowly and can be very persistent. They are caused, for example, by joint wear (osteoarthritis), a herniated disc in the cervical spine or frozen shoulder.

The shoulder pain is noticeable in different ways - the symptoms vary depending on the cause. It can be painful if those affected spread their arms or lift them to the side. Often there is also pain when lying down, so that it is sometimes difficult for affected patients to find a comfortable and pain-free sleeping position. In some cases of shoulder pain, the mobility of the shoulder joint is noticeably restricted, the joint stiffened (“frozen shoulder”).

Shoulder pain can arise here

Shoulder pain can have many causes. In most cases, the pain is not caused by the shoulder joint itself, but by injuries or diseases of muscles, tendons or the bursa around the joint.

Shoulder pain: causes and possible diseases

In about 85 percent of cases, the cause of shoulder pain is not in the shoulder joint itself, but in the area near the joint (periarticular cause). For example, weak muscles or misalignments as well as damage to muscles, tendons, joint capsules and / or synovial fluid caused by injury or illness can cause shoulder pain. In addition, diseases of internal organs (gallstones, heart attack, etc.) or rheumatic diseases can also be associated with shoulder pain.

Overall, the following diseases and injuries are common causes of shoulder pain:

Chronic muscle tension: Chronic tension in the neck and shoulder muscles is often to blame for shoulder pain. It mostly affects people in sedentary professions who work a lot with their head and upper body bent forward (for example at the computer). People who are generally prone to cramps, tension headaches or depression also often develop tension-related neck and shoulder pain.
Joint wear: In the case of osteoarthritis of the shoulder joint (omarthrosis), the cartilage layer on the joint surfaces, which ensures smooth mobility of the shoulder joint, wears down more and more. The consequences are increasing shoulder pain when moving the shoulder as well as restricted mobility over the years. The symptoms are most noticeable when the arm is turned outward or raised to shoulder level (or higher). Possible causes of omarthrosis are age-related wear and tear, circulatory disorders in the head of the humerus, rotator cuff tear, frequent dislocation of the shoulder or rheumatoid arthritis. If no cause can be found for the painful joint wear, doctors speak of idiopathic (= no recognizable cause) shoulder joint osteoarthritis.
Bottleneck syndrome (impingement syndrome): Bottleneck or impingement syndrome of the shoulder is understood to be functional disorders of the shoulder due to a narrowing between the roof of the shoulder and the humerus: irritation, calcification or wear of the tendons and bursa makes the space in the shoulder joint too narrow, so that the head of the humerus hits the roof of the shoulder and the tendon is literally pinched in the joint. The result is shoulder pain, especially when exercising.

If the arm is raised to the side or backwards (e.g. to pull something out of the back pocket), the shoulder pain can even become very severe. They can usually be felt on the outside of the upper arm. Later on, you may experience shoulder pain at night.

The cause of the impingement syndrome is usually long-term stress on the shoulder, for example in athletes who make a lot of overhead movements with their arms, such as handball players, volleyball players and swimmers (“athlete's shoulder”). Even people who often have to raise their arms above their heads at work (such as painters, aircraft mechanics) often suffer from shoulder pain due to the impingement syndrome.
Inflammation of the shoulder bursitis (subacromial bursitis): An inflammation of the shoulder bursa can also lead to shoulder pain and restricted movement of the shoulder joint. It usually develops as part of the impingement syndrome.
Rupture of the rotator cuff (rotator cuff rupture): The rotator cuff is a strong "coat" of muscles and tendons that holds the humerus head in the shoulder socket and at the same time enables arm movements in all directions (rotation). One or more of the rotator cuff tendons may partially or completely tear, resulting in sudden shoulder pain.

The rotator cuff tear is usually the end stage of impingement syndrome. The tendons are already damaged by the constriction in the joint before they tear. An acute rupture of the rotator cuff without previous damage to the tendons is rare, but can happen, for example, if you fall on your outstretched arm.
Dislocated shoulder joint (shoulder dislocation): After a fall on the (outstretched) arm or a blow on the shoulder, the humerus can “jump” out of the socket. Such a dislocated shoulder can also be responsible for shoulder pain and limited shoulder and arm mobility.

