Shoulder Pain

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Pain in the shoulder region can include pain in the upper arm, the shoulder blade, the pectoral area, the armpit, and sometimes even the neck. Your shoulder joint acts like a ball and socket, allowing your arm to move forward, backward, and to both sides, as well as twisting inward and outward, allowing your arm to rotate.

The bones associated with your shoulder include:

Humerus – the upper arm bone, the top of which is the “ball” part of the joint

Shoulder blade – There are three parts of the shoulder blade:

Scapula –traditionally considered the shoulder blade itself. The upper outer part of the scapula is cup-like, forming the “socket” part of the joint, called the glenoid fossa.
Acromion – located at the upper, outer aspect of the scapula. Articulates with the clavicle.
Coracoid process – a small, hook-like structure that points forward and to the side, located in front of the acromion

Clavicle – the collar bone

Many muscles attach to the shoulder via tendons, allowing the joint to create movement of your arm. These include:

Supraspinatus, infraspinatus, teres minor, and subscapularis

Surround the joint and make up the rotator cuff
Provide movement and stabilization of the joint

Biceps brachii (the long head of the biceps muscle)

Stabilizes the humerus in the socket during arm movement
Has a long tendon that traverses through a sheath at the front of the shoulder

Pectoralis, latissimus dorsi, serratus anterior

Muscles of the shoulder girdle
Provide stabilization and movement of the shoulder

The varied movement of the shoulder requires assistance from a variety of other structures. Strong connective tissue provides stability and flexibility in the joint. Blood vessels in the region ensure there is always an adequate blood supply for movement. Nerves communicate signals that allow for your desired movement to occur. A small fluid sack called a bursa is located at the upper, outer tip of the humerus, providing cushion and protection of the joint, tendons and ligaments.

With so many complex structures working together to ensure proper function for your shoulder, there are many ways in which an injury can occur. If any of these structures wear out or sustain damage, you may experience pain.

Common Causes of Shoulder Pain

There are many potential causes of shoulder pain, both chronic and acute. A proper diagnosis is crucial to ensuring you receive the most effective treatment for your condition.

One-Time Injuries

In some instances, your shoulder pain may be caused by an injury associated with a one-time event. These include:

Fractures – a sudden blow to the shoulder may cause a break in one of the bones at the joint and damage the nerves or blood vessels in the area. Fractures most commonly occur in vehicle accidents, sports injuries, and serious falls. Possible fracture sites are:
- Humerus – most commonly due to a fall on an outstretched hand
- Clavicle – usually due to a direct blow to the shoulder or chest
Dislocations – occurs when the humerus gets knocked out of its socket. This injury also occurs with vehicle accidents and serious falls. The surrounding ligaments and muscles can be damaged with this type of injury.
- Anterior dislocation: The most common type of dislocation at the shoulder joint. The humerus (upper arm bone) is pushed forward out of the socket.
- Posterior dislocation: The humerus is pushed backward out of the shoulder socket.
- Subluxation: This is a partial dislocation where the humerus has been partially pushed out of the socket.
Sprains and strains – Stretched or torn ligaments result in a sprain, as do stretched or torn muscles. These injuries occur when you place too much pressure on your muscles and ligaments. Most common when lifting heavy objects overhead, participating in sports, or with a dislocation.

Wear-and-Tear Injuries

Repetitive motions can result in significant wear and tear to your shoulder. These injuries often occur in work environments or from athletic activities, and they can be quite painful. Common examples of repetitive motion injuries include:

Bursitis – The bursa can fill with fluid and become swollen, causing redness and sensitivity. Damage can occur from overuse or from trauma to the joint. This causes pain at the outside of the arm-shoulder junction.
Tendonitis – The tendons in your shoulder can become impinged or damaged from overuse or lifting heavy loads, causing painful inflammation.
- Rotator cuff tendonitis – the tendon of the supraspinatus muscle is compressed beneath the acromion. This is common and often seen with repetitive flexion of the shoulder.
- Rotator cuff tear – a common condition due to overuse in overhead activities, as a progression of tendonitis, or with acute trauma to the shoulder.
Cartilage damage – The most common type of cartilage damage in the shoulder involves the labrum. This cartilage in the joint acts as a cushion, allowing smooth movement between the humerus and the glenoid.
- Overuse – often due to repetitive overhead activities (often sports-related), this may be painless or can cause pain, instability, and “catching” in the shoulder.
- Osteoarthritis – a slow, progressive degenerative process where the cartilage breaks down.
- Adhesive capsulitis – AKA frozen shoulder. This typically results from chronic, long-term inflammation of the shoulder.

