Shoulder pain

How common it is

Shoulder complaints sit inside the wider group of chronic musculoskeletal conditions, which in 2022 were estimated to affect almost one in three people in Australia. ^[1]

In younger people shoulder pain is more likely to follow an accident or injury, while with age natural wear occurs in the shoulder joint and the rotator cuff tendon, which over time may become persistent pain. ^[2]

What can be behind it

The shoulder trades stability for range, held in place by the group of tendons and muscles called the rotator cuff. Tears can follow an injury such as a fall, or develop over a period of time as we age. ^[2] The bursa between the cuff tendon and the bony tip of the shoulder can become inflamed, most commonly with repetitive movements. ^[2]

Problems with the joints and associated nerves of the neck and upper back can also be a source of shoulder pain, and that pain is often felt at the back of the shoulder joint and through to the outside of the upper arm. ^[2] Sensations of pins and needles and burning pain are more likely to be associated with nerves from the neck than the shoulder joint itself. ^[2]

• Rotator cuff irritation or wear
• An inflamed bursa under the tip of the shoulder
• Referral from restricted joints in the neck or upper back
• Stiffness in the mid back limiting how the shoulder blade moves

How we assess it

We test the shoulder and the neck in the same visit, because that comparison is the whole point. Active and resisted movement of the arm, tests that load the cuff, and then cervical movement and palpation to see whether your familiar pain can be reproduced from the neck.

Some shoulder pain is not musculoskeletal at all. Shoulder pain may also be caused by problems affecting the abdomen, the heart and the lungs, ^[2] so anything in your history that fits that picture, particularly pain with exertion, breathlessness or sweating, is a medical referral on the day and not something we adjust.

What care looks like

Where the examination implicates the neck or the upper back, that is what gets adjusted, and the shoulder work is soft tissue and movement rather than the main event. Where the shoulder itself is the source, we are honest about the limits of what adjusting can do for it and about when a referral serves you better.

The examination includes the neck, upper back and shoulder rather than focusing only on the painful area. We explain what we find before discussing care or referral.

When to seek urgent care

We are not an emergency service. If you have loss of bladder or bowel control, numbness in the saddle area, weakness in both legs, or pain after a serious accident, call 000 or go to an emergency department.