Shoulder Pain: Causes and When to See a Shoulder Specialist
A guide to the most common causes of shoulder pain, organized by where it hurts and how it started, from Frisco orthopedic sports medicine surgeon Dr. Andrew Dold, MD.
The shoulder is the most mobile joint in the body, which makes it prone to wear, strain and injury. Your age, how the pain started and which movements hurt are strong clues to the cause. Use this guide to understand the likely possibilities. Dr. Dold can then confirm the diagnosis with an exam and imaging.
- Have shoulder or arm pain with chest pain, shortness of breath or sweating (call 911)
- Fell and the shoulder looks deformed or you cannot move the arm (go to the emergency room)
- Suddenly cannot lift the arm after an injury
- Felt the shoulder slip out of place
- Still have pain after 2 to 3 weeks of rest and simple care, or pain that wakes you every night
Pain on the outside of the shoulder when lifting the arm
This is the most common pattern. The pain is usually felt on the outer upper arm and is worst when reaching overhead or behind the back.
- Rotator cuff tendinitis and impingement: pain with overhead reaching, often in athletes and people over 40
- Partial rotator cuff tear: pain similar to tendinitis that lingers
- Full rotator cuff tear: pain plus weakness, trouble lifting the arm, night pain
- Calcific tendinitis: sudden, severe pain from calcium deposits in the tendon
Stiffness: a shoulder that won’t move
- Frozen shoulder (adhesive capsulitis): gradual pain followed by marked stiffness, more common in people aged 40 to 60 and in people with diabetes
- Shoulder arthritis: deep aching, stiffness and grinding, usually in older adults
- Rotator cuff arthropathy: arthritis that follows a long-standing large rotator cuff tear
Pain at the top of the shoulder
- AC joint separation: pain and a bump at the top of the shoulder after a fall onto the shoulder
- AC joint arthritis and distal clavicle osteolysis: pain at the top of the shoulder with bench press, push-ups or reaching across the body
- Collarbone fracture: pain and deformity over the collarbone after a fall
Pain at the front of the shoulder
- Biceps tendinitis and tears: pain at the front of the shoulder, sometimes with a “Popeye” bulge after a rupture
- SLAP tear: deep pain and clicking with overhead throwing or lifting
- Pectoralis major rupture: sudden pain and bruising at the front of the armpit, often during bench press
A shoulder that slips or dislocates
A shoulder that has come out of joint often tears the labrum, the cartilage rim of the socket. Young athletes have a high chance of it happening again. See shoulder dislocation and instability and posterior shoulder instability.
Shoulder pain in throwing athletes
Pitchers and other overhead athletes get specific problems, including GIRD (loss of internal rotation), SLAP tears and, in young players, Little Leaguer’s shoulder. Elbow pain in throwers can mean a UCL injury.
Pain that may not come from the shoulder
Pain from the neck often spreads over the shoulder blade and down the arm, with tingling or numbness. Rarely, shoulder or arm pain is a sign of a heart problem, especially with chest pain or shortness of breath, which needs emergency care.
How Dr. Dold diagnoses shoulder pain
- A detailed history and hands-on exam of the shoulder and neck, including strength and rotator cuff tests
- X-rays, usually taken at your first visit in our Frisco office
- An MRI or MR arthrogram when a rotator cuff, labral or other soft-tissue injury is suspected
- Sometimes an ultrasound or a diagnostic injection
Treatment options
Most shoulder pain improves without surgery, with activity changes, physical therapy and, when appropriate, injections. When surgery is needed, for example for many rotator cuff tears or a shoulder that keeps dislocating, Dr. Dold performs arthroscopic (keyhole) repairs. See shoulder surgery and procedures and all shoulder and elbow conditions.
Why see Dr. Dold
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Fellow of the American Orthopaedic Association (FAOA), the American Academy of Orthopaedic Surgeons (FAAOS), the American College of Surgeons (FACS) and the Royal College of Surgeons of Canada (FRCSC)
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
Why does my shoulder hurt when I lift my arm?
Pain when raising the arm, especially between shoulder and head height, most often comes from the rotator cuff tendons or the bursa above them. Weakness as well as pain can mean a rotator cuff tear.
Why does my shoulder hurt at night?
Night pain, especially lying on the sore side, is common with rotator cuff problems, frozen shoulder and calcific tendinitis. Pain that wakes you regularly is a good reason to have the shoulder examined.
When should I see a doctor for shoulder pain?
Go to the emergency room after a fall if the shoulder looks deformed or you cannot move the arm, and call 911 for shoulder or arm pain with chest pain or shortness of breath. Book a visit if you have weakness, the shoulder slipped out of place, or pain lasts more than 2 to 3 weeks.
Do I need an MRI for shoulder pain?
Not always. An exam and X-rays come first. An MRI helps when a rotator cuff tear, labral tear or other soft-tissue injury is suspected, or when pain has not improved with treatment.
Can shoulder pain come from my neck?
Yes. A pinched nerve in the neck can cause pain over the shoulder blade and down the arm, often with tingling. Dr. Dold checks the neck as part of a shoulder exam.
Research cited on this page
- Hermans J, Luime JJ, Meuffels DE, et al. Does this patient with shoulder pain have rotator cuff disease? The Rational Clinical Examination systematic review. JAMA. 2013;310(8):837-847. PubMed
A painful arc and pain with resisted outward rotation were the most useful exam findings for rotator cuff disease; “lag” tests were most useful for spotting a full-thickness tear. - Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. PubMed
For frozen shoulder of less than a year, an early cortisone injection into the joint was linked to better outcomes, ideally combined with a home exercise program. - Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329-338. PubMed
For impingement-type shoulder pain without a significant tear, bone-shaving (decompression) surgery gave no extra benefit over arthroscopy alone, which is why non-surgical care comes first. - Page MJ, Green S, McBain B, et al. Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev. 2016;(6):CD012224. PubMed
Review of 60 trials: low-quality evidence suggests exercise and manual therapy may work about as well as a cortisone injection or decompression surgery for rotator cuff pain.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 5, 2026. This page is general information, not medical advice.