The first time the shoulder dislocates, ligaments or bone structures in the joint area can be injured. This can lead to a new shoulder dislocation again and again later, even with relatively low loads. There are also people whose shoulder joints are generally unstable and who jump out of the joint socket during everyday movements (habitual shoulder dislocation). This can be recognized by suddenly shooting shoulder pain. Whatever the reason for frequent shoulder dislocations - it promotes shoulder arthrosis.
Upper arm fracture and collarbone fracture: Shoulder pain and painful movement restrictions of the shoulder can also be caused by a fracture of the upper arm near the shoulder (proximal humerus fracture) or by a collarbone fracture (clavicle fracture). A fracture of the upper arm is usually the result of a fall on the outstretched arm or elbow. A broken collarbone can also happen when falling onto the outstretched arm or when falling onto the shoulder.
Hemorrhage in the joints: A fall or blow to the shoulder or the (outstretched) arm can also cause hemorrhage into the shoulder joint, especially in people with bleeding disorders. Symptoms include shoulder pain and limited shoulder and arm mobility.
Biceps tendon tear: In the case of sudden, sharp pain on the outside of the shoulder, a biceps tendon rupture could be the reason - i.e. the tear of one of the biceps tendons that attach the arm flexor muscle in the shoulder area. Other signs of a biceps tendon rupture include bulging above the elbow and weakness in the arm when trying to bend it.
Frozen shoulder: A shrunken shoulder joint capsule painfully restricts the mobility of the shoulder - the shoulder is, so to speak, "frozen". The whole thing develops gradually over several phases. In most cases, frozen shoulder occurs in tow from another shoulder disease or injury (such as osteoarthritis of the shoulder, calcified shoulder, rotator cuff tear or dislocation of the shoulder). Primary frozen shoulder, the cause of which remains unknown, is rarer than this secondary frozen shoulder. The disease occurs mainly in women between 40 and 60 years of age. Diabetics are also at increased risk of frozen shoulder.
Calcareous shoulder (Tendinosis calcarea): Here, calcareous crystals have deposited on the tendons of the rotator cuff (presumably due to reduced blood flow). The calcium deposits cause shoulder pain when arm movements, especially when moving overhead. If lime crystals are also deposited in the bursa of the shoulder joint, the shoulder pain becomes even more severe and the arm movements are further restricted. A calcareous shoulder develops preferentially between the ages of 30 and 50.
Polymyalgia rheumatica (PMR): This inflammatory rheumatic disease causes muscle pain, especially in the shoulder and pelvic girdles. Characteristic are shoulder pain that increases with movement and is particularly pronounced in the morning. Pain in the neck, buttocks and thighs is also possible. Polymyalgia rheumatica occurs preferentially in the age group of the over 60-year-olds and here especially in women.
Bacterial shoulder joint inflammation (bacterial omarthritis): It is caused by bacteria that have either reached the joint via the blood or infected the joint directly, for example as part of a joint puncture (removal of synovial fluid using a needle). The signs of bacterial shoulder joint inflammation are rapidly increasing, severe shoulder pain and fever. There may also be swelling and / or redness in the area of the shoulder joint.
Fibromyalgia: Fibromyalgia is a mostly chronic pain disorder that is associated with persistent pain in many parts of the body (e.g. shoulder pain, neck pain, back pain and pain in the legs). Often there are also sleep disorders, fatigue, depressive mood and headaches or migraines. Fibromyalgia syndrome is quite common, primarily in women.
Shoulder-arm syndrome (cervicobrachial syndrome): In the shoulder-arm syndrome, neck and shoulder pain occurs, which can radiate to the arm, hands, fingers and the back of the head. Due to the pain, the head can only be moved to a limited extent. The symptoms originate in the middle and lower cervical spine, although the exact cause can be very different.

