Not being able to lift our arms because of shoulder pain is a prevalent problem. Some of you woke up and couldn’t move your shoulder. Some of you may have had an injury yesterday and now find it hard to lift or move your shoulder. There are many possible reasons why you cannot raise your arm or move your shoulder. We will walk through five of the most common reasons you can’t lift or move your shoulder.
Shoulder pain can be one of the more annoying and painful conditions. For many of you, you woke one morning, and your shoulder hurts. Often that pain is on the top of the shoulder, or the pain is on the side of the shoulder.
Some of you might have severe pain when trying to sleep, and others might only have shoulder pain when trying to lift the arm. These clues help us determine what is going on in your shoulder. As an example, calcific tendonitis produces severe pain due to inflammation. The pain doesn’t allow you to sleep well, and it makes it very hard to move your shoulder, but the muscles are otherwise structurally intact- typically, these patients do not have a tear.
Whether you have pain at night, pain when lifting, weakness following a fall– all these clues matter. Most of you will not recall a shoulder injury. Some may have had pain following a shot in the shoulder. Some of you might have taken a bad fall. Let’s dive into what we typically hear from patients on any given day in the office of a shoulder specialist.
Most patients do not recall an injury, fall, or a change in their workouts to a more aggressive exercise regimen. Some might have had spring or fall projects around the house that made you use the shoulder more than usual. In most instances, you are 40-70 years old, and this might be your dominant or your non-dominant arm.
Three broad categories of why you can’t lift your arm.
- The first reason why you have difficulty lifting your arm is pain. Not all shoulder pain implies that something is torn. A painful rotator cuff due to tendonitis or bursitis will make it very challenging to lift your arm because it hurts too much. There are many possible reasons why that inflammation is present, and we will go into more depth on each down below. Inflammation is also the reason why you may have severe shoulder pain why trying to sleep.
- The second reason you may have trouble moving your shoulder is that you injured or tore something. If you had a recent severe fall or injury, then you may have torn a tendon. If the tendon tears are large enough, that will cause significant weakness of the shoulder.
- The third reason is neurological. Parsonage-Turner Syndrome (brachial neuritis) is a rare cause of shoulder pain and weakness. We are not sure what causes it, but it often follows a viral illness. It starts with very severe pain but no loss of motion or weakness. Within a few weeks of onset, you will notice significant weakness around the shoulder. That weakness can be so severe that you have difficulty lifting the arm. Some patients with painful shoulder motion have an issue with their necks. Neck issues such as arthritis and pinched nerves can manifest as shoulder pain and weakness.
Losing the ability to move your shoulder is a common problem. Because of that, we are going to review the most common reasons that will cause:
- Pain on top of the shoulder
- loss of shoulder motion
- Shoulder pain and difficulty when lifting the arm
- Causes of stiffness and difficulty in moving your shoulder.
Many problems can occur in the shoulder, making it difficult or too painful to lift or move your shoulder. More often than not, this is due to an issue with the rotator cuff or the “bursa,” which sits above the rotator cuff. Most of you with severe night pain have bursitis… or inflammation of the subacromial bursa.
The rotator cuff (tendonitis, tear) and bursa (inflammation or bursitis) are the most common causes of pain and loss of motion in the adult shoulder. Rotator cuff pain is the number one reason you have pain on the outside or top of your arm. It is also the most common reason you may not be able to lift or move your arm.
Shoulder pain could also be brought on by injury. Believe it or not, traumatic injuries are a less frequent cause of shoulder pain. Rotator cuff injuries can be caused by chronic repetitive stress from working out, throwing, or overhead sports. Rotator cuff injuries can also be caused by a fall or perhaps even a long day gardening or painting your house. It is not unusual to lose the ability to move your shoulder after a long day of chores that you don’t typically perform often.
This should not be a cause for alarm. Most people who wake up and can’t move their shoulder because of pain will recover uneventfully within a few days or weeks.
