Causes Of Shoulder Pain 

The shoulder is not ‘a joint’ rather it is a complex series of joints that work in unison to create the large range of movement you have between your torso and your upper arm. Our hands and arms have in many ways been a major key to our success as a species (possibly even more than our brains believe it or not) because it is the combination of a mobile arm and an opposable thumb that has enabled us to manipulate our environment to the extent that we have. 

Having great range of movement in the shoulder, and having such a complex, symphonic series of joints and muscles makes for an area that is susceptible to pain and injury. The more complex the movement is in a body part, the more opportunities there are for something to go wrong. Despite all this shoulders actually do suffer very few issues relative to the complexity of their design… when our posture is good that is. When our posture is not so good shoulders tend to suffer. 

Shoulder Pain Caused By Poor Posture 

Using dental pain as an example, there are many tooth decay related issues that can occur within any of your teeth and at any level of severity, yet they ALL relate to the consumption of sugar. Similarly when it comes to shoulder pain, there are many different issues that can occur (listed and explained below), and they virtually ALL have their root cause in your postural habits. 

When our posture is well tended to and well maintained all is well with the shoulder, all the muscles work perfectly in unison, all the tendons do their job unimpinged, the ball and socket stays well located and free of strain to its cartilage. This is what is happening in people who lead long active lives without so much as a thought of shoulder pain, they do exist!! Shoulder problems are virtually unheard of in children partly for this reason, they have great posture. 

When you have a persistent postural issue, it’s usually made up of bad habits, excessively tight muscles at the front of the body, muscle wasting behind the shoulder and unhealthy adaptation of the spines connective tissue. This situation causes chronic strain and impingement within the connective tissues of the shoulder, eventually this often means pain. The ingredients of your occupation and lifestyle will dictate where, when and how bad that pain proves to be.

Shoulder Pain Caused By Rib Issues 

If you have movement issues and/or stubborn knots inside your shoulder blade it is very likely that your upper ribs have locked up on you, where they attach to your spine. The area inside the shoulder blade is a major focus of postural strain in the human body, it is heavily predisposed to locking of the small rib joints where they meet the spine. 

Your spinal column is made up of a series of bones, these bones move and flex because of the discs and small joints that connect them. Throughout  the middle section of your back (thoracic spine) the bones also articulate with your ribs to form your rib cage. This is where your rib (costovertebral) joints come in.

The area just inside the shoulder blade is an area where large numbers of people get pain at one time or another. Pain and knots in this area often feel muscular, but are in fact being caused by a rib that has locked where it attaches to the spine. Many people with this issue feel like they want massage but find that it beings unsatisfactory levels of relief. 

Shoulder Pain Caused By Scar Tissue

It is common knowledge that scar tissue can develop after significant traumatic injuries. It is far less well known that there are forms of scar tissue that build up in response to stubborn lifestyle related strain in the body. Although you may not be familiar with the concept of this scar tissue you will definitely have seen it’s affects.

Picture the average long standing (or rather sitting) office worker with poor posture, you may have noticed that they kind of change shape over time. If we sit hunched ultimately we become hunched, and eventually we can’t sit up straight even if we try, because we have changed shape. A big part of this change is a fibrous build up of scar tissue in the spine and shoulders. And it is a major factor in many cases of stubborn shoulder pain. Once scar tissue has established itself in the shoulder and spine, it can make it very hard for the shoulder tissues to perform their roles without excessive pressure and irritation. 

Desk work is a particularly excellent way to develop scar tissue in the shoulder and spine. Many other of life’s tasks and activities can however contribute to the build up of scar tissue also.

Shoulder Pain Caused By Muscle 

Your shoulder is the most highly mobile joint in your body, it’s range of motion is far greater than any other joint in the body. Having a large range of motion is very useful but it makes for a far less stable joint, the more a joint moves the more opportunities there are for something to go wrong. 

The secret to all this movement combined with the relative infrequency of shoulder injuries is stabilising muscles. The action of the rotator cuff combined with additional support from the muscles of the back and chest is what enables a large range of movements without frequent injury

Having a joint that is heavily dependent on muscles for support means that there is high volume of muscle tissue, and that muscle tissue is always working hard. This is a recipe for muscle pain, and sure enough a very significant number of shoulder pain cases are in fact muscle pain. It is worth remembering that all rotator cuff issues come under this heading, because the rotator cuff is made up of muscles. 

