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Understanding Shoulder Pain

Older male patient visits doctor for shoulder pain.

On my first visit, I automatically felt better but along came with soreness. I did continue treatment, I saw him (Dr. Alex Jimenez) maybe two or three times out of the week. Shortly after that I started noticing change.
The shoulder consists of a number of joints which merge together with other complex structures, including muscles, tendons and ligaments, to provide a wide range of movement in the arm, like scratching your back.

This increased range of motion, however, can cause a variety of health issues. It might lead to problems with impingement or it might even result in instability on the bony structures or the soft tissues of the shoulder. Shoulder pain might be felt continuously or it might occur through movements of the shoulder. Moreover, shoulder pain can be temporary or it might become chronic and require proper diagnosis and treatment.

The article below describes a few of the common causes of shoulder pain and discusses various treatment approaches to help improve shoulder pain. A qualified and experienced healthcare professional may be able to provide you with more information regarding your shoulder pain.

Anatomy of the Shoulder

The shoulder is a complex structure which is made up of three bones: the upper arm bone, also known as the humerus, the shoulder blade, also known as the scapula, along the collarbone, also known as the clavicle.

The head of the upper arm bone fits into a round socket on the shoulder blade, called the glenoid. A variety of ligaments, tendons and muscles then function by holding the upper arm bone. These collection of soft tissues are referred to as the rotator cuff. The main function of the rotator cuff is to both attach and cover the head of the upper arm bone in the shoulder.

Causes of Shoulder Pain

Most health issues that cause shoulder pain fall into four big categories:

  • Tendon inflammation, bursitis and tendinitis, or a tendon tear
  • Instability
  • Arthritis
  • Fracture or broken bone

Other much less common causes of shoulder pain can include factors such as tumors, disease or aggravated conditions, and nerve-related problems. Below, we will discuss the common causes of shoulder pain in detail.


The bursae are small, fluid-filled sacs which are found between joints throughout the entire body, including the shoulder. These function by decreasing friction between the bone and the muscles as well as act as cushions between the soft tissues and the bones.

Occasionally, excessive utilization of the shoulder can contribute to the swelling and inflammation of the bursa between the rotator cuff and a part of the shoulder blade called the acromion. The outcome measure of this health issue is a condition known as bursitis.

Bursitis often occurs in association with rotator cuff tendinitis, discussed below. The soft tissues in the shoulder can then become painful and inflamed. As a result, daily tasks, such as cleaning or brushing your hair and getting dressed, can become challenging to perform.


A tendon is a cord which connects the muscles to the bones at different sites. Tendinitis is a consequence of inflammation in this soft tissue.
Ordinarily, tendinitis is frequently categorized as one of two types:

  • Acute. Overhead physical activities or ball projecting during a sport game or work may result in acute tendinitis.
  • Chronic. Degenerative diseases like arthritis or degenerative wear and tear as a result of age, may lead to chronic tendinitis.

The joints in the shoulder most commonly affected with tendinitis include the four rotator cuff tendons, particularly the shoulder tendons. The rotator cuff consists of four muscles and their respective tendons which keep the shoulder stable and protect the head of the upper arm bone. The rotator cuff provides equilibrium and shoulder movement.

Tendon Tears

The splitting and tearing of the tendons may by caused by severe damage or trauma from an injury as well as from degenerative changes in the joints due to the normal aging process, long-term overuse and the general wear-and-tear of the joints. These tears may divide the tendon completely out of its attachment or they may only be partial. Normally of tears, the tendon is entirely separated from the bone. Rotator cuff and biceps tendon injuries are among the most common types of tendon tears.


Shoulder impingement happens when the cap of the shoulder blade, known as the acromion, places pressure on the underlying soft tissues once the arm is raised away from the torso. When the arm is raised, the acromion rubs, or "impinges" on, the rotator cuff tendons and bursa. This may result in tendinitis and bursitis, restricting motion and causing pain.


Shoulder instability occurs when the head of the upper arm bone is forced out from the shoulder socket. This can occur as a consequence of a sudden injury or even due to the excessive use of the shoulder.

Shoulder dislocations may only be partial, where only a part of the head of the upper arm may come out partially from the socket. This is also referred to as a subluxation. A complete dislocation usually means that the ball of the upper arm at the shoulder comes out all of the way from the socket.

When the ligaments, tendons, and muscles around the shoulder become torn or loose, dislocations can happen differently. Dislocations, which might be complete or partial, cause unsteadiness and pain when the arm is moved or lifted. Episodes of dislocations or subluxations result in an increased chance of developing arthritis in the shoulder joint, among others.


Health issues resulting in shoulder pain may also lead to arthritis. There are various kinds of arthritis. The most common kind of arthritis in the shoulder is osteroarthritis, also called the "wear-and-tear" arthritis. Osteoarthritis symptoms can include pain, stiffness and swelling which may begin during the day and may worsen throughout the day.

