Shoulder pain is one of the most common orthopedic complaints and can severely limit daily life. Whether it’s sudden shoulder pain following an accident or chronic pain that develops over months, the causes of shoulder pain are varied. Often, it is not the bones but the soft tissues—such as the muscles and tendons of the rotator cuff or the bursa beneath the acromion—that cause painful inflammation. A classic example is impingement syndrome, in which the shoulder joint becomes too narrow. However, calcific tendinitis or frozen shoulder can also be the cause. An accurate diagnosis and treatment by a specialist in orthopedics and trauma surgery are crucial for maintaining shoulder mobility. In most cases, symptoms can be alleviated through conservative therapy—including physical therapy and targeted exercises—before surgery becomes necessary.
Causes of Shoulder Pain
In other joints, such as the hip or knee, the joint cartilage typically causes the pain.
In the case of shoulder pain, however, the initial cause is often a functional coordination disorder of the muscles surrounding the shoulder.
Local degeneration and chronic overuse of tendon insertions or other stabilizing soft tissues lead to permanent, painful changes in this area.
The shoulder is not subjected to weight-bearing stress, which in other joints of the body leads to cartilage damage and joint wear (osteoarthritis). Osteoarthritis of the shoulder joint is therefore a rare cause of shoulder pain.
However, spontaneous local inflammation—often calcific tendinitis (calcific shoulder)—is frequently identified as the cause.
The acromioclavicular joint, via the clavicle, is the only bony connection between the arm-scapula complex and the rib cage. Consequently, it is the first to become overloaded when functional disorders of the shoulder occur.
This situation is often the starting point for shoulder pain. This explains why, in cases of osteoarthritis of the shoulder joint, the acromioclavicular joint is most commonly affected.
Symptoms of Shoulder Pain
Initially, only individual structures of the shoulder joint are usually affected. Therefore, shoulder pain can typically be localized to specific tendon insertions or soft tissue structures of the shoulder joint through certain provocative shoulder tests.
A range of clinical examination methods—some of which are highly specific—are used for this purpose, indicating a disturbance or lesion in individual soft tissue structures.
Shoulder pain can usually be triggered by specific movements and stress. It often radiates into the arm or neck. This alone provides a clear indication of the affected structures.
Pain at rest, especially at night, suggests a chronic inflammatory condition, such as calcific tendinitis. Advanced joint degeneration can also cause these symptoms.
Treatment of Shoulder Pain
Treatment methods for shoulder pain typically begin with conservative therapies that do not involve surgery. Through targeted physical therapy focused on the shoulder, dysfunction or coordination problems in the shoulder joint can be addressed, and pressure on painful soft tissue structures can be relieved.
Accompanying physical measures to alleviate local inflammation and irritation are often helpful.
These include:
- Electrotherapy
- Ultrasound treatments
- Cold or heat therapy, and
- others, such as decontracting massages
Targeted local injection therapy into the affected structures is also often very effective. However, this requires that the painful structures be located beforehand.
Conservative measures are ineffective, however, if damage to the rotator cuff or other soft tissue structures is too advanced. Patients then continue to suffer from pain.
In such cases, surgical treatment—usually arthroscopic—is indicated as part of arthroscopic shoulder surgery:
This allows detached tendon segments as well as soft tissue structures on the shoulder and within the shoulder joint to be reconstructed or reattached.
The indication for surgery is determined on a case-by-case basis.
It depends on:
- the extent and location of the damage, as well as
- the patient’s age and symptoms
The decision as to whether surgical intervention is necessary must be discussed with the treating specialist on a case-by-case basis.
Prognosis for Shoulder Pain
Targeted conservative therapy is often successful, especially for shoulder pain that has only recently developed. In cases of pain that begins spontaneously, this therapy should generally be continued for at least half a year.
In cases of more severe injuries or long-term pain, a high percentage of the damage can be repaired through surgery. Even major tendon tears can be reconstructed through replacement surgery on a case-by-case basis.
In cases of severe osteoarthritis of the shoulder joint, joint replacement with a shoulder prosthesis is also very successful. A shoulder joint prosthesis can also be implanted using minimally invasive techniques.
If there is an extensive defect in the rotator cuff and advanced osteoarthritis, implantation of an inverse shoulder prosthesis is recommended.
This procedure typically results in an excellent restoration of function in the severely damaged shoulder joint.
FAQ: The 8 Most Important Questions About Shoulder Pain
What are the most common causes of shoulder pain?
The cause of shoulder pain often lies in the soft tissues surrounding the shoulder joint. Among the most common triggers are impingement syndrome (where the space under the acromion is narrowed) and inflammation of the rotator cuff or the bursa. Calcific tendinitis, in which calcium deposits form in the tendon, or osteoarthritis caused by joint wear and tear are also possible causes. Less commonly, acute injuries such as a torn tendon or a fracture of the humeral head are responsible.
What provides quick relief for acute shoulder pain?
For acute pain that occurs suddenly, rest is important at first. Avoid overhead movements and putting strain on the affected arm. Cooling the area with ice packs can reduce inflammation and relieve pain. Anti-inflammatory pain relievers (such as ibuprofen) can also provide short-term relief. However, if symptoms persist, see a doctor to obtain an accurate diagnosis and begin treatment.
What exercises help with shoulder pain?
Targeted exercises are a central component of conservative therapy. Various exercises can help strengthen the muscles and better center the humeral head within the joint. Among the best exercises are pendulum exercises for loosening up or gently strengthening the external rotators with a Theraband. Many people with shoulder pain benefit from exercises they’ve learned in physical therapy, which they can perform regularly at home.
When is it considered impingement syndrome?
Impingement syndrome refers to a painful pinching of tendons (usually the supraspinatus tendon) or the bursa in the space beneath the acromion (subacromial space). Typical symptoms include pain when raising the arm sideways between 60 and 120 degrees. The cause is often a muscular imbalance or bony spurs on the acromion, which narrow the space and promote chronic inflammation.
What is a frozen shoulder?
Frozen shoulder, also known as adhesive capsulitis, is a condition affecting the joint capsule. The capsule becomes inflamed, thickens, and shrinks, leading to a severe restriction of mobility—the shoulder feels as if it were frozen. The course of the condition is protracted and is divided into phases of pain, stiffness, and finally resolution. Treatment for this type of shoulder pain requires a great deal of patience and gentle mobilization.
How is shoulder pain diagnosed?
The orthopedic surgeon begins with a medical history and a thorough physical examination, during which they assess range of motion and perform specific tests. An ultrasound reveals inflammation, effusions, or calcium deposits in the soft tissues. X-rays show bone changes such as osteoarthritis or the shape of the acromion. If damage to tendons or cartilage is suspected, an MRI provides detailed images to determine the cause of shoulder pain.
When is shoulder surgery necessary?
Surgery is usually considered only if conservative treatment fails to bring about improvement over several months. This may be the case with advanced impingement, large calcium deposits, or tears in the rotator cuff. Joint replacement (prosthesis) may also be necessary in cases of severe osteoarthritis. Most procedures today are performed using minimally invasive (arthroscopic) techniques.
Can shoulder pain be prevented?
Yes, you can prevent shoulder pain by avoiding one-sided strain and prolonged overhead work. Regular exercise of the shoulder muscles and the rotator cuff helps stabilize the joint. Maintain good posture, as slumped shoulders narrow the space under the acromion. Stretching exercises help maintain mobility and relieve tension.
Share this article