Nerve Injuries

Damage to nerves in the shoulder are uncommon, but can occur:

Nerve Pain – Usually caused by nerve compression, it is often associated with numbness, tingling, or burning sensations that can extend down to the arm and hand. In severe cases, you may experience weakness of the arm.
- Axillary Nerve Compression – the axillary nerve is pinched as it crosses under the humerus in the armpit area.
Thoracic Outlet Syndrome – compression of the brachial plexus (a bundle of nerves from the neck to the shoulder area) between the neck and the armpit can cause pain in the neck, shoulders, and arm on the affected side. Usually seen in people with an anatomic predisposition. These include:
- Muscle abnormality – the scalene muscles in the neck can become large (hypertrophy) and compress the nerves as they traverse the muscle.
- Bone abnormality – some people have an extra rib in the neck, called a “cervical rib”, which impinges the brachial plexus. Collarbone dislocations can cause impingement as well.
- Chronic overuse – especially with overhead activities. Also seen in athletic endeavors such as swimming and rowing.

Arthritis

Arthritis can develop from inflammation of the shoulder joint, causing pain and stiffness which gets worse over time. The most common types of arthritis impacting the shoulder include:

Rheumatoid arthritis – This occurs when your immune system attacks your joints, causing swelling and pain.
Osteoarthritis – This develops when the cartilage in your shoulder breaks down, causing the bones to rub together. Osteoarthritis results in pain and stiffness.
- Acromioclavicular Joint – occurs when the surrounding cartilage deteriorates. It can cause pain at the top point of your shoulder.
- Glenohumeral Joint – less common, this occurs at the junction of the humerus with the glenoid. It can cause pain in the back of the shoulder.

Treatment for Shoulder Pain

At the Denver Spine and Pain Institute, we recommend conservative treatments whenever possible. Depending on the specific cause of your shoulder pain, your treatment may include:

Physical therapy – The goals of physical therapy are to improve mobility, decrease pain and address any mechanical or muscular conditions that may be contributing to your shoulder pain.

Medication – Anti-inflammatory medications and muscle relaxants can help provide short-term relief of symptoms, making it easier for you to participate in physical therapy.

Injections – If the combination of physical therapy and medications don’t provide enough relief, injections may deliver more long-term relief of your symptoms. Our specialists will attempt to identify the most likely pain generator and deliver medication via injection to that area with the use of image guidance. The most common types of injections in the shoulder are:

Joint injections – local anesthetics and steroid are injected into the affected joint.
Bursa injections – local anesthetics and steroid are injected directly into the bursa.

Regenerative medicine – Regenerative medicine therapies include platelet rich plasma (PRP) and stem cell treatments.

If these conservative treatments fail to provide adequate relief, surgery may be necessary. Our team will perform all appropriate diagnostic testing prior to your surgical consultation to determine the precise cause and location of your pain. These diagnostic tests will provide your surgeon with the information necessary to plan your procedure.

Restoring a Pain-Free Life

Chronic shoulder pain can significantly impact the quality of your life, making it hard to perform routine daily tasks and participate in your favorite activities. Fortunately, you don’t have to live with this pain any longer. At the Denver Spine and Pain Institute, we offer the most advanced treatments to alleviate your shoulder pain, helping you enjoy life again.

We’re the only sports, back and pain specialists in the country providing a Connected Care Approach™ specifically designed to get you back to enjoying life faster. This approach involves:

A full spectrum of care, including physicians, physical therapy, massage, diet and lifestyle coaching, behavioral health, research, and cutting edge treatment options
Developing caring and therapeutic relationships that address your unique needs
Discussing options and providing the guidance you need from a dedicated healthcare partner
Mobilizing an experienced team who coordinates your care program

Musculoskeletal Disorders