Not being able to lift our arm because of shoulder pain is very common. Shoulder pain can be one of the more annoying and painful conditions. For many of you, you simply woke one morning and your shoulder hurts. Often that pain in on the top of the shoulder or 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 are not unusual issues when it comes to shoulder pain. Most of you will not recall a shoulder injury. Most did not change their workouts or start to exercise more aggressively. In most instances, you are 40-60 years old, and this might be your dominant or your non-dominant arm. Because this is such a common problem that I see the my office everyday we are going to review the more common reasons that will cause:
- Pain on top of the shoulder
- Shoulder pain when lifting the arm
- Causes of stiffness and difficulty in moving your shoulder.
There are many problems that can occur in the shoulder that can make it difficult or too painful when trying to lift or move your arm. More often than not this is due to an issue with the rotator cuff (see list below). The rotator cuff is the most common cause of pain in the adult shoulder. Rotator cuff pain is the number one reason why you have pain on the outside or top of your arm. It is also the main reason why you may not be able to lift or have pain when you move your arm.
Shoulder pain could also be brought on by injury. Believe it or not, traumatic injuries are a less frequent cause 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.
The rotator cuff are 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 important to the proper functioning of the shoulder.
If the rotator cuff is injured, inflamed, strained or torn, you may find that you are unable to lift your arm. Common rotator cuff issues that hurt when we raise our arm include:
- 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 is more common. In middle age, rotator cuff tendinosis, calcific tendinitis, AC Joint arthritis and a frozen shoulder are more common causes of pain. Let’s run through the most common reasons why you have pain on the top or side of your shoulder and why you have pain when trying to lift your arm.
Rotator Cuff Tendinosis
Rotator cuff tendinosis, by definition implies some degree of rotator cuff degeneration. With that degeneration comes an increase in the numbers of nerves and blood vessels. That is the body’s response to the degeneration, and that is why the pain occurs. Too many nerves in the area produces pain with certain motions. If the pain is severe enough you will be unable to raise your arm or unable to sleep on that side.
When patients have rotator cuff tendinosis, physical therapy is generally effective at managing the pain. If the pain persists despite therapy, we now have a biological patch which may be able to reverse tendinosis and alleviate your shoulder pain.
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. These posts here, here, and here go into far more detail 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 that it is normally attached to. This is usually part of the natural progression of tendinosis. If enough of the rotator cuff starts to separate then 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 on the side of the shoulder. In addition, you may find it very painful when trying to lift the arm overhead.
Some partial tears hurt, while others do not. Determining if your partial tear is painful is usually possible with a physical exam. Most people with partial tears of the rotator cuff are going to respond to physical therapy. If physical therapy and other non-surgical treatments do not improve your pain, then surgery to place a unique biological patch has a very high likelihood of alleviating your night pain and pain with 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 now you can not 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 had 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 may 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 in order 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. You are usually very easy to diagnose in the office since the pain can at times be very significant. In this situation, calcium crystals deposit inside the tendon itself. That leads to a significant increase in the number of nerves in that area, and that causes severe pain. Luckily, a non-surgical approach with an ultrasound guided injection to wash the calcium out of the rotator cuff results in pain relief in the majority of 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 very common cause pain and of 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, or the pain can be underneath the shoulder in the axilla. In this situation, the ligaments and capsule around the shoulder become very thick, very tight and very inflamed. The diagnosis is straight-forward… 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. A shoulder pulley system can help you perform stretching on your own. On occasion we might recommend an injection directly into the shoulder to diminish the inflammation. For people who do not improve with physical therapy will can consider an arthroscopy, which is a surgery performed with small holes and cameras. During that surgery we can 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 because of rotator cuff tendonitis. This simply means that the rotator cuff is inflamed from performing too much activity. Often times 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), and particularly in overhead athletes, a stress fracture of the humerus is a possible cause of shoulder pain. These stress fractures actually 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. This is a more subtle form a instability than a youngster who was tackled or hit and dislocated their shoulder. Rotator cuff tendonitis due to instability is most commonly seen in children who are throwers, volleyball players and swimmers. By addressing the underlying instability issue with physical therapy both the instability and the secondary rotator cuff tendonitis will resolve. On occasion, surgery to address the instability can tighten the ligaments and this will also resolve the rotator cuff issue. For many painful shoulders a compression/ice sleeve can ease the pain.
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 small bump above their shoulder. 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 is 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 useful too. For people who do not respond or improve after these treatments surgery might be the right 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.
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We can not guarantee the effectiveness of the sleeves/ice wraps. Many find them very useful. Some may not.
Disclaimer: this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.