Painful muscle tension in the neck, for example, due to frequent desk work or psychological stress, herniated discs in the cervical spine, congenital vertebral malformations, vertebral fractures, bacterial infections of the spine, osteoporosis and tumors on the spine are possible.
Tendonitis: When the tendons in the shoulder area wear out, chronic inflammation can develop. When moving, it then hurts in the shoulder area - locally on the sides and above as well as on the humerus.
Herniated disc in the cervical spine: Sudden shooting, electrifying pain in the shoulder, upper arm and neck indicate a herniated disc in the lower cervical spine. In addition, the pain often radiates into individual fingers and increases when the head is turned.
Shoulder girdle compression syndrome (thoracic outlet syndrome): The term includes various rare symptoms in the shoulder area. What they all have in common is that they are triggered by a narrowing of the blood vessel-nerve cord leading to the arm in the upper chest area. The consequences are alternating shoulder pain, tingling and numbness on the outside of the shoulder.
Carpal tunnel syndrome: In carpal tunnel syndrome, the middle arm nerve (median nerve) in the area of the carpal tunnel is damaged. The carpal tunnel is a narrow passage on the wrist that is formed by the forearm and carpal bones and ligaments. The middle arm nerve and the flexor tendons of the fingers run in it.

The nerve damage causes pain, numbness or tingling in the first three fingers (sometimes also in the ring finger). The symptoms initially only occur at night and in the early morning, later also during the day. The pain can also radiate into the forearm and shoulder. In most cases, the cause of carpal tunnel syndrome remains unexplained. The disease occurs primarily in middle-aged women.
Neuroborreliosis: Borreliosis (Lyme disease) is a bacterial joint inflammation. It is triggered by bacteria (Borrelia burgdorferi) that are transmitted to humans by ticks. The disease can also spread to the nervous system and is then called neuroborreliosis. People sometimes develop shoulder pain.
Shingles: This painful rash is caused by the same virus as chickenpox, variella zoster virus. It usually stretches in a belt shape and on one side of the trunk from the spine to the front. In addition to severe back pain, shingles can also cause shoulder pain.
Heart attack: If the pain suddenly occurs in the left shoulder and behind the breastbone, a heart attack could be the cause. This is especially true if the patient also develops chest tightness, shortness of breath, and fear of death. However, these symptoms can also have other causes, such as chest tightness (angina pectoris) or a panic attack. In any case, it is advisable to see a doctor immediately!
Biliary colic: If the shoulder pain occurs on the right and the person concerned experiences swelling and decongesting colic-like pain in the upper and middle abdomen, it is probably a biliary colic. The cause is either a gallbladder inflammation or a gallstone stuck in the duct between the gallbladder and the small intestine. If you suspect biliary colic, you should consult a doctor immediately!
Embolism in the lungs: In the case of a pulmonary embolism, a blood vessel in the lungs is blocked by a blood clot that has washed ashore. Symptoms depend on the size of the blocked vessel. For example, chest pain that radiates into the shoulder or stomach, shortness of breath or accelerated breathing, coughing (possibly coughing up blood), rattling noises when breathing, sweating, racing heart, fear, dizziness or fainting are possible.
Lung Tumor (Pancoast Tumor): Pancoast Tumor is a rare form of lung cancer that develops at the tip of the lung. In addition to back pain, it can also cause shoulder pain.

Shoulder pain: when should you see a doctor?

A doctor's visit is advisable in the following cases of shoulder pain:

very severe shoulder pain
persistent shoulder pain
recurring shoulder pain
Shoulder pain after a fall on the shoulder or arm or after an accident
significant restriction of movement of shoulder and arm
The pain is radiated to other parts of the body such as the neck or arm
Concomitant symptoms such as numbness or tingling

A doctor should be alerted as soon as possible in the following situations:

very severe, undulating pain in the right shoulder and right upper abdomen, often accompanied by nausea and vomiting (suspected biliary colic)
severe pain in the right shoulder and upper right abdomen with fever and chills (suspected gallbladder inflammation)
Sudden shoulder pain on the left side and pain behind the breastbone, tightness in the chest, shortness of breath, fear of death, often dizziness and / or nausea (suspected heart attack or angina pectoris)
Sudden chest pain radiating to the shoulder, possibly accompanied by symptoms such as shortness of breath or rapid breathing, rapid heartbeat, sweating, cough or coughing up blood, dizziness, fainting (suspected pulmonary embolism)

Shoulder pain: diagnosis

In the case of shoulder pain, the doctor will first ask you in detail about your medical history (anamnesis). It is important, for example, when and how often the pain occurs in the shoulder, whether it is only noticeable when moving the arm or shoulder or even at rest and whether other complaints besides the shoulder pain such as loss of strength in the arm or numbness in the fingers appear.