Most shoulders with persistent pain are full of ‘pressure points’ or ‘myofascial trigger points’ (the sore spots you feel in muscles) and muscle groups in spasm. In many of these cases releasing these points is key to achieving pain relief and restoring movement. While using exercises to bring the muscles back to full health is the key to successful longer term outcomes. 

Shoulder Pain caused By Bursitis – Bursa Impingement

Bursae are small, fluid-filled sacs that are placed throughout the body in places where there is a great deal of friction. They act as lubricated pads between bones and soft tissues, and help reduce friction during movement between the shifting muscle tendon and bone.

Bursitis is a condition where the bursa becomes inflamed due to excessive pressures being placed upon it. Bursitis can lead to shoulder pain, and limitation of pain free movement in the  shoulder.

The conventional explanation for bursitis, that you will find all over the internet, is that straight forward ‘overuse’ is what causes shoulder bursitis. The reality is though that there is always a million other humans overusing their shoulders, and not getting bursitis. This is the case, because the true cause of bursitis is postural imbalances and poor movement habits, that put excessive compression on your shoulder. 

The other commonly observed myth about bursitis is that if you have an enlarged bursa on you ultrasound scan that must be the cause of your pain. The far more complex and nuanced truth is that many people with enlarged bursae in their shoulder do not have bursa pain, the bursa is enlarged but it’s soft tissue pain that they are experiencing. The fact is hinted at by the extremely hit & miss nature of cortisone injection into the bursa. 

Shoulder Pain Caused By Tendinosis 

If you have shoulder pain that prevents you from lifting your arm easily without pain, but you do still basically have reasonable use of the shoulder, a highly likely cause of this is tendinosis. 

A tendon is a flexible cord that enables muscle to attach to bone. In reality your tendons are not separate structures to your muscles, we just talk about them like that, they are in a sense the ends of the muscle itself. It would be hard to put into words how strong and durable your shoulder tendons are, but like all tissues they do have their limits. It is in pushing the limits of what the shoulder tendons can handle that creates tendinosis.

The most common tendons to be affected by tendinosis in the shoulder are the four rotator cuff tendons and the biceps tendons. The rotator cuff is made up of several small muscles and their tendons, that cover the head of your humerus (arm bone) and hold it in the shoulder socket. Your rotator cuff helps provide safe, fluid shoulder motion and stability. The bicep tendon assists with bending the elbow by anchoring the bicep muscle to the front of your shoulder. 

In a nutshell there is a better than 95% type of probability that your shoulder tendinosis is largely caused by long standing postural change in your body. The other perhaps 5% of cases happen purely due to extreme overuse, like tennis serves or painting ceilings.

When your posture becomes slightly ‘round shouldered’, it reduces the already small space (between the bones) that your rotator cuff tendons have to work within. In other words poor posture causes pinching of the tendons. When combined with many hours spent each day with bent elbows poor posture can also cause shortening and irritation of the biceps tendon. Postural alterations in combination with the normal activities of life are what lead to the majority of tendon tears in the shoulder. 

Shoulder Pain Caused By Tendon Tears

Tendons are flexible cords that attach muscle to bone and enable movement. Your tendons are not really separate structures to your muscles, we just talk about them like that. Tendons are in a sense the ends of the muscle itself. Shoulder tendons are extremely strong and durable, but like all tissues they do have their limits. It is in pushing the limits of what the shoulder tendons can handle that creates tears.

Tendon tears vary greatly in severity, partial tears thankfully are far more common than complete tears. Partial tears involve a discrete portion of the tendon while in most complete tears, the tendon is pulled away from its attachment to the bone. Rotator cuff and biceps tendon injuries are by far the most common tendons to rupture. .

Tendon tears in the rotator cuff can result from acute injury where the movement or force is so extreme that a completely healthy tendon partially ruptures. Far more commonly tendon tears are caused by underlying degenerative changes in the tendon and weakened it over a long period of time. 

The happy news about tendon tears is that they don’t always require surgery and they don’t always amount to a ‘pain sentence’. It is quite normal for many tears to be able to stabilise the shoulder with exercises and live completely pain free. In other cases, modern shoulder surgery techniques are minimally invasive and often extremely effective. 

Shoulder Pain Caused By Labrum Tears

Your labrum is a connective tissue ring that helps fix your shoulders ball and socket joint (glenohumeral joint) in place. The margins of the labrum are attached to the bone with tiny ligaments that run the circumference of the labrum .

