Why Does My Shoulder Hurt?

March 7, 2022

By Mary Rose Strickland, PT, DPT, OCS

Did you recently hurt your shoulder lifting, reaching, or doing other movements?  Or maybe it has been aching and gradually bothering you more and more over time?  Outside of actual trauma (falling on to your shoulder, falling on an outstretched arm, car accident, etc) below may help you understand what is going on in your shoulder.

Shoulder joint is a complex joint that includes your collar bone, the big “ball and socket” traditional shoulder joint, as well as your shoulder blade.  The main shoulder joint has a space called the subacromial space where rotator cuff muscles sit in between bones that create a floor and a ceiling.  70% of shoulder pain is subacromial in nature and termed Subacromial Pain syndrome (SAP).  This can eventually cause irritation to the rotator cuff muscles.

Most shoulder pain will resolve in 4-8 weeks, but some may take longer.

Common symptoms:

• Pain at the side of upper arm with raising your arm to the side
• Difficulty lifting your arm (especially above shoulder height)
• Reduced strength
• Difficulty sleeping on side (or even opposite side)

Other causes of shoulder pain that should be ruled out by your Physical Therapist:

• Frozen shoulder
• Arthritis
• Pain being referred from your neck

Imaging:

• X-ray is not useful for soft tissue disorders. X-ray is best suited for excluding bone conditions such as a fracture.  Without trauma, a fracture is not likely.  Therefore, x-rays have limited utility and are often not recommended.
• Advanced imaging (MRI) should be reserved for when someone is not responding to 6-8 weeks of conservative management. MRIs are not needed to diagnose or determine course of treatment.  They may be recommended sooner if it will change our course of care.
• It is common after the age of 30 to see degenerative changes – arthritis, partial rotator cuff tears, or bursa issues. Structural abnormalities found on images are also common in people without symptoms, therefore presence of them does not always correlate to your problem. Clinical exam findings should be addressed vs. treating off of an image, for this reason.

Management:

1. Starts with:

• Active rest – continue to use it as able to encourage blood flow and joint nutrition to promote healing; balance between not OVER-using and further irritating
• Cold for first 48 hours, then use heat over the shoulder
• Exercise therapy should be primary intervention
• Over-the-counter anti-inflammatories as deemed safe for you by your PCP/Pharmacist

2. If not responding, may consider:
   • Corticosteroid injection

3. Last option:
   • Arthroscopic subacromial decompression surgery as there is conflicting evidence regarding meaningful outcomes (compared to conservative treatment). Subacromial decompression surgery should be reserved for adults with shoulder pain for more than three months, and have not experienced any progress with completing a full course of physical therapy.

Dr. Mary Rose is a Physical Therapist, President, and Co-Owner of New Life Physical Therapy. She is board certified in Orthopedic Physical Therapy through the American Board of Physical Therapy Specialties, and is board certified in Lifestyle Medicine through the American College & Board of Lifestyle Medicine.  She can be reached at DrMaryRose@newlifept.com