Shoulder pain is a common complaint we see in our clinic. In fact, 2 out of every 10 patients in the US come in complaining of shoulder pain. Many patients immediate go to Dr. Google and tell us their diagnosis, such as bursitis, biceps pain or rotator cuff tear or an impingement…but today let’s dive in to see how and what causes the “why does my shoulder hurt when I lift my arm”.
Why Shoulder Pain Occurs When Arms Are Lifted
What most patients consider their “shoulder” is actually 2 different joints:
Acromioclavicular joint (AC Joint) – which is where the clavicle meets the shoulder bone (scapula)
Glenohumeral joint (GH joint)– which is where your arm bone (humerus) meets the shoulder bone (scapula), this is the main ball and socket joint of the shoulder.
The AC joint is held together by a network of ligaments and your GH joint is much more complex: it has a capsule that holds the bones together keeping the ball and socket together, a labrum that cushions between the ball and socket. The rotator cuff muscles envelop the humeral head (ball part of the ball and socket joint) to allow motion and stability. Then you have all the other muscles such as the pectoralis, biceps, deltoid, serratus, latissimus, rhomboids, levator scapula and more that attach to various aspects of the shoulder to allow multiple degrees of motion.
Symptoms Of Shoulder Pain When Moving The Arms
Shoulder pain when moving the arm can come in various forms and associated symptoms such as:
Intense Pain When Lifting The Arm. Pain described as multiple different sensations such as:
Limited Range Of Shoulder Motion
Excessive range of motion
Possible Conditions That May Cause The Shoulder Pain
Shoulder pain can be very non-specific, meaning that multiple structures and issues can cause identical pain in the shoulder. Most shoulder examination maneuvers are very limited in their ability to assess exactly what the problem is. With pain when lifting your shoulder, it is critical to take a detailed history, good examination, coupled with imaging to fully understand what is causing the shoulder pain. Many conditions can present with these symptoms ..let’s discuss.
Shoulder impingement occurs when the top outer edge of your shoulder blade, called the acromion, rubs against (“impinges on”) or pinches your rotator cuff beneath it, causing pain and irritation.
While pain when active movement, there should be no pain while at rest of in any other direction.
Now, if have impingement, we still need to understand the underlying mechanism such as shoulder instability of the capsular ligaments that allow the shoulder to move improperly to impinge
Location of pain typically on the outer area of the shoulder around where the deltoid muscles are.
Shoulder arthritis is common as we age and with any history of trauma or previously surgery can increase the risk for developing arthritis.
Arthritis can be in either the main glenohumeral joint or the AC joint.
Both can cause pain with raising your arm but there is typically an association with a “grinding” or crepitus (bone crutching) sensation that accompanies the pain with movement.
AC joint pain can be more on the top of the shoulder where glenohumeral joint can be more in the front or back of the shoulder
Rotator Cuff And Bursa Injuries
Rotator cuff is a collection of 4 main muscles and tendons that envelope the shoulder joint and they can get damaged causing pain with lifting the shoulder.
There are multiple terminologies that typically all mean the same thing such as tendonitis, tendinosis and bursitis – all typically describe pain and damage coming from the rotator cuff areas.
Pain from rotator cuff tendons typically located outside of the shoulder around the deltoid area but can also present with front of the shoulder pain.
Also associate with pain while laying on the shoulder and night pain.
Frozen Shoulder Syndrome
Frozen shoulder can cause pain while trying to lift your arm BUT the movement of the arm is extremely limited and unable to go through all the normal range of motion
Both active and passive (meaning with patient not using their muscle and the physician moving the shoulder) not able to get full range of motion.
SLAP Tears And Bankart Lesions
Labral injuries all can present similar to other injuries such as rotator cuff tears and biceps injuries
Location of pain can also vary from back, front and top of the shoulder
Can be an association with crepitus, popping or clicking of the shoulder
Biceps Tendon Rupture
Biceps tendon runs in the front of the shoulder and can also create pain with lifting shoulder.
It also attaches to the labrum as well
Important to understand as well, there is extensive amount of research also showing many of these pathologies exist in perfectly normal shoulders with ZERO shoulder pain! This is why it is critical to have extensive history information and a physical examination along with imaging findings to understand what the source of the pain is!
AC Joint Impingement
AC joint Impingement is a painful condition that occurs when the space beneath the acromion bone is narrowed. This narrowing can result in irritation of the rotator cuff tendons and bursa. A bursa is a fluid-filled sac that reduces the friction on tendons and muscles as they cross bony surfaces. A tendon is thick collagen tissue that connects muscles to bones. The rotator cuff tendons provide important support and enable movement in the shoulder. If severe, impingement can cause tears in the rotator cuff tendons. Patients with AC joint impingement typically have pain with elevation of the arm and or while lying on the shoulder.
The shoulder is a truly remarkable joint. It allows you to reach out into virtually all directions: overhead, forward, and backwards. Unfortunately, like other joints in the body the shoulder is susceptible to irritation and injury.
