What Cause Shoulder Pain and Which Are Dangerous Symptoms Requiring a Medical Consultation?

Shoulder pain causes come from 2 main factors: accidental causes such as falls, sports injuries, or road accidents, and spontaneous causes such as joint degeneration, frozen shoulder conditions, or repetitive use injuries.
The location of shoulder pain may help identify the cause. For example, front shoulder pain may result from biceps brachii tendon inflammation or tears, upper shoulder pain may originate from acromioclavicular joint inflammation, side shoulder pain is often caused by shoulder tendon inflammation or tears, and back shoulder pain – the most common shoulder pain – results from inflamed shoulder muscles mostly due to overuse.
Shoulder pain at nighttime occurs from various causes such as sleeping on the affected side, lack of shoulder movement, or sometimes minor sports injuries that trigger inflammatory processes during nighttime.
Shoulder pain symptoms that require immediate medical attention range from arm weakness and muscle weakness to frozen shoulder conditions. Patients should seek prompt treatment from medical specialists.
Diagnosing shoulder pain involves taking medical history to determine whether the cause is accident-related or spontaneous, physical examination to find tender points, shoulder movement assessment, and muscle strength testing.
Shoulder pain treatment can be achieved through non-surgical methods such as pain medications like paracetamol, muscle relaxants, and non-steroidal anti-inflammatory drugs, physical therapy including ultrasound, shock wave therapy, and acupuncture, depending on the physician’s discretion. For surgical methods, these include both arthroscopic and open surgical procedures.
Shoulder pain treatment at kdms Hospital in Bangkok, Thailand, patients will be taken care of by medical experts specialized in bone, joint, and muscle conditions. With comprehensive care from initial consultation to post-treatment recovery, we ensure patients can return to their normal quality of life.

Shoulder pain is a common symptom found across all age groups, particularly among those who use their shoulder muscles extensively such as athletes or workers who frequently use their shoulders. Shoulder pain can arise from many causes, which can be divided into two main groups: accident-related and spontaneous. Additionally, the location of shoulder pain can assist in diagnosis.

This article will help you understand more about shoulder pain, including its various causes, diagnostic methods, and treatment approaches.

Table of Contents

What causes shoulder pain?

When taking medical history to identify shoulder pain causes, doctors will determine whether the shoulder pain originates from accidents or occurs spontaneously considering the following factors:

Accident-related shoulder pain

Falls

This shoulder pain most commonly involves direct impact to the shoulder, which may result in muscle bruising. If severe enough, it can cause shoulder tendon tears, shoulder dislocation, shoulder subluxation, or labral tears.

Sports-related injuries

This shoulder pain may occur from repetitive use beyond the body’s repair capacity, such as throwing balls, weightlifting, or playing sports requiring rapid and forceful shoulder movements like badminton, volleyball, etc.

Road accidents

Strong collisions or impacts can cause injuries to shoulder bones, joints, and tendons, potentially resulting in bone fractures, joint dislocations, and shoulder tendon tears.

Spontaneous shoulder pain

Shoulder joint degeneration

This shoulder pain commonly occurs in elderly patients or those with rheumatoid arthritis. The pain may result from cartilage wear or chronic shoulder tendon tears, leading to shoulder joint degeneration. Treatment may require artificial shoulder joint replacement surgery.

Repetitive shoulder use

Repetitive shoulder use such as work requiring frequent lifting or prolonged computer use may cause inflammation of muscles and tendons around the shoulder.

Frozen shoulder condition

Frozen shoulder is a condition that reduces shoulder joint mobility and causes pain.

Tendon inflammation and bone spur impingement syndrome

This results from bone spurs compressing shoulder tendons, causing inflammation and potentially leading to tendon tears.

Calcific tendonitis

This can occur spontaneously with severe pain symptoms, diagnosable through X-ray imaging.

Shoulder pain location

The location of shoulder pain may help identify the cause of shoulder pain as follows:

Front shoulder pain

This may result from biceps brachii tendon inflammation or tears. Treatment methods range from shoulder rest, anti-inflammatory medications, steroid injections to surgery.

Upper shoulder pain

This may result from acromioclavicular joint inflammation, muscle pain, and etc.

Side shoulder pain

This shoulder pain is often caused by shoulder tendon inflammation, tears, or bone impingement. Symptoms typically include pain when lifting arms overhead and pain when sleeping on the affected side. However, if pain radiates down the arm, it may also indicate cervical spine nerve compression.

Back shoulder pain

This shoulder pain is commonly caused by inflamed shoulder muscles, mostly from overuse. The pain typically affects the back shoulder muscles, scapular muscles, and neck muscles.

Basic first aid for shoulder injuries

Patients can provide initial treatment with cold compression therapy during the first 24-48 hours, taking pain medications such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), and reducing shoulder activity. If weakness, numbness, deformity, or persistent pain occurs in the shoulder, patients should consult medical specialists.

