Shoulder Pain

Pain in the shoulder can occur at any age. Sometimes the shoulder pain is acute (e.g. during sports or after lifting a heavy load), but more and more people also suffer from chronic shoulder pain (e.g. due to joint wear).

The pain can have many different causes and can severely restrict and impair the affected person in everyday life. Behind the shoulder pain can be, for example, a so-called impingement syndrome (bottleneck syndrome), but also acute injuries, inflammation or signs of wear and tear in the shoulder joint. An example of this is shoulder contusion.

Often, pain in the shoulder can be treated by consistent and long-term physiotherapy to strengthen the muscles; surgery is only necessary in a few cases. Most shoulder pain originates in the soft tissues of the shoulder joint, which means that it is not the bones that are affected, but rather the muscles, tendons, joint capsule, synovial fluid (synovia) and bursae. Pain restricts mobility in the shoulder, and many everyday activities, such as putting on a shirt, combing hair or blow-drying, require good coordination of the shoulder and arm muscles.

Frequently, the patient has to be relieved of postures, which is why early therapy is particularly important. Depending on the cause, pain in the shoulder can occur in different places and during different movements and activities. Problems in the cervical spine can also lead to pain symptoms in the shoulder and radiate into the arm or hand.

The so-called shoulder girdle is formed by two bones on each side of the shoulder, i.e. the two clavicles (claviculae) and shoulder blades (scapulae). Together with the humerus, the shoulder blade forms the shoulder joint. In addition, the scapula forms two bony projections, the acromion and the coracoid.

The shoulder joint is mainly stabilized by four muscles and their tendons, the so-called rotator cuff. The four muscles (musculus supraspinatus, m. infraspinatus, m. teres minor and m. subscapularis) move from the scapula to the humerus, where they attach their tendons. For this reason, they lie around the head of the humerus like a cuff and form a “roof” over the shoulder joint.

The space below the acromion, the subacromial space, is often affected by wear and tear problems in the shoulder joint. A bursa facilitates the sliding process between the tendons and the bony acromion. This can lead to shoulder pain due to inflammation, for example.

The shoulder joint is primarily moved and mobilized by muscles and tendons, which results in a large range of motion. However, this increases the risk of instability and the shoulder joint is therefore easily injured. Signs of wear and tear of the shoulder are caused by chronic overloading and imbalances in the muscles.

Painful shoulder wear and tear is particularly common in activities performed above the head, such as painting, handball or tennis. This mainly affects the movement sequences in the shoulder, painful inflammation and swelling are the result. In impingement syndrome (bottleneck syndrome) there is a constriction between the acromion and the humerus.

The tendon and bursa running there are exposed to a constant state of irritation, which causes inflammation. In the shoulder, tears, adhesions and shrinkage of the joint capsule in the area of the soft tissue can occur, leading to shoulder pain. Joint degeneration (arthrosis) can be another cause of shoulder pain.

Shoulder joint arthrosis is favored by overstrain (such as years of weight training), joint space narrowing in old age, rheumatic diseases (e.g. rheumatoid arthritis) or circulatory disorders. Damage or tearing of the muscles or tendons of the rotator cuff (rotator cuff rupture) causes pain and can severely restrict the mobility of the arm. Painful inflammation of the shoulder joint (periarthritis humeroscapularis) can lead to stiffness of the shoulder (capsulitis adhaesiva) or the so-called “frozen shoulder” due to lack of movement.The so-called calcified shoulder (tendinosis calcarea) refers to a deposit of calcium crystals in the rotator tendon caused by recurring minor tendon injuries or local circulatory disorders of the tendon.

The calcareous shoulder is particularly painful at night. Accidents, fractures and injuries in the shoulder area can also lead to severe pain symptoms. A collarbone fracture (clavicula fracture) or injuries in the area of the humerus (e.g. humeral head fracture) are common.

Dislocations of the shoulder joint (shoulder joint luxations) can cause severe pain and have various causes. The shoulder often dislocates repeatedly, resulting in a chronically unstable shoulder, which should be treated surgically by arthroscopy. Other causes of shoulder pain are tendon inflammation or bursitis subacromialis.

These are mainly caused by mechanical overload, infections, rheumatic diseases and gout. Tension and hardening of the shoulder muscles due to incorrect posture and stress, for example, due to sitting for too long, strains the shoulders, back and neck and can lead to pain. In addition, shoulder pain can also come from the spine, be caused by nerve inflammation or nerve injury, by rheumatological diseases and also by internal diseases (e.g. heart attack, biliary colic, lung tumors, etc.).

Since the causes of shoulder pain vary greatly, different symptoms may also be the main cause. Shoulder pain (e.g. due to impingement syndrome or rotator cuff injury) often impairs the mobility of the arm. The pain often makes it almost impossible to lift the arm and many everyday activities are difficult to perform.

Shoulder pain occurs particularly frequently when the arm is spread sideways (abduction) and is particularly severe at an angle of about 60 to 120 degrees, which is why doctors and therapists also refer to it as the “painful arc” or “painful arc”. Nocturnal shoulder pain is also typical if you unconsciously lie down on the painful side or turn to that side during sleep. If the pain emanates from the cervical spine, there is often radiating pain from the shoulder to the arms and hands. In tendonitis, shoulder pain can be triggered by very different arm and shoulder movements, depending on which muscle tendon is affected.