Where is my shoulder pain coming from?
How to tell the difference between shoulder pain referred from the neck versus the rotator cuff
It can be tough to determine the source of pain in our body. Medical diagnostic tools we have don’t always pinpoint pain sources, either. What I mean by that is that 2 people may have similar looking x-rays or MRI’s and one person may have no pain and the other have excruciating, debilitating pain. When it comes to the shoulder, there are a lot of reasons there may be pain in the area. Today, I’m going to give you some of the assessments that I do in my physical therapy practice that helps me determine what I might focus on to help you alleviate pain, restore mobility or gain strength. Please do not mistake this for medical advice, but use it instead as a guide.
Let’s talk about areas outside the shoulder that can refer pain to the shoulder.
The nerves that exit out of the cervical spine in your neck can refer pain to the shoulder. My clients tend to describe it as deep, throbbing, burning, pins and needles, tingling, or numb. People tell me they like to keep their arm resting overhead with the forearm resting on the top of their head to alleviate pain.
Organs can refer pain to the shoulder and/or the shoulder blade. The heart, pancreas and the left lung refers pain to the left shoulder. The gall bladder, liver and the right lung refers pain to the right shoulder.
What do certain movements tell you about the shoulder?
Pain in the front of the shoulder when you reach overhead can be impingement
Pain when you lay on the shoulder could be a sign of bursitis
Pain in the front of your shoulder when you reach behind your back can indicate tight pectorals (chest muscles)
Pain with reaching out to the side can indicate issues with your rotator cuff
Pain that starts at some point with lifting the arm and the higher you lift if the pain stops, this is a “painful arc” and that can indicate tendinitis
The feeling of the shoulder slipping or coming out of socket can indicate labral issues or joint instability
In the clinic, I like to look at the range of motion of the neck and the shoulder. First, pay attention to how your shoulder feels as you look up, down, lean to the right, lean to the left and turn your head to the right and to the left. Next, look at your shoulder motion and notice how that feels. Check both sides. Reach overhead, out to the side, behind your head, and behind your back. Notice any difference in the mobility, the quality of movement, and pain. Does moving a certain way change your pain for better or worse? Where in your range of motion with reaching does your shoulder hurt? That can give you clues about your source of pain. For example, if you have pain with reaching overhead from about 115 degrees on up, then you may have some stiffness related to how your collar bone is moving.
Next, let’s look at strength. Hold one arm forward at about shoulder height. Take your other arm and press down as you try to hold the arm at shoulder height. Notice how that feels. Can you hold it under pressure? Do the same with pressing out the side. To check internal and external rotation, bend your elbow and bring the elbow down at your side. Press with the other hand at your wrist in both inward and outward motions. Check both sides.
Looking at range of motion and taking note of the quality of motion and the amount of motion can give you valuable insight as well as these simple muscle tests. Doing these tests won’t exactly tell you what might be going on with your shoulder, but it’s a valuable first step.
Some red flags with shoulder pain that demand immediate medical attention include stroke or heart attack.
Signs of stroke (FAST)
F- FACE facial drooping on one side
A-ARMS weakness or numbness in one arm
S-SPEECH slurred speech and/or difficulty understanding words that are being spoken
T-TIME time is of the essence, every minute counts when you notice these symptoms
Signs of a heart attack-
Chest tightness, pain or pressure
Pain in the neck, jaw, shoulder and/or upper back
Shortness of breath
Pain in the stomach or heartburn-type pain
Fatigue even with little to no activity
Dizziness can also be a sign of stroke and heart attack.
If you aren’t sure why you have shoulder pain, it’s always best to see your medical provider to help you determine the best course of action. A lot of people ask me who they should see, so here are some recommendations:
Primary care provider to determine if any organ issues are causing shoulder pain
Orthopedic doctor or Sports Medicine doctor for bone/joint/muscle issues
Neurologist for nerve-related issues
Neurosurgeon for spine-related issues
Physical or Occupational therapist to restore function of the shoulder
Chiropractor for joint alignment/adjustments
Rheumatologist for auto-immune, inflammatory or arthritic issues
Have you experienced shoulder pain? I’d love to know if you saw someone other than who I have listed so that I can update my list!
Take good care,
Sharon