However, since shoulder pain arises from multiple causes, each type of pain requires different treatments. For example, tendon inflammation requires limited movement in the initial period, while frozen shoulder requires emphasis on shoulder movement. Therefore, patients should consult medical specialists for targeted treatment, optimal care, and reduced complications.

Which shoulder pain symptoms require immediate medical attention?

If shoulder pain doesn’t improve after taking pain relievers and is accompanied by arm weakness, muscle weakness, or frozen shoulder symptoms, patients should seek immediate medical treatment. Rapid and timely treatment increases opportunities for faster and more effective recovery.

How to indicate diseases from shoulder pain

Doctors will take medical history to determine whether the cause of shoulder pain is accident-related or spontaneous, conduct physical examinations to find tender points, assess shoulder movement, and test muscle strength.

X-ray examination helps diagnose causes of shoulder pain that may result from joint degeneration, dislocation or subluxation, bone spurs, and calcific tendonitis. If tendon or labral tears are suspected, doctors may consider additional magnetic resonance imaging (MRI) examinations.

Treatment methods for shoulder pain

Treatment methods for shoulder pain include both non-surgical and surgical approaches. Typically, doctors will diagnose and recommend treatment approaches starting with non-surgical ones.

Non-surgical treatment methods

Recommendations for specific behavioral modification, including refraining from shoulder activities for shoulder inflammation and bruising, encouraging to practice shoulder movement for frozen shoulder, or avoiding overhead arm lifting during painful periods for patients with bone spur impingement syndrome to reduce inflammation.
Medications, including pain relievers like paracetamol, muscle relaxants, and non-steroidal anti-inflammatory drugs (NSAIDs).
Physical therapy, including ultrasound, shock wave therapy, acupuncture, or shoulder manipulation, depending on the physician’s discretion.

Surgical treatment methods

Doctors recommend surgery when non-surgical approaches fail to improve conditions or when surgical indications exist. Current surgical procedures are divided into arthroscopic and open surgery. Choosing a method depends on the condition and disease severity.

Arthroscopic surgery

Adhesive capsulitis: Perform arthroscopic surgery to release adhesions, combined with shoulder manipulation
Rotator cuff tear: Perform arthroscopic surgery to repair shoulder tendons
Bone spur impingement: Perform arthroscopic surgery to remove bone spurs
Calcific tendinitis: Perform arthroscopic surgery to remove calcium deposits
Recurrent shoulder dislocation: Perform arthroscopic surgery to repair shoulder labrum

Open surgery

Shoulder osteoarthritis: Perform open surgery for artificial shoulder joint replacement
Chronic shoulder tendon tears that cannot be repaired: Perform open reverse shoulder replacement surgery
Joint dislocation with fractures: Perform open surgery to adjust joints and repair bones

It’s evident that if shoulder tendon tears are left untreated for too long, they will worsen the condition and shorten tendon length. Especially accident-related shoulder tendon tears, leaving the injuries untreated affects treatment methods. This may make arthroscopic repair surgery impossible, requiring open surgery with reverse shoulder replacement technique instead. Therefore, if patients feel uncertain about treatment, they should consult medical specialists for appropriate and timely care.

The perks of treating shoulder pain at kdms Hospital

Treating shoulder pain at kdms Hospital in Bangkok, Thailand, patients will receive diagnosis and treatment from specialized medical experts to accurately identify the cause of shoulder pain. Moreover, we offer a fast screening procedure of magnetic resonance imaging (MRI), short waiting time for surgery, arthroscopic surgery with less pain and faster recovery, and customized physical therapy programs for smooth treatment results.

In summary

Shoulder pain can arise from various causes, whether accident-related or spontaneous. Using your shoulder excessively while neglecting proper shoulder care may develop into chronic shoulder pain.

If experiencing shoulder pain, patients should consult medical specialists for diagnosing the condition, identifying shoulder pain causes, and seeking appropriate treatment approaches to restore effective shoulder function.

Q & A

Shoulder pain at night time may result from various causes such as sleeping on the affected side, lack of shoulder movement, and improper positioning of arms, shoulders, and neck. Sometimes, minor sports injuries can trigger inflammatory processes during nighttime.

Everyone should do proper shoulder warm-ups and cool-downs before and after exercises, including stretching shoulder muscles, rotating shoulder joints in all directions, and massaging shoulders gently to improve blood circulation. Additionally, sports with extensive shoulder use like badminton, volleyball, basketball should apply shoulder muscle rest periods to let the tendons recover and practice muscle strengthening exercises specifically for each sport type.

If you experience chronic shoulder pain lasting over 3-6 months, consult medical specialists. Chronic shoulder pain can arise from multiple causes, and delayed diagnosis and treatment may reduce treatment effectiveness or make the condition more difficult and complex to treat.

This depends on the condition of the tendons before surgery. With good tendon condition and appropriate surgery, patients can return to playing sports normally within 6-9 months.

An article by Pongtep Na Nakorn, M.D., Experienced Sports Medicine and Shoulder Surgeon