Osteoarthritis might also be associated with work or sports accidents as well as chronic wear-and-tear problems. Other kinds of arthritis could be linked to rotator cuff tears or an inflammation of the joint lining.

Many times, individuals who already have arthritis in the shoulder joints will attempt to prevent moving their shoulder in an effort to reduce arthritis pain and discomfort, However, this often contributes to the stiffening or the tightening of the soft tissues surrounding the shoulder joints, leading to a painful restriction of movement.


Fractures are frequently referred to as broken bones. Shoulder fractures commonly involve the clavicle, or the collarbone, the humerus, or the upper arm bone, and the scapula, or the shoulder blade.

Shoulder fractures in elderly patients are frequently the consequence of a fall from standing height. In the average person, harm from a motor vehicle accident or a sports accident often causes shoulder fractures.

Fractures frequently cause acute pain, swelling, and bruising concerning the shoulder. If a shoulder fracture is suspected, it's important for the person to seek immediate medical attention by a healthcare professional.

Diagnosis for Shoulder Pain

In the instance of any of the health issues mentioned above resulting in extreme shoulder pain, seek medical attention as soon as possible to receive a proper diagnosis. While many cases of shoulder pain may resolve on their own, make sure to see a doctor if symptoms persist or worsen.

A healthcare professional will conduct a comprehensive evaluation so as to ascertain the cause of the patient's shoulder pain before providing them with the appropriate treatment options for their health issues.

Medical History

The first step for diagnosis is a comprehensive look at the patient's medical history. The doctor will ask how the problem has been previously treated and how the pain began, if they are aware of that information. Moreover, additional questions will help determine the causes of the patient's shoulder pain. Since certain actions may improve or worsen symptoms, a record may be an important tool in discovering the origin of shoulder pain.

Physical Evaluation

A thorough examination will help to discover the source of a patient's shoulder pain. A doctor will assess for tender places and will try to find physical abnormalities, swelling, deformity or muscular fatigue. They will also observe the shoulder's strength, flexibility and movement.


The healthcare professional may additionally order certain tests to help identify the reason for the patient's shoulder pain and help determine if the symptoms are due to other health issues. The following list demonstrates the variety of tests which can help determine the diagnosis.

  • X-rays. These images will reveal bone injuries.
  • Magnetic resonance imaging, or MRI and ultrasound. These imaging studies produce images of soft tissues. MRI can help your doctor identify injuries to the ligaments and tendons.
  • Computed tomography, or CT, scan. This instrument joins computer technologies and x-rays to make a better, much detailed image of the bones located in the shoulder region.
  • Electrical studies. The doctor may order an evaluation, including an EMG, or electromyogram, to assess neural function.
  • Arthrogram. In this study, dye is injected to show the joint and its surrounding soft tissues. It might be used together with an MRI.
  • Arthroscopy. During this procedure, a doctor looks inside the joint using a camera. Arthroscopy may reveal soft tissue injuries that aren't apparent in evaluations along with the exam. Arthroscopy can be used to fix the problem and help find the reason for symptoms.

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight
As the most mobile joint in the human body, the shoulder joint is often vulnerable to experience a variety of problems which can result in shoulder pain. Shoulder pain can tremendously affect an individual's ability to perform everyday tasks and, if lest untreated, it can progress into neck and back pain as well as cause other severe symptoms. Understanding the cause of a patient's shoulder pain can help diagnose their problem in order to recommend the best treatment option.

Treatment for Shoulder Pain

Chiropractic Care

Chiropractic care is a safe and effective, alternative treatment option which can help manage shoulder pain by relieving discomfort and swelling, among other painful symptoms. A chiropractor will utilize chiropractic adjustments and manual manipulations to reduce joint restrictions and correct spinal misalignments, in an effort to improve function.

Lifestyle Modifications

Furthermore, a doctor of chiropractic, or chiropractor, will recommend a series of lifestyle modifications to help promote a faster recovery process. Changing a patient's actions through a balance of rest and physical therapeutics can help improve shoulder endurance. Avoiding overexertion can also help prevent further harm and shoulder pain.

Drugs & Medications

A doctor may also prescribe drugs and/or medications to decrease shoulder pain and inflammation. It needs to be taken only as directed, however, if medicine is prescribed to ease pain. A physician can also recommend shots of numbing steroids to alleviate pain.


Surgical interventions can be used to help treat the causes attributing to shoulder pain, however, it should only be considered as a last resort. A majority of patients will react positively to alternative treatment options like chiropractic care and through lifestyle modifications.

For certain types of shoulder problems, like recurring dislocations and a few rotator cuff tears, alternative treatment options may not be recommended and surgery may be considered, in this instance. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez


Additional Topics: Acute Back Pain

Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.

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The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to contact us. Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN* email: coach@elpasofunctionalmedicine.com phone: 915-850-0900 Licensed in: Texas & New Mexico*