What Is Shoulder Pain? What Are Its Causes and Symptoms?

Shoulder pain is physical discomfort felt in or around the shoulder joint, including the muscles that support the joint, the rotator cuff tendons, and the ligaments. In fact, shoulder pain is not just a simple ache; it often appears together with limited range of motion.

From a physical therapy perspective, the causes of shoulder pain are quite varied. Apart from simple reasons such as overloading or lying on the shoulder in a side-lying position, it can result from conditions such as tendon injuries, cervical disc herniation, shoulder dislocation, nerve entrapment, osteoarthritis (calcification), and trauma. If you have frequent or persistent shoulder pain, you should know that it may not be caused by a simple strain. Interestingly, the most common cause of shoulder pain is cervical (neck) disc herniation.

What Is Shoulder Pain?

Shoulder pain is discomfort felt in the shoulder region, the most complex joint of your body. From a physical therapy perspective, this pain is only a symptom and may have various underlying causes. The shoulder joint is the largest and most mobile joint in the body, made up of the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). This complex structure allows your arm to move in four different directions.

It is particularly noteworthy that the shoulder joint has a much wider range of motion than other joints in the body. However, this flexibility makes it highly vulnerable to injuries. The shoulder is a complex system formed by bones, joints, muscles, tendons, ligaments, and nerves. This system includes the glenohumeral, acromioclavicular, and sternoclavicular joints.

An important point to know is that more than 95% of shoulder pain originates from soft tissues. These include:

• Muscle and tendon injuries or wear
• Rotator cuff (the muscles surrounding the shoulder joint) problems
• Bursitis (inflammation of the small sacs that allow ease of movement in the shoulder)
• Tendon inflammation (tendinitis)

In addition, the source of your shoulder pain is not always the shoulder joint itself. Sometimes the pain is referred to the shoulder from another region. Cervical disc herniation is the most common example of this. Pain may be felt in the shoulder as a result of compression of the nerves going to the arm.

Shoulder pain may be acute (sudden onset) or chronic (long-term). Acute pain usually occurs after a sudden movement or trauma, whereas chronic pain is associated with degenerative changes. In some cases, psychological factors such as stress and anxiety can also aggravate shoulder pain.

The answer to the question of why the shoulder hurts when breathing is mostly related to shoulder impingement syndrome. This condition occurs with movements such as reaching and wiping windows, which involve raising the arm above head level. During these movements, the tendons in the shoulder region become pinched between the bony structures.

If you have persistent shoulder pain, failing to treat it early may lead to limited range of motion, make your daily life difficult, and reduce your quality of life. Therefore, if your shoulder pain lasts more than 2 days and does not tend to improve, it is important to consult a specialist physician.

Most Common Causes of Shoulder Pain

The pain you feel in your shoulder can have many different causes. From a physical therapy perspective, examining the most common causes of shoulder pain is important for determining the right treatment approach. Persistent shoulder pain in particular can negatively affect daily life.

Tendinitis (Tendon Inflammation)

Tendinitis is inflammation or irritation of the shoulder tendons. It usually develops as a result of overuse, repetitive movements, or the aging process. Increased stress on the tendons causes damage to the fibers. This creates pain and tenderness at the top or side of the shoulder. A feeling of strain becomes especially noticeable when lifting or rotating the arm.

Symptoms of tendinitis include shoulder pain, swelling, limited range of motion, and weakness. A sound when moving the shoulder is also a common symptom. Treatment is usually carried out with rest, anti-inflammatory medications, and physical therapy.

Shoulder Impingement Syndrome

Shoulder impingement syndrome is the most common cause of shoulder pain. This condition causes pain and limited range of motion as a result of impingement in the rotator cuff, which consists of the four muscles surrounding the shoulder joint. Pain is usually felt when the arms are raised and may radiate from the shoulder down the arm.

Impingement occurs especially when the arm is raised above shoulder level and the tendon called the supraspinatus is pinched under the bony prominence called the acromion. Constantly repeated shoulder movements, weakness of the shoulder muscles, and structural problems can lead to this condition.

