Where is this Shoulder Pain Coming From?

When people say, “My shoulder hurts,” they often point to different areas in the vicinity of the shoulder such as the base of the neck, the collar bone, the shoulder blade, the chest, and/or their arm. The challenge with the shoulder is that it’s anatomically comprised of three joints: the glenohumeral joint, or GHJ (ball-and-socket); the acromioclavicular joint, or ACJ (collar bone and scapula); and the scapulothoracic joint, or STJ (shoulder blade and rib cage). Some researchers even argue that the sternoclavicular joint, or SCJ (collar bone and sternum), should also be considered part of the shoulder.

From a musculoskeletal standpoint, the list of conditions that can cause shoulder pain is quite lengthy (and NOT all-inclusive): avascular necrosis (the bone dies due to lack of blood flow), nerve injury (neck and/or peripheral), thoracic outlet syndrome, fractures in/around the shoulder, bursitis, shoulder dislocation, frozen shoulder, impingement, several types of arthritis, rotator cuff injury, sprains, tendinitis or tendon rupture, and labral tears (cartilage rim around the socket).

One of the most common causes of shoulder pain is impingement, which may occur with many of the above-mentioned conditions. This is technically referred to as “subacromial impingement” (SAI), which is essentially a reduction of the normal gap between the ball and socket, thus limiting the amount of room the joint has to function. Classic symptoms include pinching and pain when trying to put a coat sleeve on or raising the arm horizontally.

To complicate matters, conditions elsewhere in the body can also refer pain to the shoulder. In 2018, a study noted instances in which athletes failed to respond to routine treatment for shoulder pain but experienced improvements in pain and function when treatment addressed dysfunction in the cervical spine.  Non-musculoskeletal conditions can also result in shoulder pain, such as gallbladder disease, which classically refers pain to the right scapula/shoulder blade. Other abdominal organ conditions that can refer pain to the shoulder include pancreatitis, an ovarian cyst, an ectopic pregnancy, as well as post-surgical referred pain. A heart attack classically refers pain to the left shoulder and left arm but may also include the abdomen, jaw, and/or mid-back. A lung condition such as a blood clot (pulmonary embolism), infection (like pneumonia), or lung cancer or tumors may also refer pain to the shoulder.

The doctors at Quince Orchard Medical Center are trained to evaluate the whole patient and identify contributing factors for the patient’s chief complaint. In instances in which a non-musculoskeletal issue is suspected, the patient may be referred to the appropriate healthcare provider. However, a combination of manual therapies (manipulation/mobilization), exercise, ergonomic modifications, nutritional counseling, and physical therapy modalities can result in a satisfying outcome in most cases of shoulder pain.