If you have chronic postural issues in combination with an active lifestyle, or if you have some significant cartilage degeneration in your shoulder, you may at some point experience a labrum tear. Labrum tears are detachments of the margins of the labrum. Sometimes these happen in the context of extreme physical activity like a classic injury, other times they happen more quietly without you realising. 

Labrum tears are hard to treat and diagnose. If your shoulder pain is resistant to treatments that usually work for others and feels ‘catchy’ and unpredictably painful with movement you may have a tear in your labrum.

Shoulder Pain Caused By Joint Instability

Shoulder instability occurs when the support structures of the shoulder joint fail. The primary fail is usually within the muscles that stabilise the shoulder. The majority of us have some degree of weakness and muscle wasting in behind the shoulder that has been imposed on us by our modern lifestyles. If these muscles become sufficiently weakened the shoulder joint can become unstable, because these muscles hold the ball and socket in place. 

The most dramatically obvious way that shoulder instability presents itself is in sudden shoulder dislocations, and in partial dislocations (subluxations). These events are what happens when the ball and socket literally separate from one another. These are majorly and seriously acute painful events. Shoulder dislocations often happen with dynamic overhead movements of the arm.

There is a far more slow burning and insidious legacy that can arise from chronic shoulder disability. That is the development of osteoarthritis and advanced muscle wasting. Repeat dislocations and chronic mild day to day instability can cause the joint cartilage to break down and the already weakened muscles to waste further over time. 

The primary answer to shoulder instability is a long term commitment to restoring health to the muscles of the shoulder. The secondary answer to cases of shoulder instability is sometimes surgical repair of the connective tissues in the shoulder, if they are ‘too far gone’. 

Shoulder Pain Caused By Frozen Shoulder 

Frozen shoulder is a somewhat mysterious condition where the fibrous capsule that holds the shoulder joint in place spontaneous thickens. This thickening of the capsule dramatically reduces the movement of the shoulder and can also cause a certain amount of pain.

The first and most obvious difference between frozen shoulder and most other shoulder issues is that it involves less pain but a lot more stiffness. Many sufferers of frozen shoulders can barely move their shoulder joint above waist height and yet they often don’t have much pain. 

Most cases of frozen shoulder resolve within 6-12 months while some do go on a lot longer. While frozen shoulder is notoriously hard to treat you should make every effort to find physical therapies that ease it. 

Shoulder Pain Caused By Arthritis

Shoulder pain may in some instances be caused by arthritic conditions. There are many varieties of arthritis with contrasting underlying causes. The most common form of arthritis to affect the shoulder is osteoarthritis. Osteoarthritis is the common ‘wear & tear’ form of arthritis. There are other less common instances where inflammatory/auto-immune forms of arthritis can affect the shoulder joint also.  

Osteoarthritis is a complex condition and is most definitely not ‘just old age’. Genetics, lifestyle, general fitness, posture and diet all have a part to play in shoulder osteoarthritis. 

Inflammatory forms of arthritis are also complex conditions that simultaneously call for high quality medical interventions, and a serious approach to addressing underlying lifestyle, dietary and sometimes even emotional issues. 

From our perspective, if you have been diagnosed with shoulder arthritis you should view it as an opportunity to heal yourself, and do so with a good dose of optimism because there are many, many effective ways of positively impacting chronic pain of all kinds. 

Shoulder Pain Caused By Fractures 

Fracture is the technical term we reserve for broken bones. Fractures within the shoulder complex commonly involve the clavicle (collarbone), the scapula (shoulder blade) and  humerus (upper arm bone). It takes a huge amount of force to fracture any of these bones if they are healthy, they are very strong. Sports like rugby offer many rich and diverse opportunities to fracture these bones. The elderly sometimes fracture their shoulder bones in far more simple trips and falls due to their bones having lost some structural density.

If you have the slightest suspicion of a fracture in your shoulder you will obviously need to seek some medical assistance as a matter of urgency. The secret to good long term outcomes after shoulder fractures is a very serious approach to rehab and strengthening. Most people suffer with bad muscle wasting in the shoulder after a fracture, you don’t want to carry that weakness with you long term. 

Shoulder Pain Caused By Infections & Serious Health Issues

Bone and joint infections can cause shoulder pain in rare instances. Tumors can also manifest in the shoulder and cause shoulder pain. There are also instances where serious issues in the spinal column and organs can create referred shoulder pain. While all these shoulder pain causes are relatively rare, they do serve as a reminder that pain is not meant to be ignored. If you have stubborn shoulder pain get it checked out by someone who is professionally trained to diagnose these issues.