Rotator Cuff Tear

A rotator cuff tear occurs when the four muscles around the shoulder and their tendons are damaged. It is seen especially in people over the age of 40 due to wear and tear. In young people, it may result from trauma (a fall, a blow, etc.).

Symptoms include pain radiating from the shoulder to the arm, difficulty lifting the arm, and weakness. Lying on the affected side increases the pain. The treatment method varies depending on the type and severity of the tear. In the case of a complete tear, surgical intervention may be required.

Frozen Shoulder Syndrome

Frozen shoulder (adhesive capsulitis) is a condition characterized by tightening, thickening, and inflammation of the shoulder joint capsule. The fluid in the shoulder joint decreases and movement becomes severely restricted. It is usually seen between the ages of 40 and 65 and is more common in women.

This condition progresses in three stages: inflammation (onset of pain, 6-9 months), freezing (pain decreases but stiffness increases, 4-12 months), and thawing (range of motion begins to improve, 6 months-2 years). It may present especially as left shoulder pain. Night pain is prominent and may disrupt sleep patterns.

Shoulder Bursitis

Shoulder bursitis is inflammation of the fluid-filled sacs (bursae) located around the shoulder joint. These sacs normally reduce friction, but they can become inflamed due to strain or repetitive movements.

Its symptoms include shoulder pain, limited range of motion, swelling, and tenderness. The pain becomes more noticeable when the arm is raised overhead or when lying on the shoulder. It may occur for various reasons, such as frequent repetitive shoulder movements, trauma, or infection.

Shoulder Dislocation and Trauma

Because the shoulder joint is the most mobile joint in the body, it is the joint most prone to dislocation. Out of every 100,000 people, 12 present to hospitals with a shoulder dislocation, and its incidence in the population is between 2% and 8%.

The most common dislocation occurs when the arm and shoulder are forced outward and sideways in an open position. Its symptoms are severe pain, inability to use the arm, and deformity in the shoulder region. In particular, if the first dislocation occurred at the age of 18-20, the probability of recurrence is 80%.

Differences Between Left and Right Shoulder Pain

The side of your shoulder pain can give you important clues about the source of the problem. The causes of pain on the right and left sides of the body are usually different, and these differences may change your treatment approach.

Why Does the Left Shoulder Hurt?

Left shoulder pain is usually caused by muscle strains, tendon tears, or problems with internal organs. Rotator cuff tendinopathy and subacromial impingement syndrome occur especially as a result of overhead movements or overuse. Nerve entrapment in the left shoulder is also common and is associated with brachial plexus problems, thoracic outlet syndrome, or cervical disc herniation.

In addition, inflammation and nerve entrapment in the left shoulder can cause sharp pain and numbness. Left shoulder pain is more common in women, and the risk increases with age.

Why Does the Right Shoulder Hurt?

Although right shoulder pain has mechanical causes similar to those on the left side, there are some important differences. Right rotator cuff tears usually occur as a result of trauma (a fall or accident) or intense sports activities. Conditions such as gallstones, liver diseases, or appendicitis can present as pain referred to the right shoulder.

Common problems in the right shoulder include subacromial impingement syndrome, bursitis, and acromioclavicular joint arthritis. These problems are seen more often in occupations that involve working above your head, such as painters or construction workers.

Relationship Between Heart Attack and the Left Shoulder

Left shoulder pain can sometimes be a sign of life-threatening conditions. During a heart attack, chest pain can radiate to the left arm, shoulder, neck, or jaw. This referred pain results from reduced blood flow to the heart and requires emergency medical intervention.

If your left shoulder pain is accompanied by a feeling of tightness in the chest, shortness of breath, sweating, or nausea, you should go to the emergency department immediately. Shoulder pain of cardiac origin is usually not related to movement and does not go away with rest.

