• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
Howard J. Luks, MD, Orthopedic Surgeon

Howard J. Luks, MD

Orthopedic Surgeon Sports Medicine Specialist

  • Articles
  • Notes
  • Podcast
  • Book
  • Education
    • Shoulder Injuries
    • Knee Injuries
    • Elbow Injuries
  • About
Blog / Articles / Shoulder

Why does the top of my shoulder hurt ?

Howard J. Luks, MD Updated September 17, 2018

Pain on top of the shoulder

Sorry to say, but most people will eventually suffer from shoulder pain. Whether your pain is due to an injury or you simply woke up with the pain many of you worry that you might have a serious shoulder issue. The location of the pain in your shoulder might indicate to us what the problem might be. Pain on top of the shoulder is usually due to the AC Joint.

Shoulders can bother us in many different areas. People can complain of pain on the side of the shoulder, the front of the shoulder, or the top of the shoulder. Most of the time a good shoulder doctor will know your diagnosis by listening to you for a few minutes. That is how important the location of the pain, and the cause of the pain are in determining why the top of your shoulder hurts or clicks.

Collarbone fractureShoulder pain can occur due to age or activity related issues such as arthritis.  Pain on the top of the shoulder can also start following an injury. The most common type of injury which causes pain on the top of the shoulder is a fall directly on the side of the shoulder.

The AC Joint

AC JointThe AC Joint is the most common cause of pain or clicking on top of the shoulder.

The AC joint is created by the joining of the clavicle and a portion of the shoulder blade. This is a very small, yet very important joint.  Every time you move our shoulder your AC joint will move.  If you lift anything with your hand all the force will go through the AC joint.  Therefore if your AC joint is bothering you, most activities might cause pain. The AC joint can hurt due to recent traumatic injuries, age, or activity related repetitive stress.

Traumatic AC Joint Injuries

AC Separations: If you suffered an injury when you fell onto the side of your shoulder you may have AC joint separation. An AC separation implies that the ligaments that normally hold the AC joint together have been injured or torn.  If the ligaments are simply strained or stretched then you will notice mild swelling, but you will not have a significant bump.  In more severe AC joint injuries you will notice a bump.  Depending on the severity of the injury to the ligaments that hold the AC joint together you may have a small bump or a very alarming bump.  Some of these bumps can look terrible.  We created this video below which goes into much more depth about AC separations. Most AC separation do not require surgery. But we also cover who might benefit from surgery in far more detail during the video.

Does an AC Separation or a Separated Shoulder Require Surgery?

Distal Clavicle Fractures: A unique type of clavicle fracture can occur after a fall onto the side of the shoulder.  The word distal means “end”. So this would be a fracture of the far end of the clavicle near the AC joint.  These fractures are usually managed without surgery.  But, many distal clavicle fractures will not heal.  Despite not healing, after 8-12 weeks most of these distal clavicle fractures will not cause pain.  If a broken bone doesn’t heal, but doesn’t hurt we call that a painless non-union. Surgery for distal clavicle fractures can be very tricky and risky.  Surgery will often fail, the screws and plates will often fail and need to be removed.  Most of these fractures are best managed without surgery unless your surgeon offers you a very good reason why you should assume the risks of surgery.

Overuse AC Joint Injuries:

Many people will develop pain on top of the shoulder simply as a result of activity and lifestyle. The AC joint is a very common area for osteoarthritis to occur. Osteoarthritis of the AC joint is very common in general. If we x-ray anyone over the age of 45 we will find evidence of osteoarthritis of the AC joint.  This does not mean that you are going to be permanently crippled. Most people with signs of osteoarthritis of the AC joint have no pain in their AC joint. Obviously, without pain, no treatment is needed. AC Joint osteoarthritis is probably the most common cause of clicking on the top of your shoulder.  Clicking in this area without pain should not be a cause for concern.   If you have painful arthritis of the AC joint we discussed that in more detail in this post.

distal clavicle osteolysis
Copyright: Medical Media Group.