The rotator cuff is a series of four muscles that are deep to or underneath your deltoid muscle. Together those four muscles control your shoulder motion and are critically necessary to the proper functioning of the shoulder.
5 Most Common Reasons You Cannot Lift Your Shoulder
Here are the most common reasons why you may not be able to move your arm. While there can be neurological reasons, like Parsonage-Turner Syndrome, most of you cannot move the arm or shoulder because of pain. The most common causes of shoulder pain and loss of motion are:
- rotator cuff tendonitis
- rotator cuff tendinosis
- rotator cuff tears
- partial rotator cuff tears
- calcific tendonitis
- adhesive capsulitis or a frozen shoulder
The cause of your shoulder pain and the reason why it hurts will vary by age. Some problems are more common in different age groups. In younger athletes, tendonitis or inflammation of the rotator cuff is more common.
Let’s run through each of these individually.
Rotator Cuff Tendinosis
In people over 30, rotator cuff tendonitis is rare, and rotator cuff tendinosis becomes a more common cause of shoulder pain that hurts when we try to lift our arm or shoulder.
Rotator cuff tendinosis, by definition, implies some degree of rotator cuff degeneration. With that degeneration comes an increase in the number of nerves and blood vessels. That is the body’s response to the deterioration, and that is why the pain occurs- the new nerves formed during this process can lead to significant pain.
Too many nerves in the area produce pain with certain motions. If the pain is severe enough, you will be unable to raise your arm or sleep on that side.
When patients have rotator cuff tendinosis, physical therapy is generally effective at managing the pain. If the pain persists despite treatment, we now have a biological patch that may alleviate the pain due to tendinosis.
Many people who cannot lift their arm due to shoulder pain from rotator cuff tendinosis will be told that they have impingement syndrome and a bone spur. This video post discusses our current thoughts on bone spurs and shoulder pain.
Other posts about rotator cuff tendinosis:
Partial Rotator Cuff Tears
As the rotator cuff continues to age or degenerate, a portion of the rotator cuff might separate from the bone it is attached to. This is usually part of the natural progression of tendinosis.
If enough rotator cuff starts to separate, we have a small cleft or defect in the rotator cuff attachment. We call that a partial tear. Partial tears are not large enough to cause weakness of the shoulder. However, if you have a painful partial tear, you can have pain on top or the side of the shoulder. In addition, you may find it very painful when trying to lift the arm overhead.
Most people with partial tears of the rotator cuff are going to respond to physical therapy. Some partial tears hurt, while others do not. Determining if your partial tear is painful is usually possible with a physical exam. Suppose physical therapy and other non-surgical treatments do not improve your pain. In that case, surgery to place a unique biological patch is highly likely to alleviate your night pain and pain caused by lifting your arm. See this post for more information about the patch and how it works.
Traumatic Shoulder Pain
Some of you are reading this because you fell on your shoulder and cannot move your arm. In acute traumatic situations like this, there is a chance that you ripped the rotator cuff off from the bone. If you fell and now have significant weakness in your arm, you should see an Orthopedic Surgeon soon. This post covers what to look for if you think you have a serious shoulder injury.
The rotator cuff controls how well the shoulder functions. If your injury caused a rotator cuff tear, your complaints and symptoms might be related to the size of the rotator cuff tear. If enough of the rotator cuff has torn, then it might be impossible to move your arm due to severe weakness. Many people with acute, large, traumatic rotator cuff tears will require surgery to restore function. In general, the treatment of rotator cuff tears depends on the cause of the rotator cuff tear, and I go into more detail in these posts here and here.
Calcific tendonitis of the rotator cuff can be a VERY painful entity.
Patients with calcific tendonitis are usually very easy to diagnose in the office since the pain can be very significant. In this situation, calcium crystals deposit within the tendon itself. That leads to a considerable increase in the number of nerves in that area, and that causes severe pain. The calcium deposit is not dangerous. If you have calcific tendonitis, it does not mean that you take in too much calcium or something wrong with your kidneys.
