Shoulder pain can make everyday activities such as reaching overhead, getting dressed, lifting, exercising, working, or sleeping uncomfortable.

For some people, shoulder pain develops after an injury or repetitive activity. For others, symptoms gradually appear without one obvious cause.

Because many different muscles, tendons, joints, bursae, ligaments, and nerves can contribute to shoulder symptoms, understanding the pattern of pain and movement restriction is an important first step in determining an appropriate approach to care.

Why Is the Shoulder Prone to Pain?

The shoulder is designed to allow a large range of motion.

The shoulder joint works together with the rotator cuff muscles, tendons, ligaments, joint capsule, shoulder blade, and surrounding muscles to control movement and stability.

Because so many structures contribute to shoulder movement, pain can develop for several different reasons.

Symptoms may originate directly from the shoulder, or in some cases pain felt around the shoulder may actually be related to the neck or another nearby structure.

Common Symptoms of Shoulder Problems

Shoulder symptoms can vary considerably depending on the structures involved.

They may include:

• Pain when lifting the arm

• Pain when reaching overhead

• Pain when reaching behind the back

• Pain when lifting or carrying objects

• Aching around the front, side, or back of the shoulder

• Pain when lying on the affected side

• Night-time shoulder pain

• Shoulder stiffness

• Reduced range of motion

• Weakness when raising or rotating the arm

• Clicking or catching sensations

• Pain spreading toward the upper arm

The location of pain alone does not always identify which structure is responsible. Different shoulder conditions can produce similar symptoms, which is why assessment is important when symptoms persist.

What Can Cause Shoulder Pain?

There are many possible causes of shoulder pain. Some of the more common patterns include rotator cuff problems, shoulder impingement, frozen shoulder, bursitis, biceps tendon irritation, overuse injuries, ligament injuries, and pain referred from the neck.

Rotator Cuff Problems

The rotator cuff is a group of muscles and tendons that help stabilize the shoulder and control movements such as raising and rotating the arm.

Rotator cuff problems may develop gradually from repetitive use and age-related tendon changes, or they may occur following an injury.

Symptoms can include pain when lifting the arm, discomfort when lying on the affected side, weakness, and difficulty with overhead activities.

Rotator cuff problems can range from tendon irritation or tendinopathy to partial or complete tendon tears.

Because symptoms do not always indicate the extent of tendon involvement, medical assessment or imaging may sometimes be appropriate when significant weakness, trauma, or persistent symptoms are present.

Shoulder Impingement Syndrome

Shoulder impingement syndrome is a term commonly used to describe pain that occurs when structures around the rotator cuff and the space above the shoulder become irritated during certain arm movements.

People may notice pain when raising the arm, reaching overhead, putting on a jacket, or performing repetitive work or sports activities.

Symptoms often overlap with rotator cuff tendinopathy and shoulder bursitis.

Rather than relying on one movement or test alone, the overall pattern of symptoms, strength, mobility, activity history, and clinical findings should be considered.

Shoulder impingement may involve irritation of the rotator cuff tendons and the subacromial bursa beneath the acromion.

Frozen Shoulder

Frozen shoulder, also called adhesive capsulitis, is characterized by progressively increasing pain and stiffness with significant restriction of shoulder movement.

It often develops gradually.

People with frozen shoulder may have difficulty reaching overhead, fastening clothing behind the back, putting on a coat, or performing other daily activities that require shoulder rotation.

Frozen shoulder commonly progresses through stages in which pain and stiffness change over time.

Because other shoulder conditions can also cause painful and restricted movement, proper assessment is important before assuming that stiffness is caused by frozen shoulder.

Shoulder pain and stiffness can make overhead movement and everyday activities difficult.

Biceps Tendinitis and Biceps Tendon Pain

The long head of the biceps tendon travels through the front of the shoulder.

Irritation of this tendon may cause pain toward the front of the shoulder, particularly during lifting, pulling, overhead movement, or repetitive activity.

Biceps tendon problems can sometimes occur together with rotator cuff or other shoulder conditions.

For this reason, symptoms around the front of the shoulder should be assessed in the context of overall shoulder movement and function rather than considered in isolation.

Shoulder Bursitis

Bursae are small fluid-filled sacs that help reduce friction between tissues around joints.

When a bursa around the shoulder becomes irritated, symptoms may include aching, tenderness, and pain with certain arm movements.

Shoulder bursitis frequently occurs alongside rotator cuff-related shoulder problems rather than as a completely separate condition.

Repeated overhead activity, changes in activity level, or irritation of nearby tissues may contribute to symptoms.

Overuse and Repetitive Strain

Shoulder pain does not always begin with a single injury.

Repeated lifting, overhead work, sports, exercise, or other repetitive movements may gradually irritate muscles and tendons around the shoulder.

A sudden increase in activity can also contribute.

For example, increasing gym training, repeatedly lifting above shoulder height, or performing an unfamiliar activity for extended periods may result in shoulder discomfort even when no specific injury occurred.

Activity modification and gradual rehabilitation may be important parts of recovery in these situations.

Posture and Shoulder Movement

Shoulder movement does not occur independently from the rest of the upper body.

The shoulder blade, upper back, neck, and surrounding muscles all contribute to normal arm movement.

Changes in mobility, prolonged positions, muscle tension, or movement habits may influence how the shoulder feels during certain activities.

However, posture alone should not automatically be assumed to be the cause of shoulder pain.

