Shoulder and upper arm pain: Why?

Pain that sits deep in the shoulder and runs down the outside of the upper arm is an incredibly common complaint at Princeton Orthopaedic Associates. That question leads to others: Is the neck the real source of the pain? What does a torn rotator cuff actually mean? Why does a stiff shoulder take so long to settle? Where does treatment start? How likely is a dislocated shoulder to come out again? And which warning signs need care right away?

You're in good company. Shoulder pain is one of the most common reasons people see a doctor for aches and pains. Not rare. And not something you have to live with.

Quick answers before the details

Start here: what your shoulder may be telling you

Could my shoulder pain actually be coming from my neck?

Yes, and it gets missed a lot. Nerves leave the neck and run through the shoulder into the hand, so a pinched nerve in the neck can make the outer shoulder and upper arm ache while the shoulder itself is healthy.

Pain that comes from the neck often changes when you move your neck, and it can bring tingling, numbness or weakness down the arm. Neck and shoulder problems also show up together, so we check both at the same visit.

My shoulder is getting stiff, not just sore. What is frozen shoulder?

Frozen shoulder is when the lining around the ball-and-socket joint becomes inflamed and tight. Reaching behind your back or turning the arm outward gets hard, and the stiffness shows up in every direction. It most often shows up in middle age.

It also tends to move through phases, which can help you know what to expect when progress feels slow. Most people get much better, but it can take a year or more, and some stiffness can linger, so we don't simply wait it out.

Every shoulder moves through these at its own pace. We'll help you with the pain and keep the shoulder moving along the way.

What does treatment usually start with?

Almost always with movement. For most tendon pain at the top of the shoulder, guided exercise is the first treatment, because it helps pain, motion and strength.

• If we need a closer look at a tendon, an ultrasound or MRI can help.
• If pain is too strong to do your exercises, an injection may calm it down enough to get started.
• For a rotator cuff tear that didn't come from an injury, we usually start with exercise too, and talk about surgery only if you aren't improving after a few months.
• If you do have surgery, we get the shoulder moving again early rather than keeping it still for long.

Here's what that means for you. Starting with rehab isn't a delay tactic, and we're not hoping the problem quietly goes away. Rehab is the treatment.

I dislocated my shoulder once. Will it happen again?

Age at the first dislocation is one of the strongest clues we have. Younger people are more likely to have it happen again, usually within the first couple of years. That's why we don't treat a teenage wrestler and a 55-year-old gardener the same way.

Older shoulders behave differently. After 40, it's less likely to come out again, but we look more carefully for damage that came with the dislocation, like a rotator cuff tear or a nerve injury. A first dislocation after 40 is worth checking for both.

Which symptoms shouldn't wait?

Most shoulder pain can be watched for a couple of weeks while it settles down. Some signs shouldn't wait, though. If any of these apply to you, get seen promptly rather than giving it more time:

• Shoulder or arm pain along with chest pain or pressure, sweating, nausea, jaw pain, or shortness of breath. Call 911. This can be a heart attack, not a shoulder problem. Be especially careful with sudden left-sided shoulder or arm pain, and in women and people with diabetes, whose warning signs can look unusual.
• An injury that leaves the shoulder looking out of place or unable to move. Go to the emergency room, since a dislocated shoulder needs to be put back in right away.
• An injury followed by pain and weakness, or suddenly not being able to raise your arm, which can mean a torn rotator cuff.
• Signs of infection such as red skin, a very painful joint, fever, or feeling generally unwell. Get checked the same day.
• New numbness, tingling, or weakness anywhere in the arm or hand.
• Any new lump or swelling around the shoulder.
• Weight loss you can't explain, or a past history of cancer.
• Constant pain at rest that never lets up, or night pain that doesn't change when you shift position.
• New swelling in several joints at once.

Watch for a slower timeline as well. If your pain isn't getting better after about three months of treatment, it's time to see a specialist, and sooner if the shoulder feels loose or the pain after an injury is severe.

What happens when you come see us?

We listen first. How the pain started, which positions set it off, whether it wakes you, whether anything travels into the hand, and what you can't do right now. Then we examine the shoulder and the neck together, test your strength, and watch how your shoulder blade moves when you lift.

Imaging comes after the exam, not before it, and only when it will change the plan. X-rays show bone. Ultrasound and MRI show tendons and soft tissue. Plenty of patients leave with a diagnosis and a rehab plan, no scan needed.

Let's figure out what's going on with your shoulder

Our shoulder and sports medicine team at Princeton Orthopaedic Associates sees this every day, from the weekend pickleball ache to the arm you can no longer lift. We'd invite you to come in for a clear answer and a plan built around what you need to get back to.

Schedule Exam with our team and let's start with the cause, not just the pain.

Are you suffering from pain?

Please contact us! We'd love to help.

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This blog post is meant to be informative and should not act as a self-diagnosis tool. If you’d like to see one of our doctors, please contact us here.