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What Causes Shoulder Pain Without Injury?

Shoulder pain is very common, affecting around 1 in 3 adults at some point in their lives. While injuries like rotator cuff tears or dislocations often cause shoulder pain, there are many other potential causes of shoulder discomfort even when no acute injury has occurred. Understanding the various reasons you may be experiencing shoulder pain can help guide effective treatment.

Muscle Strains

Using your shoulders heavily and repeatedly can lead to muscle strains or small tears. Lifting heavy objects, doing overhead activities, throwing, or swinging a racquet or club vigorously are examples of shoulder motions that can overwork the muscles and cause microtears or strains. While a major acute injury may cause sudden severe pain, repetitive smaller strains cause more gradual onset of aches and loss of strength.

The rotator cuff muscles which stabilize the shoulder joint are particularly prone to strains. The supraspinatus muscle at the top of the shoulder and infraspinatus on the back of the shoulder often get strained, causing localized pain in those areas. Strengthening exercises for the rotator cuff along with resting the shoulder can help strains heal.

Tendinitis

Inflammation of the tendons around the shoulder is another common source of pain. Tendinitis occurs when the tendons become irritated and inflamed, often due to overuse or repetitive motions.

Rotator cuff tendinitis causes pain when moving the shoulder, particularly with overhead reaching or lifting. Rest, ice, anti-inflammatory medications, and physical therapy exercises usually help resolve tendinitis.

Biceps tendinitis results from inflammation where the long head of the biceps muscle attaches at the shoulder. Pain occurs in the front of the shoulder and often radiates down the bicep muscle. Resting the arm and avoiding provoking activities aids healing.

Bursitis

There are several bursae or fluid-filled sacs around the shoulder joint which can become inflamed and irritated, leading to a condition called bursitis. Symptoms include localized shoulder pain, tenderness, and limited motion.

Subacromial bursitis affects the bursa between the acromion bone and rotator cuff. It causes pain with overhead motions. Subdeltoid bursitis involves the bursa under the deltoid muscle near the outer shoulder, causing lateral shoulder pain. These types of bursitis often result from overuse, repetitive shoulder motions, or acute injury. Applying ice, taking anti-inflammatory medications, and avoiding aggravating activities helps treat bursitis. If it persists, a doctor may inject corticosteroid medication into the bursa to reduce inflammation.

Arthritis

Degenerative joint conditions like osteoarthritis or inflammatory types of arthritis such as rheumatoid arthritis commonly affect the shoulder joint. Arthritis leads to deterioration of the joint cartilage and bones, causing shoulder pain, stiffness, and decreased range of motion. It may cause a grating or cracking sensation with shoulder movements. Medications, exercise, physical therapy, and sometimes surgery are used to manage arthritis shoulder pain.

Frozen Shoulder

Also called adhesive capsulitis, frozen shoulder occurs when the ligaments around the shoulder joint become inflamed, thickened, and scarred. This causes severe stiffness and restricted shoulder motion, with significant pain at the limits of movement. The exact cause is unclear but may involve inflammation, scar tissue formation, or atrophy of shoulder muscles from disuse. Diabetes is a risk factor. Gentle stretching exercises lead to gradual improvement over months, though sometimes cortisone injections or physical therapy modalities are warranted.

Referred Pain

Nerves from tissues near the shoulder like the neck or chest wall can cause pain to be felt in the shoulder region. Disc herniations in the cervical spine often cause neck pain to radiate into the shoulder and arm. Angina or heart attacks could also be felt as shoulder pain. Referred shoulder pain needs appropriate diagnosis and treatment of the originating source, which may require imaging tests like MRI.

Impingement Syndrome

Impingement syndrome is a common cause of shoulder pain from the soft tissues in the rotator cuff or bursa getting compressed or “impinged” against the bones of the shoulder joint with overhead motions. This causes inflammation, tendinitis, and shoulder weakness. Rest, modifying activities, physical therapy, and sometimes surgery are used to treat impingement syndrome.

Calcific Tendinitis

Calcium deposits can build up in shoulder tendons, especially the supraspinatus tendon. The calcium nodules can become painful if they enlarge and press on nearby tissues. Pain is worse with shoulder movements. The calcium deposits may eventually dissolve and absorb on their own over time. Treatments like steroid injections aim to reduce inflammation and discomfort until that occurs. Surgery can remove significant calcium buildups that cause ongoing symptoms.

Pinched Nerve

A pinched nerve in the neck, such as from a herniated cervical disc, can cause radiating shoulder pain, numbness, or weakness in the arm and hand. Herniated discs or bone spurs compressing the spinal nerves need to be treated to resolve the symptoms, sometimes requiring surgery. Physical therapy, medications, or bracing may help manage symptoms.

Shoulder pain without an acute injury can result from many conditions that irritate the muscles, tendons, or joints. Proper diagnosis is key to direct appropriate treatment. Rest, ice, anti-inflammatory medications, and avoiding aggravating activities can help reduce symptoms in many cases. Your doctor may recommend imaging tests or referral to physical therapy or specialists like orthopedics or rheumatology to manage chronic shoulder problems. Don’t hesitate to seek medical advice if shoulder pain persists for more than a few days or interferes with daily activities.