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Red Flag Shoulder Pain: When to See a Doctor?

Shoulder pain is very common, with about 1 in 3 people experiencing it at some point in their lives. While minor shoulder aches often resolve on their own, certain “red flag” symptoms indicate a more serious problem requiring medical attention. Knowing when to see a doctor for shoulder pain can help prevent complications and speed up recovery.

Sharp, Sudden Onset of Pain

Most shoulder pain develops gradually, but a sudden, acute onset of severe pain is a warning sign. Causes of acute shoulder pain that may require prompt medical care include:

  • Rotator cuff tear – The tendons supporting the shoulder can tear from injury or degeneration, causing sudden pain.
  • Dislocated shoulder – Forceful motions can knock the upper arm bone out of the shoulder socket, resulting in immediate, debilitating pain.
  • Broken bone – A fractured clavicle, humerus, or scapula from trauma will have rapid onset of serious shoulder pain.
  • Frozen shoulder -Inflammation that causes the shoulder capsule to become stiff can come on quickly, restricting movement.

Seeking quick treatment for acute shoulder pain can facilitate proper healing of muscle, tendon, and bone injuries before they worsen.

Pain At Night

Shoulder pain that disrupts sleep or keeps you from lying comfortably on your side is considered a red flag. Potential causes include:

  • Arthritis – Erosion of shoulder joint cartilage causes pain, especially when lying on the affected shoulder.
  • Bursitis – Inflammation of the bursae fluid sacs between bones and tendons becomes more noticeable and painful at night.
  • Rotator cuff tear – Attempt to sleep on the torn tendon causes sharp pain that jolts you awake.
  • Dislocation – The shoulder joint can partially or fully dislocate during sleep.

Nighttime shoulder pain interferes with rest, delays healing, and indicates a more serious problem. Prompt medical care can identify the cause and help you sleep better.

Pain With Overhead Motions

Typically, shoulder pain is most noticeable when moving the arm overhead. However, inability to lift the arm over the head without sharp pain is a red flag warranting medical assessment. Potential reasons include:

  • Impingement – Compression of the rotator cuff tendons causes pain when lifting the arm.
  • Adhesive capsulitis – Inflammation stiffens the shoulder capsule, restricting overhead motion.
  • Labral tear – Cartilage tears within the shoulder socket lead to pain on overhead motions.
  • Calcific tendinitis – Calcium deposits in the rotator cuff tendons cause intense pain if inflamed.

Treating the underlying cause of overhead shoulder pain, whether it’s impingement, tendinitis, or soft tissue tears, facilitates proper healing and function.

Trauma and Injury

Any forceful blow directly to the shoulder or falling onto an outstretched arm can lead to acute pain and injury. Seek medical care promptly after shoulder trauma such as:

  • Sports impacts – Direct hits in football, hockey, rugby and other contact sports cause severe shoulder pain.
  • Falling – Bracing your fall with an outstretched hand can dislocate, fracture, or tear rotator cuff tendons.
  • Motor vehicle accidents – Forcing the arm against the body in a crash can tear tissues and dislocate joints.
  • Assaults or fights – Punches, kicks or other blows to the shoulder require evaluation.

Traumatic shoulder injuries like fractures, dislocations, and complete rotator cuff tears often require surgical repair and physical therapy. Prompt treatment improves outcomes.

Significant Swelling

The shoulder joint and surrounding muscles can swell following injury or overuse. However, noticeable visible swelling without trauma is considered abnormal. Some examples of conditions causing pronounced shoulder swelling include:

  • Bursitis – The bursae sacs become severely inflamed and fill with fluid.
  • Tendinitis – Swelling of an inflamed tendon, such as the biceps tendon.
  • Arthritis – Damaged shoulder cartilage releases inflammatory chemicals that cause swelling.
  • Infection – Swelling, redness, and warmth signal a possible bone or joint infection requiring antibiotics.
  • Blood clot – A deep vein thrombosis in the arm veins causes obvious swelling.

Identifying the reason for shoulder swelling helps determine proper treatment, which may range from rest and ice to medications or surgery.

Weakness or Instability

Sudden loss of shoulder strength or the feeling your shoulder might “give out” needs prompt evaluation to determine the cause. Potential reasons can include:

  • Rotator cuff tear – Damaged shoulder tendons lead to weakness and instability.
  • Dislocation – The shoulder joint is vulnerable to recurrent dislocations after an initial injury.
  • Nerve injury – Compressed nerves running to the shoulder and arm cause weakness.
  • Frozen shoulder – Stiffening of the shoulder capsule affects range of motion and stability.

Regaining shoulder strength and function depends on an accurate diagnosis and specific treatment plan. Surgery, physical therapy and pain management are often needed.

Referral Pain

Sometimes shoulder pain is actually radiating from another part of the body. Serious health conditions like heart disease, lung problems, and pancreatitis can all cause shoulder and arm pain. Reasons to see a doctor include:

  • Pain down the arm – Nerves pinched in the neck often cause pain to radiate down the shoulder and arm.
  • Shortness of breath – Lung-related shoulder pain may signal pneumonia or other problems.
  • Abdominal symptoms – Inflammation of the pancreas or gallbladder irritates nerves causing shoulder pain.

Let your doctor know if shoulder pain accompanies other unusual symptoms. They can help determine if your pain is referred from another medical issue needing care.

The Takeaway

It’s important to recognize red flag symptoms of more serious shoulder problems requiring medical attention. See your doctor promptly for shoulder pain at night, after injuries, with weakness/instability, swelling, or neurological symptoms. Getting an accurate diagnosis leads to proper treatment and restoration of shoulder function. Don’t ignore red flags – seek care when shoulder pain is severe or persists. With the right care, you can get back to pain-free movement.