There are many problems that can occur in the shoulder that can make it difficult or too painful to lift your arm. Generally, an issue with the rotator cuff (see list below) is the most common reason why you may not be able to lift or move your arm. Pain that is severe enough that you can not lift your arm can be caused by injuries, overhead sports, general repetitive use and heavy gym workouts.
The rotator cuff are a series of four muscles that are deep to or underneath your deltoid muscle. Collectively they 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
- calcific tendonitis
- adhesive capsulitis or a frozen shoulder
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 and 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.
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.
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 resulted in 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 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. In this situation, the ligaments and capsule around the shoulder become very tight and very inflamed. The diagnosis is straight-forward… since the definition 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.
There are many reasons why you might find it too painful or too difficult to lift your arm. The rotator cuff is the most likely cause of the problem. Hopefully this post and the links provided assist you in determining why you can’t lift your arm.
My disclaimer applies.
Some of these links are affiliate links.
We can not guarantee the effectiveness of the sleeves/ice wraps. Many find them very useful. Some may not.