Osteoarthritis is the most common cause of disability in the United States, affecting up to 32.8% of patients over sixty years of age (1). Shoulder arthritis is a common condition estimated to be as high as 16-20% in the middle aged and elderly population (2). Shoulder arthritis can compromise range of motion, strength and be a source of debilitating pain. This blog will review the shoulder.
Frozen shoulder, also known as adhesive capsulitis, is a painful loss of shoulder movement and range in motion. The incidence of frozen shoulder is 3-5% in the general population and up to 20% in those with diabetes. The peak incidence is between 40-60 years of age. The exact mechanism is poorly understood. In general, the capsule becomes inflamed, thickened, and contracted with pain and significant restriction in range of motion. causes are poorly understood but risk factors include trauma, prolonged immobility, systematic diseases such as diabetes, stroke, connective tissue disease, and heart disease. Other causes include post-surgery, chronic inflammation causing stimulation of myofibroblasts
Are you plagued by shoulder pain that has now transitioned from intermittent to constant and keeps you up at night? Are daily shoulder movements, such as dressing and reaching for objects in the kitchen cabinets, painful? Is your range of motion decreasing as your pain is increasing? You may have a full- or partial-thickness rotator cuff tear. Has conservative therapy in the form of heat, ice, stretching, rest, and acupuncture failed to provide significant relief? Has an MRI demonstrated a full-thickness or partial-thickness tear of the rotator cuff? What to do? If left untreated, full-thickness and 26% of partial-thickness tears will progress.
Pain is the most common symptom. It typically occurs with the elevation of the arm, forced movement overhead, and when lying on the shoulder. Impingement can also cause shoulder pain when reaching across the body. Narrowing of the subacromial space is the most common cause of shoulder impingement syndrome (6). The subacromial space is the area between the top of the arm bone (humerus) and the AC joint. This narrowing compresses or pinches the rotator cuff tendons and bursa. If left untreated the rotator cuff tendons can become inflamed, damaged, and or torn.Bursa and tendons can not be seen on x-ray. An x-ray may demonstrate…
The labrum is a cartilaginous cup that circles the shallow shoulder socket (the glenoid) to make the socket deeper. The labrum supports and stabilizes the shoulder joint. Causes of Shoulder Labral Tears
Injury to the labrum typically occurs from repetitive trauma in overhead throwers, such as in baseball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground or getting your arm jerked. Symptoms of Shoulder Labral Tears. Typical symptoms include pain in the front of the shoulder or deep inside the joint. Treatment options initially include physical therapy which is designed to restore range of motion and strength to the shoulder.
History is a key part of finding out what is causing your shoulder pain when lifting your arm!
Questions Your Physician May Ask You
When did your shoulder start hurting?
What are your symptoms? Describe the problem in full detail.
Onset of pain – was it associated with any trauma
If yes, then describe how it was injured – mechanism of injuries can give details on what was injured.
Location of the pain
Duration of the pain
Does it hurt at night or wake you up from sleep?
Has the pain been getting better or worse?
What makes it worse?
What makes it better?
Do you smoke or did in the past?
Is there association with any neck pain?
Many times pain can be coming from your cervical spine with a nerve irritation in your neck causing the shoulder pain.
Your doctor will ask you to move your shoulder and test in certain positions. Here is a brief list of different tests.
AC joint compression test
Apprehension and relocation test
Drop arm Test
Empty can or Jobe test
In addition to shoulder specific tests, an extensive neurological test coupled with cervical spine examination should be completed to not miss cervical spine issues creating shoulder pain!
In office diagnostic ultrasound can be very helpful in diagnosing.
Other imaging modalities include:
Magnetic resonance imaging (MRI)
Common Treatment Options
Conservative Treatment – is always a good initial first step with shoulder pain
Rest, Ice, Compression and Elevation
More data showing that heat may be a little better than icing so that should be tried as well
Non-steroidal anti-inflammatory drugs (NSAIDs)
Short course of NSAIDs can be tried but longterm consequence can come with chronic use
Goal of NSAIDs if using is to maximize physical therapy and not to be used longer than a few weeks
Caution should be used with high dose corticosteroid injections – while can give short term benefits, longterm risk such as tendon rupture
Main treatment that has shown to be effective in treating shoulder pain
Shoulder be part of all shoulder recovery treatment plans; either as solo treatment or as combination with more interventional treatment.
This option is recommended when non-surgical treatment fails as a last resort – yes there are some indications with certain injuries where surgery likely best treatment option but always discuss alternatives because once a joint is operated on – will never be the same again.
Rotator Cuff Repair
Relieve Yourself From Shoulder Pain Immediately
While traditional medicine with corticosteroids and surgery has been the mainstay of treating cases over the last 50 years. These come with marginal success as well considerable risks associated with them. We have developed a regenerative medicine approach to address shoulder issues with platelet rich plasma and bone marrow concentrate. Continue to research better ways to treat shoulder conditions with a more holistic and natural treatment.
If you’ve been dealing with shoulder pain when you lift your arm, reach out and set up an in-depth evaluation to get an accurate diagnosis and will discuss possible ortho-biologic treatment with the goal of avoiding corticosteroids and surgery!
Doctors that Can Help Treat Shoulder Pain When Lifting Arm
Christopher J. Centeno, MD
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…