Shoulder and Arm Pain

What is it?

The shoulder has the widest range of movement of any joint in the body. That mobility depends on the muscles and tendons surrounding the joint (the rotator cuff), its ligaments and the joint capsule. Shoulder and arm pain can come from any of these structures, or from irritation of the nerve roots that leave the neck.

The distinction matters. Pain from the shoulder itself usually worsens with shoulder movement and tends to stay above the elbow. Pain from the neck changes with neck movement, can spread below the elbow into the fingers, and often comes with numbness and tingling. Shoulder pain can occur at any age, but tendon problems and frozen shoulder become more common from middle age onwards.

What causes it?

The main causes of shoulder and arm pain are:

• Rotator cuff problems: weakening of the tendons through overuse or age (tendinopathy), shoulder impingement and tendon tears.
• Frozen shoulder (adhesive capsulitis): thickening and tightening of the joint capsule, causing pain and marked stiffness; it is more common in people with diabetes.
• Osteoarthritis: wear in the shoulder joint or in the joint where the collarbone meets the shoulder.
• Pain from the neck: nerve root compression caused by a herniated disc or narrowing of the nerve openings (cervical disc herniation).
• Myofascial pain: trigger points in the muscles around the shoulder and shoulder blade.
• Nerve entrapment: compression of nerves at the elbow or wrist (such as carpal tunnel syndrome), or irritation of the suprascapular nerve around the shoulder.

Some serious conditions can also cause pain felt in the shoulder and arm. In particular, pain spreading to the left arm together with chest pain may come from the heart and needs emergency assessment.

How is it diagnosed?

The examination assesses active and passive shoulder movement, muscle strength and tests aimed at particular tendons. Marked restriction of passive movement suggests frozen shoulder, while pain at a certain angle when raising the arm to the side points to impingement. Examining the neck and the nerves helps to establish whether the pain is coming from the neck.

Shoulder X-rays, ultrasound or MRI are requested when needed. Ultrasound is also useful because it can assess the tendons during movement and guide injections. If nerve root compression in the neck is suspected, a neck MRI may be arranged, and EMG can assess nerve entrapment. In some people, diagnostic nerve blocks help to clarify the source of the pain.

Treatment options

Treatment depends on the source of the pain and, where needed, is planned together with orthopaedic and rehabilitation specialists.

Conservative care

• Activity changes: briefly easing off movements that make the pain worse, without keeping the shoulder completely still.
• Physiotherapy and exercise: programmes that maintain range of movement and strengthen the muscles around the shoulder are the foundation of treatment.
• Posture and ergonomics: standing tall, not letting the shoulders slump forward and supporting your arms when working at a desk reduce the load on the shoulder.
• Medication: short courses of painkillers and anti-inflammatory medicines can be used.
• Cold and heat: can bring short-term relief when pain is at its worst.

Interventional pain treatments

• Injections into or around the joint: may support physiotherapy in selected patients, particularly with frozen shoulder and impingement.
• Radiofrequency treatment: for long-standing shoulder pain, pulsed radiofrequency can be applied to the suprascapular nerve, which carries sensation from the shoulder joint. It is considered particularly when surgery is not suitable or not wanted.
• Trigger point injection: may support an exercise programme when clear trigger points are present in the muscles around the shoulder and shoulder blade.
• Non-surgical cervical disc treatment: if arm pain is caused by nerve root compression from a herniated disc in the neck, the methods within this approach come into consideration.

In suitable patients these methods can provide a meaningful reduction in pain and make it easier to take part in physiotherapy; results vary from person to person.

When is surgery considered?

For full-thickness rotator cuff tears, impingement that does not respond to treatment, advanced arthritis or progressive weakness caused by a neck problem, surgery is assessed with an orthopaedic surgeon or a neurosurgeon.

When should you see a doctor?

See a doctor if your shoulder or arm pain is not easing after a few weeks, wakes you at night, makes it hard to lift your arm, or comes with numbness or weakness in your hand. An algology (pain medicine) specialist will assess whether the pain is coming from the shoulder or the neck and plan suitable treatment with you; you can request an appointment through our contact page.