Assessment should consider symptoms, mobility, strength, daily activities, work demands, and other relevant factors together.

Referred Pain From the Neck

Not all pain felt around the shoulder originates from the shoulder itself.

Problems involving the cervical spine or nerves in the neck may sometimes produce pain around the shoulder blade, shoulder, or arm.

Symptoms related to the neck may also include:

• Neck pain or stiffness

• Pain extending into the arm

• Tingling or numbness

• Changes in sensation

• Weakness

• Symptoms that change with neck movement

Shoulder pain and neck-related pain can sometimes overlap.

If your symptoms include significant neck pain, arm tingling, numbness, or weakness, assessment of the neck may also be appropriate.

You can also read my article on neck pain for more information about common neck-related symptoms and treatment considerations.

Neck-related nerve irritation can sometimes produce pain felt in the shoulder or upper arm.

Shoulder Sprains and Ligament Injuries

Ligaments help stabilize the joints of the shoulder.

A fall, sports injury, collision, or other trauma may stretch or injure these structures.

One example is an injury to the acromioclavicular, or AC, joint at the top of the shoulder.

Symptoms following a ligament injury may include localized pain, swelling, tenderness, or difficulty moving the arm.

Shoulder pain that begins after significant trauma should be medically assessed, particularly if there is deformity, substantial weakness, swelling, or inability to raise the arm.

Do I Need an X-ray or MRI for Shoulder Pain?

Imaging is not required for every person with shoulder pain.

In many cases, health history, symptoms, movement, strength, and physical assessment provide useful information before imaging is considered.

However, an X-ray, ultrasound, MRI, or other investigation may sometimes be appropriate depending on the history and symptoms.

Imaging may be considered when there has been significant trauma, substantial weakness, persistent loss of movement, suspected fracture or tendon tear, or symptoms that are not improving as expected.

If you already have an X-ray, ultrasound, MRI, or radiology report, you are welcome to bring it to your appointment.

Imaging findings should be considered together with your symptoms and clinical assessment rather than interpreted on their own.

When Should You Seek Medical Attention?

Many cases of shoulder pain can be managed conservatively, but some symptoms should be assessed promptly by a physician or other appropriate healthcare professional.

Seek medical attention if you experience:

• Severe shoulder pain after a fall or significant injury

• Visible deformity of the shoulder

• Sudden inability to raise or use the arm

• Significant or rapidly worsening weakness

• Severe or increasing swelling

• Persistent numbness or tingling in the arm or hand

• Fever together with a hot, red, or markedly swollen joint

• Chest pain, shortness of breath, or unexplained shoulder pain associated with other concerning symptoms

If you are uncertain whether your symptoms require medical investigation, it is appropriate to speak with your physician or another qualified healthcare provider.

Treatment and Management Options for Shoulder Pain

Treatment depends on the cause of the symptoms, how long they have been present, the degree of pain or movement restriction, and the individual’s daily activities and health history.

Conservative management may include:

• Temporary modification of aggravating activities

• Gradual return to normal movement

• Mobility and strengthening exercises

• Physical therapy or rehabilitation

• Medical treatment when appropriate

• Acupuncture or other conservative therapies in appropriate cases

Complete rest is not necessarily required for every shoulder problem. In many cases, maintaining comfortable movement and gradually restoring function may be part of recovery.

The appropriate approach depends on the individual condition.

Can Acupuncture Help With Shoulder Pain?

Acupuncture may be considered as part of a conservative approach for some people experiencing shoulder pain.

Research on acupuncture for shoulder conditions has produced mixed results, and the strength of evidence varies depending on the specific condition being studied.

For this reason, acupuncture should not be presented as a guaranteed treatment for every type of shoulder problem.

In my practice, treatment is individualized according to the location and pattern of symptoms, shoulder movement, muscle tension, health history, and other relevant clinical findings.

Depending on the individual assessment, care may include acupuncture and may sometimes be combined with electrotherapy, manual therapy, or other approaches within my scope of practice.

The goal is to help manage symptoms and support comfortable movement and function while monitoring how the shoulder responds to care.

The number and frequency of treatments can vary depending on the condition and individual response, and improvement cannot be guaranteed.

What to Expect at Your First Appointment

Your first appointment begins with a discussion of your symptoms and health history.

Questions may include when the pain began, which movements aggravate it, whether there was an injury, how the symptoms affect daily activities or sleep, and whether you experience neck pain, numbness, tingling, or weakness.

Your shoulder movement and other relevant clinical findings may then be assessed to better understand the pattern of symptoms.

If you have previous X-rays, ultrasound results, MRI images, radiology reports, or other relevant medical records, you are welcome to bring them with you.

If acupuncture is appropriate, an individualized treatment plan will be discussed based on your assessment and response to care.

Acupuncture Care for Shoulder Pain in Moncton

If shoulder pain is affecting your work, exercise, sleep, or everyday movement, an individualized assessment can help identify the pattern of your symptoms and determine whether acupuncture may be an appropriate part of your care.

Learn more about my acupuncture and manual therapy services.

Acupuncture appointments for shoulder pain are available in Moncton, New Brunswick.

Book an acupuncture appointment in Moncton.

Written by Jung Dae Kwon, R.Ac.

Registered Acupuncturist in New Brunswick

Doctor of Korean Medicine — Licensed in the Republic of Korea

This article is provided for general educational purposes and is not a substitute for medical diagnosis or treatment. Individual results and treatment needs may vary.