The shoulder is a complex area of the body that includes many joints, tendons, ligaments, and muscles. When one small part breaks down or does not function properly, it can affect everything else around the shoulder and cause many different problems. When this happens, your body uses pain to tell you something is not working correctly. Such pain can range from a small, occasional ache to a severe, constant pain that keeps you awake at night.

The most common causes of shoulder pain are impingement syndrome, rotator cuff tendon tears, shoulder arthritis, frozen shoulder, and biceps tendon tears. Some patients have more than one of these problems, so your doctor will need to know the details of your symptoms, perform an examination, and sometimes order special tests in order to make the correct diagnosis.

Impingement syndrome is the most common cause of shoulder pain. Patients with impingement syndrome experience pain when they raise their hand above their shoulder or out to the side. It can also cause pain and stiffness when a patient reaches behind his back, or tries to reach toward his other shoulder. In severe cases, the shoulder pain is more bothersome at night and can wake the patient up if he rolls onto the painful side. When asked to point to the pain, the patient will either indicate one or two spots on the front of the shoulder, or put his whole hand over the side of the shoulder. Because they feel pain radiating down the arm or up toward the neck, some patients worry that the nerves are also injured, but this is not the case. The nerves are normal, but the pain from the shoulder can spread all the way down the arm.

Every time we move our shoulders, the shoulder muscles pull on the rotator cuff tendons. These tendons can wear out, just like any other part of the body, and when they do, they can start to cause pain. The rotator cuff tendon has a soft tissue bursa (a small pouch) that protects the tendon from injury. If that bursa becomes inflamed or worn out, the tendon can become damaged and cause pain. Pain can also be caused by bone spurs growing over the rotator cuff tendons. This is part of the normal aging process, although it is less common than damage to the bursa. Such bone spurs can rub against the bursa and irritate the rotator cuff tendons. The pain occurs when the arm is raised to shoulder height, because that is the position where the rotator cuff is strained the most.

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