A very common cause of shoulder pain in weight lifters is AC joint “osteolysis.” I know, we use all these big words :-(.  Osteolysis means dissolving bone.  The clavicle is very small.  It has a very small cross sectional area.  It is smaller than a quarter in most of us. That means that all the weight you push is transmitting its force through that little bone.  Over time that will lead to stress and inflammation. That inflammation can cause the bone to start to breakdown and dissolve.  if a weight lifter develops osteolysis and wants to remain very active in the gym they will usually require surgery.  Otherwise, if they decrease the weight they push they will usually feel better within a few weeks.  But the pain will come back as soon as they return to heavy weight lifting.  We call this issue a Weight-Lifters Shoulder… and I cover that in more detail in this post.  

 

 

Categories: Shoulder

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.
Longevity... Simplified: Living A Longer, Healthier Life Shouldn’t Be Complicated

My new book is available now.

“The seven simple steps to make ‘longevity simplified’, will help to improve your metabolic health right now.” – Dr. Neil Meigh

Learn More
Read Reviews

Related Articles

calcific tendonitis and severe shoulder pain
Why Does My Shoulder Hurt So Much?
Rotator Cuff Tears
Is a Subacromial Decompression Useful In Treating Shoulder Pain
man carrying barbell at the gym
Distal Clavicle Osteolysis: The Weightlifter’s Shoulder
human X-ray result chart
Video: Treating Clavicle or Collarbone Fractures
rotator cuff return to work
Returning to work after rotator cuff surgery
Shoulder Dislocation
The Dislocated Shoulder : Video Discussion of Treatment Options
Howard J. Luks, MD

Howard J. Luks, MD is an orthopedic surgeon & sports medicine specialist. An expert in shoulder, knee, and other sports injuries, he is widely known as one of the country’s best orthopedic surgeons.

Book Appointment · About · Contact

Facebook Twitter LinkedIn YouTube

Like what you’re reading?

Get the latest posts in your inbox

Reader Interactions

Comments

  1. Dr. Sunil Dedhia says

    October 4, 2019 at 8:26 am

    This article is very interesting and impressive. Thanks for sharing awesome post.

Primary Sidebar

Howard J. Luks, MD is an orthopedic surgeon & sports medicine specialist. An expert in shoulder, knee, and other sports injuries, he is widely known as one of the country’s best orthopedic surgeons.

Book Appointment · About · Contact

Facebook Twitter LinkedIn YouTube

Like what you’re reading?

Get the latest posts in your inbox

Longevity... Simplified: Living A Longer, Healthier Life Shouldn’t Be Complicated

My new book is available now.

Learn More
Read Reviews

Reader Favorites

  • Batters shoulder posterior labral tear
    Batter’s Shoulder : Posterior Labral Tears
  • LEg exercises improve longevity
    Runners require strength too: What to do and when to do it
  • calcific tendonitis and severe shoulder pain
    Why Does My Shoulder Hurt So Much?
  • lactate polarized training
    Lactate, the lactate shuttle, and lactate threshold workouts in polarized training
  • Zone 2 heart rate training
    Zone 2 Heart Rate Training For Longevity and Performance
  • knee swelling
    Pain In The Front Of The Knee: 6 Common Causes
  • Polarized training for runners
    Polarized training for everyday runners: Part 1
  • Exercise is more important than ever
    Does Exercise Cause Osteoarthritis?

Howard J Luks, MD

Orthopedic Surgery & Sports Medicine
128 Ashford Avenue
Dobbs Ferry, NY 10522

Phone: (914)-559-1900
Book Appointment

Pages

  • About
  • Upcoming Books
  • Testimonials
  • In The News
  • Media Photos
  • Contact

Topics

  • Shoulder
  • Knee
  • Elbow
  • Metabolic Health
  • Osteoarthritis
  • Training

More

  • COVID
  • Ankle
  • Hip
  • PRP
  • Running
  • Sports Medicine
  • Articles
  • Notes
  • Podcast
  • Book
  • Education
  • About

© 2023 · Howard J Luks, MD · Disclaimer & Terms · Privacy Policy
The information on this site is not intended or implied to be medical advice, diagnosis, or treatment.
This site should be used for informational purposes only.