This is followed by a physical examination (clinical function tests, palpation of trigger points, tendons and joints, movement test). Based on the medical history and physical examination, the doctor can usually make assumptions about the possible cause of the shoulder pain. Further investigations bring clarity:

Orthopedic examination: It is standard for shoulder pain and can provide information on osteoarthritis of the shoulder joint, impingement syndrome, calcified shoulder, fibromyalgia and broken bones (collarbone or upper arm fracture), for example.
Neurological examination: Here the functional and conduction state of nerve tracts is checked if a herniated disc in the cervical spine is possibly causing the shoulder pain.
Blood tests: If neuroborreliosis or shingles could be behind the shoulder pain, a blood sample from the patient can be tested for antibodies against the pathogen causing the disease. If a heart attack is suspected, the heart enzymes are determined in the blood sample. Coagulation disorders as a possible cause of bleeding in the joints can also be determined using a blood analysis.
X-ray examination: X-rays are taken if the shoulder pain is triggered, for example, calcified shoulder, polymyalgia rheumatica. a broken bone or a dislocated shoulder joint are possible.
Ultrasound examination: Using ultrasound (sonography), for example, frozen shoulder, biceps tendon rupture, gallbladder inflammation and gallstones can be identified as the cause of shoulder pain.
Joint puncture: If the doctor suspects a bacterial inflammation of the shoulder joint, he will take a sample of the synovial fluid with a thin needle (joint puncture) in order to create a bacterial culture. If bacteria can actually be grown from the synovial fluid, this confirms the doctor's suspicion.
Lumbar puncture: If neuroborreliosis is the cause of shoulder pain, a sample of the cerebrospinal fluid (liquor) is taken from the lumbar spine with a thin needle. In the laboratory, the sample is examined for Borrelia - the pathogen that causes neuroborreliosis.
Magnetic resonance imaging (MRI): Magnetic resonance imaging or magnetic resonance imaging is indicated when shoulder pain may be caused by shoulder impingement syndrome, joint wear, a rotator cuff tear, or shoulder girdle compression syndrome.
Computed tomography (CT): If the cause of shoulder pain is, for example, a lung tumor (Pancoast tumor), a pulmonary embolism, a shoulder-arm syndrome or a herniated disc in the cervical spine, this can be clarified using computed tomography.
Electrocardiogram (EKG): A recording of the electrical activity of the heart reveals whether a heart attack may have caused the pain in the shoulder.
Heart catheter examination: A heart catheter examination is also always carried out for shoulder pain if a heart attack could be the trigger for the pain.
Lungoscopy: In this examination, also known as bronchoscopy, a small camera attached to the tip of a thin tube or metal tube is inserted through the mouth or nose into the trachea and its main branches (main bronchi). This allows the doctor to examine these airways from the inside. This is mainly done if a lung tumor is suspected.

Shoulder pain: therapy and exercises

The treatment of shoulder pain depends on the type and extent of the discomfort.

Treatment by the doctor and physiotherapist

If there is an injury or illness behind the shoulder pain, the doctor will treat it accordingly. For example, he will straighten a dislocated shoulder joint (shoulder dislocation) using a lever technique and then immobilize it in a bandage for some time. Then the shoulder is slowly accustomed to movement again with physiotherapy exercises.

In some cases the cause of shoulder pain cannot be treated: The wear and tear on a shoulder joint (omarthrosis) cannot be reversed. But at least one can try to relieve shoulder pain with conservative measures. Patients with osteoarthritis of the shoulder receive anti-inflammatory and pain-relieving medication (for example, as tablets or as injections into the shoulder joint). Physiotherapy (physiotherapy, heat applications, etc.) can also have a pain-relieving effect.

