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Shoulder Pain – Causes, Symptoms and Treatment

Shoulder pain is one of the most common musculoskeletal complaints, caused by injuries, inflammation, or wear and tear. It can significantly limit mobility and quality of life.

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Things worth knowing about "Shoulder Pain"

Shoulder pain is one of the most common musculoskeletal complaints, caused by injuries, inflammation, or wear and tear. It can significantly limit mobility and quality of life.

What Is Shoulder Pain?

Shoulder pain is among the most frequent complaints affecting the musculoskeletal system. The shoulder joint is the most mobile joint in the human body, which also makes it especially susceptible to overuse, injury, and degenerative changes. Pain may originate in the joint itself, in surrounding muscles, tendons, or bursae, and can radiate into the arm, neck, or upper back.

Causes

Shoulder pain can have many different underlying causes. The most common include:

Rotator cuff problems: The rotator cuff consists of four muscles and their tendons that stabilize the shoulder joint. Inflammation, tears, or overuse of these structures are among the most frequent causes of shoulder pain.
Impingement syndrome: In shoulder impingement, tendons or bursae become compressed within the shoulder space, causing pain especially when lifting the arm.
Shoulder osteoarthritis (glenohumeral arthritis): Degenerative wear of the shoulder joint leading to chronic pain and restricted movement.
Frozen shoulder (adhesive capsulitis): An inflammatory condition of the joint capsule that causes progressive stiffness and loss of mobility.
Acromioclavicular (AC) joint problems: Injuries or arthritis of the AC joint cause pain at the top of the shoulder.
Bursitis: Inflammation of the fluid-filled sacs (bursae) that cushion the joint, resulting in intense, often burning pain.
Muscle tension: Stress, poor posture, and repetitive strain frequently lead to tightness in the shoulder and neck muscles.
Calcific tendinitis: Calcium deposits within the tendons of the shoulder cause sudden, severe pain episodes.
Referred pain: Conditions affecting the cervical spine, heart, or gallbladder can also manifest as shoulder pain.

Symptoms

Symptoms vary depending on the cause but commonly include:

Pain during specific arm movements or at rest
Nighttime pain that disturbs sleep
Reduced range of motion in the shoulder joint
Weakness in the arm or shoulder muscles
Tenderness over the joint or surrounding muscles
Clicking or grinding sensations during movement
Radiation of pain into the arm, neck, or upper back

Diagnosis

To diagnose shoulder pain, doctors use a combination of approaches:

Medical history and physical examination: Questions about onset, pain characteristics, and triggering factors, as well as targeted functional tests of the shoulder joint.
Imaging techniques: X-rays reveal bony changes. Magnetic resonance imaging (MRI) provides detailed information about soft tissue structures such as tendons, muscles, and bursae. Ultrasound can also be used to assess tendons and bursae.
Laboratory tests: If inflammatory or rheumatic conditions are suspected, blood markers such as CRP and ESR may be measured.

Treatment

Conservative Treatment

For most shoulder conditions, conservative management is the first step:

Physiotherapy and exercise therapy: Targeted exercises to strengthen shoulder muscles, improve mobility, and correct postural imbalances.
Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac can relieve pain and reduce inflammation.
Injection therapy: Corticosteroid injections into the joint or bursa can effectively reduce pain in inflammatory conditions.
Cold and heat therapy: Ice packs for acute inflammation, heat applications for chronic muscle tension.
Rest: Short-term immobilization may be appropriate after acute injuries but should not be prolonged.

Surgical Treatment

If conservative measures are insufficient, surgical intervention may be required. Common procedures include:

Arthroscopic decompression for impingement syndrome
Tendon repair or reconstruction for rotator cuff tears
Shoulder joint replacement (shoulder prosthesis) for advanced osteoarthritis

When to See a Doctor

The following warning signs require prompt medical evaluation:

Sudden, severe pain following an accident or fall
Shoulder pain combined with chest pain, shortness of breath, or radiation into the left arm (possible cardiac event)
Persistent pain lasting more than two weeks without improvement
Noticeable swelling, redness, or warmth around the shoulder
Loss of strength in the arm or hand

Prevention

Many causes of shoulder pain can be prevented or delayed with targeted measures:

Regular shoulder and neck strengthening exercises to support stabilizing muscles
Ergonomic workplace setup, especially for desk-based work
Avoiding repetitive overuse and awkward postures
Taking regular movement breaks during prolonged sitting or repetitive tasks

References

German Society for Orthopaedics and Trauma Surgery (DGOU): Guidelines on Shoulder Disorders - Diagnostics and Treatment (2022).
Herold, G. et al. - Internal Medicine. Cologne: Self-published, 2023.
World Health Organization (WHO) - Musculoskeletal Health, Global Report 2021.

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