The Effect of Sleeping Position

Your sleeping position can significantly affect your shoulder pain. In one study, it was determined that different sleeping positions create a predisposition to different shoulder pathologies. For example:

• People who sleep in the "soldier" position (on the back) experience biceps tenosynovitis at a higher rate
• In people who sleep in the "fetal" position (on the side), pain with movement, subacromial impingement syndrome, and partial supraspinatus tendon rupture increase markedly
• Supraspinatus tendinitis is seen at a higher rate in people who sleep in the "log" position (face down)

As a general rule, you should avoid lying on your painful shoulder. When lying on your side, you can place a pillow under your knees, and when lying on your back, you can reduce pressure by placing a thin pillow under your shoulder. Adopting an appropriate sleeping position can help reduce your pain and improve your sleep quality.

Symptoms That Accompany Shoulder Pain

Shoulder pain does not usually appear alone; it often presents together with other symptoms. These symptoms can give important clues about the cause and seriousness of the pain. Physical therapy specialists can create more effective treatment plans by evaluating these symptoms.

Pain That Worsens at Night

Shoulder pain that gets worse at night may be a sign of problems such as rotator cuff injuries, bursitis, or inflammation in the shoulder joint. The pain usually intensifies when lying on the shoulder and reduces your sleep quality. Frozen shoulder syndrome is also a condition that causes pain that increases especially at night.

There are several reasons for increased night pain. Accumulation of stress on the shoulder throughout the day, changes in sleeping positions, or unsuitable mattress surfaces can trigger pain. In addition, changes in the amount of fluid accumulated in the shoulder may also contribute to increased night pain.

If you have shoulder pain that increases only at night and does not go away, this may rarely be caused by soft tissue or bone tumors around the shoulder. In this case, you must consult a doctor.

Limited Range of Motion

It is quite common to experience limited range of motion together with shoulder pain. You may have difficulty lifting your arm up, pushing it backward, or extending it sideways. In some patients, loss of strength may be seen when carrying loads with the arm or during overhead movements.

Limited range of motion begins with inflammation in the shoulder joint. In the early stage, severe pain is felt when the arm is raised. In later stages, the pain may decrease, but the limitation of motion increases. This may make it difficult for you to perform your daily tasks.

Numbness in the Arm and Shoulder

A sensation of numbness and tingling spreading down the arm together with shoulder pain may be a sign of nerve entrapment. Cervical disc herniation, brachial plexus problems, or spinal problems can lead to this condition.

Numbness in the left arm, especially when seen together with symptoms such as chest pain, shortness of breath, and sweating, may be a sign of a heart attack, so you should seek medical help urgently. Numbness in the right arm is usually caused by diabetes, nutritional disorders, or nerve entrapment.

Carpal tunnel syndrome is also a condition that results from compression of the median nerve, which runs to the hand and fingers, at the wrist, and it can cause arm numbness.

Shoulder Pain When Breathing

Pain felt in the shoulder when breathing is usually caused by stress or pressure on the shoulder muscles. This type of pain can be experienced especially after muscle strain, excessive exercise, or lifting heavy loads.

Poor posture or prolonged sitting positions can also create muscle tension in the shoulders and neck and lead to pain when breathing. Rarely, conditions such as lung problems or costochondritis (originating from the ribs) can also cause this symptom.

How Does Shoulder Pain Go Away and What Helps?

There are many effective methods you can apply at home to relieve your shoulder pain. The right treatment approach varies according to the cause and severity of the pain. However, the aim of all treatment methods is to reduce pain, relieve inflammation, and restore mobility.

Cold and Hot Compress Applications

A cold compress should be preferred for acute shoulder pain, and a hot compress for chronic pain. If there is a recent trauma or swelling, you can apply a cold compress for 20 minutes, 3-4 times a day. For this, wrap ice in a towel and never let it touch the skin directly. In cases of chronic muscle tension, you can apply a hot compress for 15-20 minutes twice a day. These applications reduce inflammation and support healing by increasing blood circulation.

Herbal Solutions: Turmeric, Lavender Oil

Turmeric can relieve shoulder pain with its strong anti-inflammatory properties. Mix it with coconut oil, apply it to the painful area, and wait for it to dry. This mixture is especially effective when applied before sleep. Lavender oil is also effective in relaxing muscles. You can mix 3-5 drops of lavender oil with olive oil and massage the painful area for 10 minutes, or add it to your bath water. In addition, rosemary oil also has a soothing effect on shoulder pain.