In very severe cases, i.e. severe shoulder pain due to advanced osteoarthritis, an artificial shoulder joint can be used.

In general, there are the following therapy options, depending on the cause and severity of the shoulder pain:

pain relievers or anti-inflammatory drugs
Immobilize
Physiotherapy (physiotherapy, heat / cold treatment, etc.)
alternative healing methods
surgical interventions (e.g. suturing torn tendons, setting up a complicated humerus fracture, inserting an artificial shoulder joint)
alternative / complementary healing methods (such as acupuncture)

You can do that yourself

Cold / warmth: In the case of acute or suddenly worsening shoulder pain (e.g. due to bursitis, biceps tendon rupture, rotator tendon rupture or calcified shoulder), cold is generally beneficial - for example in the form of ice, cold packs or moist, cool compresses. In the case of chronic shoulder pain, on the other hand, warmth is usually perceived as more pleasant.
Ergonomic workplace: important if the shoulder pain is due to muscle tension from frequent desk work. Because an ergonomic workplace prevents uneven strain on the muscles in the shoulder, neck and back and thus painful muscle tension. Pay attention to the correct height of the table and chair, the correct distance to the keyboard and the palm rests in front of the keyboard.
Acupuncture, cupping & Co .: The World Health Organization (WHO) expressly recommends acupuncture for shoulder-arm syndrome. Massages, cupping and arnica ointments can also alleviate shoulder pain for those affected.
Targeted training: In order to prevent a painful “athlete's shoulder”, a complex chronic overload, the shoulder muscles should be built up in a targeted and even manner and the muscles and ligaments in the back of the shoulder should be stretched regularly. A sports doctor or experienced trainer will show you suitable exercises.

The stretching exercises for the rear shoulder area in combination with physiotherapy are also advisable if someone already suffers from an “athlete's shoulder”: They can often be used to alleviate moderate shoulder pain (if the shoulder pain is more severe, they will be operated on). Regular shoulder movement exercises are recommended to prevent recurrence of symptoms.

In the case of chronic shoulder pain (for example due to osteoarthritis or calcified shoulder), those affected often get used to a relieving posture, which shortens the shoulder muscles over time. To counteract this, the muscles should be stretched regularly. Let a sports doctor or physical therapist show you appropriate stretching exercises for the shoulder area.

In general, regular measures are recommended for chronic shoulder pain to improve shoulder mobility and strengthen the muscles in the shoulder area - especially in the painful areas. For example, specific exercises for the shoulder girdle, massages, Feldenkrais or physiotherapy are suitable. Especially with osteoarthritis, the shoulder should be moved regularly despite the pain. Otherwise it will become increasingly stiff over time.
Relaxation techniques: Stress, tension and everyday worries are often (partly) responsible for shoulder pain. Here, relaxation processes can provide the necessary relief for muscles, tendons, ligaments and the soul. For example, progressive muscle relaxation according to Jacobson, autogenic training and yoga are suitable. Such relaxation methods are often used in combination with alternative healing methods such as acupuncture, magnet therapy or biofeedback to treat chronic shoulder pain.
Medicinal plants: If the shoulder pain is due to osteoarthritis, you can do a lot with medicinal plants to alleviate the symptoms. For acute painful joint inflammation, for example, compresses with arnica flowers or rubs with arnica ointment or gel are suitable. Circulatory baths with hay flowers or rosemary oil (together with eucalyptus oil) can be used as a beneficial heat therapy in times of minor symptoms (non-activated osteoarthritis). An anti-inflammatory tea made from devil's claw root is also recommended for osteoarthritis-related shoulder pain.
You should speak to your doctor or pharmacist about the use of over-the-counter pain relievers and anti-inflammatory drugs (such as ibuprofen) for shoulder pain: He will advise you on the selection, dosage and duration of use of a suitable preparation.

Additional information

Books:

Shoulder and neck training: Finally pain-free and relaxed! The training for self-help by Ronald Thomschke, Steffen Verlag
Strong shoulders: simply training away ailments The best exercises in spiral dynamics by Christian Larsen and Bea Miescher, TRIAS