Luckily, a non-surgical approach with an ultrasound-guided injection to wash the calcium out of the rotator cuff often results in pain relief in most cases. Surgery is very rarely necessary for calcific tendonitis. For more in-depth information on calcific tendonitis, please see these two articles here and here.
Adhesive capsulitis or a frozen shoulder is a widespread cause of pain and loss of motion of the shoulder. A frozen shoulder causes pain all around the shoulder. The pain can be on the top of the shoulder, on the side, or the pain can be underneath the shoulder in the axilla.
In a frozen shoulder, you cannot move the arm because the ligaments and capsule around the shoulder become very thick, tight, and inflamed. We have a very popular post here that goes into considerable detail about managing a frozen shoulder.
The diagnosis of a frozen shoulder is often straightforward… since the definition of a frozen shoulder is loss of motion compared to the other shoulder.
The treatment of a frozen shoulder is generally physical therapy. On occasion, we might recommend an injection directly into the shoulder to diminish the inflammation. People who do not improve with physical therapy can consider an injection or an arthroscopy. During shoulder arthroscopy, the surgery is performed with small holes and cameras, and the tight joint capsule is released. During that surgery, we can also remove or lengthen the tight inflamed tissue, which is stopping the shoulder from moving.
Rotator Cuff Tendonitis
In people under 30 years of age, including youngsters, the most common cause of shoulder pain is rotator cuff tendonitis. This means that the rotator cuff is inflamed from performing too much activity. Often rotator cuff tendonitis can be considered a training error at any age. A training error occurs if you add on a new activity or perform too many sets. A training error occurs if you jump in the pool and swim a mile after not swimming for a few weeks or months. In most cases of rotator cuff tendonitis due to over-training or improper training, the pain is going to go away within a few weeks as the shoulder gets used to your new routine.
In childhood (under 16), particularly in overhead athletes, a stress fracture of the humerus is a possible cause of shoulder pain. These stress fractures involve the growth plates of a growing child. These fractures need to be identified early as rest results in healing. If these fractures are not identified early, a young athlete could have lifelong shoulder issues. Usually, just an x-ray will suffice to diagnose these growth plate stress fractures.
In children and teenagers, rotator cuff tendonitis is usually associated with overhead sports and weight lifting. In teenagers, rotator cuff tendonitis can be caused by instability issues where the shoulder is trying to slide out of place. Instability will occur if the ligaments have become loose over time because of pitching, swimming, etc.
Rotator cuff tendonitis due to instability is most commonly seen in children who are throwers, volleyball players, and swimmers. This is a more subtle form of instability than a youngster tackled or hit and dislocated their shoulder. Both the instability and secondary rotator cuff tendonitis will resolve by addressing the underlying instability issue with physical therapy. On occasion, surgery to address the instability can tighten the ligaments, which will also resolve the rotator cuff issue.
AC Joint Arthritis:
The AC Joint is a small joint on top of your shoulder. It is where your collar bone meets the shoulder blade. Many people notice a slight bump above their shoulders. That is the AC joint. Over time that joint can suffer from arthritis. Arthritis of the AC joint is the number one cause of pain on top of the shoulder. If the pain from the AC joint is severe enough, it will cause pain when trying to lift your arm or move your shoulder. Ice, heat, anti-inflammatory medications can all help ease the pain from an arthritic AC joint. Injections can be helpful too. For people who do not respond or improve after these treatments, surgery might be the correct answer. The surgery involves clearing out the AC joint. This article on my site goes into more detail about AC joint arthritis and its treatment.
Shoulder pain when lifting the arm is very common. Most of the time, it is not due to a single injury. We reviewed many of the most common causes of pain and treatments which are usually effective. Hopefully, this has helped you determine why your shoulder hurts and why it’s painful to lift that arm overhead.