The shoulder is the most mobile joint in the body: as a ball-and-socket joint that is largely stabilized by muscles and tendons, it allows a wide range of motion. However, this also makes the shoulder susceptible to injury and wear and tear – making shoulder pain a common symptom in people of all ages.
Classify shoulder pain correctly
In addition to causes in the shoulder joint itself, however, conditions of the cervical spine and neck can also cause shoulder discomfort. We have compiled the nine most common causes of shoulder pain for you and explain which methods the doctor uses to make the diagnosis. Shoulder-neck training: 7 simple exercises against tension.
1. acute pain from overuse and injury.
After an accident or an acute overload – for example, when bench pressing – there may be sudden pain in the shoulder. This is usually due to overstretching or tearing of the joint capsule or a tendon. A dislocation of the shoulder (luxation) and a fracture of the clavicle or the humeral head, on the other hand, are usually manifested by very severe pain. Movement of the affected arm is then usually almost impossible, which is why the arm is held against the body in a protective posture. In a so-called acromioclavicular joint dislocation, the ligaments between the clavicle and the acromion tear completely or partially. In addition to severe shoulder pain, a so-called clavicle phenomenon may then occur: The outer end of the clavicle sticks up and can be pressed down like a piano key.
2. rotator cuff tear due to injury or wear and tear.
Common causes of shoulder pain are damage to the so-called rotator cuff. This refers to the tendons of four muscles that run from the shoulder blade to the humeral head and are responsible for rotational movements in the shoulder joint and for lifting the arm laterally. They also stabilize the humeral head in the glenoid cavity. Damage to rotator cuff tendons can occur either as part of an acute injury or through gradual wear and tear. Typical symptoms are pain in the shoulder as well as upper arm pain, which, depending on the tendon affected, occurs particularly during internal rotation, external rotation or when the arm is raised sideways. If there is a complete tear of one or more tendons, there may also be a lack of strength during the movements described.
3. impingement syndrome: tightness in the shoulder joint.
A wear-related damage of the rotator cuff is often based on a so-called impingement syndrome (shoulder tightness syndrome). In this case, there is too little space between the head of the humerus and the acromion, resulting in constriction of the tendons. The tendon of the supraspinatus muscle is particularly often affected, as it passes through the narrowest part of the joint. Impingement syndrome is usually manifested by shoulder pain, which occurs primarily when the arm is raised laterally between 60 and 120 degrees, since the space under the acromion is at its narrowest during this movement. If left untreated, impingement syndrome can lead to inflammation or rupture of the supraspinatus tendon as the tendon permanently rubs against the acromion. At this advanced stage of the condition, shoulder pain may also occur at rest and at night. Impingement syndrome – 8 exercises for the shoulder.
4. bursitis: shoulder pain and swelling.
Inflammation of the bursa under the acromion (bursitis subacrominalis) can be both a cause and a consequence of impingement syndrome. This is because bursitis is often caused by constant mechanical irritation – for example, during sports, constant “overhead” work, or when impingement syndrome is present. In addition, the following causes can lead to bursitis of the shoulder:
- Rheumatoid arthritis
- Gout
- Infections
- Calcium crystals in a calcific shoulder, which penetrate into the bursa
Conversely, swelling of the bursa due to inflammation can constrict the rotator cuff, leading to impingement syndrome. Symptoms of bursitis include swelling and hyperthermia of the shoulder, in addition to shoulder pain and limited mobility.
5th biceps tendon: pain due to bodybuilding.
The long tendon of the biceps muscle is not part of the rotator cuff, but it originates at the upper edge of the glenoid cavity and can cause shoulder pain in case of irritation, inflammation or tear. The cause is often incorrect or too intense training in bodybuilding. In the case of irritation or inflammation of the biceps tendon, the pain usually occurs at the front of the shoulder and can radiate into the upper arm. A complete tear of the biceps tendon is often additionally manifested by a lack of strength when flexing the arm – in some circumstances, a ”bulging” muscle belly may also be visible.
6. calcific shoulder due to wear and tear
In calcific shoulder (tendinitis calcarea), there are deposits of calcium crystals in a tendon of the rotator cuff – usually the supraspinatus tendon is affected. The cause is a wear-related lack of blood supply to the tendon. Symptoms of calcific shoulder are shoulder pain when lifting the arm and a pressure pain at the front of the humeral head. However, there are usually no signs of inflammation – such as swelling or overheating of the joint. If the crystals break into the bursa or into the joint, there may be a sudden worsening of symptoms.
7. frozen shoulder: Nocturnal pain and stiffness
”Frozen shoulder” means ”frozen shoulder” and refers to a condition in which there is adhesion of the joint capsule due to inflammation, resulting in temporary stiffening of the shoulder. The causes of ”frozen shoulder” are unexplained – however, there seems to be a connection with metabolic diseases such as diabetes mellitus. In addition, ”frozen shoulder” can occur after injury or surgery to the shoulder. The disease progresses in three phases: Initially, shoulder pain occurs, especially at night. When the pain subsides after a few weeks or months, a restriction of movement – especially when rotating and lifting the arm sideways – comes to the fore. In the third phase, the symptoms eventually subside on their own.
8. osteoarthritis of the shoulder rather rare
An arthrosis of the shoulder in the actual sense of a wear of the joint cartilage occurs rather rarely, since on the shoulder (in contrast to knee or hip) usually no large weights load. Joint wear in the shoulder therefore usually only occurs as a result of an injury – such as a fracture of the humeral head – or an infection of the joint. In addition, damage to the rotator cuff can promote the development of osteoarthritis of the shoulder.
9. left shoulder pain: Do not rule out myocardial infarction
If shoulder pain on the left side occurs suddenly and without apparent cause, a heart attack should always be considered – especially if nausea, shortness of breath, anxiety or general malaise are added. This is because in some cases a heart attack is not manifested by chest pain, but by non-specific complaints. Pain may radiate to the abdomen, back or shoulder. In this case, you should immediately visit a doctor or an emergency room.
Diagnostics: ultrasound helpful
To diagnose a shoulder condition, the doctor first takes a medical history and performs a physical examination to check joint function. In many cases, a tentative diagnosis can then already be made on the basis of the complaints described and the functional tests. To confirm the diagnosis, an ultrasound of the shoulder is often helpful. This can be used, for example, to assess the condition of the rotator cuff or to detect joint effusion as an indication of inflammation. An x-ray, on the other hand, is a good way to assess the bones in particular – for example, to detect osteoarthritis or to rule out a fracture or bone tumor.
Arthroscopy for an unclear cause
Magnetic resonance imaging (MRI) provides detailed images of the soft tissues of the joint and is therefore often used to diagnose unclear shoulder pain. If a cause still cannot be found, arthroscopy of the shoulder may be performed. Treatment – such as suturing a torn tendon – can then also be performed immediately. Sharp pain