Physical Therapy and Exercises

Physical therapy is one of the cornerstones of shoulder pain treatment. It is particularly important for increasing mobility and strengthening the muscles around the joint. The pendulum exercise (leaning forward, letting your arm hang freely and making circular movements), shoulder stretching, and strengthening exercises are the most effective movements. These exercises should be done twice a day, morning and evening, with 10 repetitions each. However, remember that if exercises increase the pain, you should stop immediately and consult a specialist.

Medication Treatment and Doctor's Recommendations

Depending on the severity of the pain, non-steroidal anti-inflammatory drugs may be used. These drugs both reduce pain and relieve inflammation. However, remember that there is a risk of side effects with long-term use. In severe and persistent shoulder pain, the doctor may administer corticosteroid injections. In some cases, the use of shoulder braces, elastic bandages, or a shoulder sling is also recommended.

If you have pain after an acute trauma, you should first rest the shoulder without straining it and apply cold. For shoulder pain that does not go away, you must consult a physical therapy or orthopedics specialist. Early treatment of shoulder pain is extremely important for preventing limited range of motion that may develop in the future.

Shoulder Pain in Summary

In conclusion, although shoulder pain may seem like a simple discomfort, there are many underlying causes. From a physical therapy perspective, correctly diagnosing the source of the pain is the first and most important step of treatment. The shoulder joint is highly prone to damage because of its complex structure.

Remember that the side of your shoulder pain and the accompanying symptoms provide important clues in the diagnostic process. While left shoulder pain can sometimes be a sign of heart problems, right shoulder pain is usually based on mechanical causes. Therefore, in severe shoulder pain with sudden onset, it is vitally important to get specialist help without losing time.

Early intervention speeds up the recovery process in shoulder pain and reduces the risk of permanent damage. In long-lasting pain in particular, it is necessary to consult a physical therapy specialist. During the treatment process, cold and hot compress applications, regular exercise programs, and, when necessary, medication treatment give effective results.

However, the most effective approach in the treatment of shoulder pain is personalized physical therapy programs aimed at the cause of the pain. These programs increase range of motion, correct muscle imbalances, and improve quality of daily life.

You can reduce the risk of shoulder pain with the right sleeping position, posture habits, and exercise routines. Undoubtedly, early diagnosis and the right treatment approach are the most important elements for a pain-free, healthy shoulder.

Frequently Asked Questions

We address your questions about shoulder pain and their answers from a physical therapy perspective.

Some mild and temporary pain may improve over time with rest and simple measures. However, professional evaluation is definitely necessary for severe pain or pain lasting more than two days. In addition, if there is no improvement in symptoms despite treatment, specialist support is essential.

If your shoulder pain has continued for more than 2-3 weeks, this may be a sign of an underlying disease. Deformity of the joint may develop over time. Early treatment can prevent more serious problems.

Shoulder bone pain is usually caused by osteoarthritis (calcification), vertebral problems, or disorders in the bone structure. In young patients especially, fractures due to trauma and labrum injuries due to shoulder dislocations are seen, while in middle age and beyond, osteoarthritis more often causes pain.

Cervical disc herniations are among the most common causes of shoulder pain. Pressure on the nerve roots in the neck vertebrae may be the source of pain felt in the shoulder. In addition, postural disorders and prolonged desk work can also trigger neck and shoulder pain.

Arm pain may be seen in shoulder joint conditions such as frozen shoulder, impingement syndrome, or bursitis. This pain usually radiates to the upper arm and appears with movement. In the case of a heart attack, left shoulder and arm pain may also occur.

For shoulder pain, you should first consult the orthopedics and traumatology department. The physical therapy and rehabilitation department can also be chosen for non-surgical treatment. If your pain is of neurological origin, you should see a neurology specialist, and if a cardiac cause is suspected, a cardiology specialist.

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