What Can Cause Shoulder Pain Without Injury?

Shoulder pain is any pain in the shoulder area. Shoulder pain is commonly caused by trauma to the shoulder area, such as rotator cuff injuries, but it can also occur without injury, such as with osteoarthritis. 

In some cases, shoulder pain may be “referred,” that is, the pain felt in the shoulder is a result of an injury in another part of the body.  

Shoulder pain may be dull or achy, or sharp and severe. Depending on the cause, shoulder pain that is not due to injury may be accompanied by symptoms such as:

• Swelling
• Tenderness and warmth around the joint
• Redness
• Shoulder stiffness
• Inability to move the arm normally
• Weakness
• Joint appears deformed
• Arm or hand weakness or numbness

Causes of shoulder pain without injury include: 

• Osteoarthritis
• Rheumatoid arthritis
• Cervical nerve root impingement 
• Thoracic outlet syndrome 
• Frozen shoulder (adhesive capsulitis)

Causes of referred shoulder pain include: 

• Heart attack
• Reduced blood flow to the heart (myocardial ischemia)
• Inflammation around the heart (pericarditis)
• Pneumonia
• Gallstones
• Pancreatitis
• Pelvic problems, such as a ruptured ovarian cyst
• Herpes zoster (shingles)
• Paget's disease
• Thoracic outlet syndrome
• Gas from laparoscopic abdominal surgery

Shoulder pain is diagnosed with a history and physical exam. Tests used to determine the cause of the shoulder pain include: 

• X-rays
• Arthrography 
• Magnetic resonance imaging (MRI)
• Ultrasound
• Lidocaine injection test 

Treatment for shoulder pain without injury depends on the cause:
 

• Osteoarthritis
  • Rest
  • Modifications to activities
  • Stretching
  • Anti-inflammatory drugs
  • Corticosteroid injections
  • Surgery
• Rheumatoid arthritis
  • Rest
  • Exercise 
  • Physical and occupational therapy
  • Nutrition and dietary therapy 
  • Disease-modifying antirheumatic drugs (DMARDs) 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
  • Steroids
  • Surgery
• Compression of a nerve in the neck (cervical nerve root impingement)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
  • Corticosteroids, either oral or injected
  • Physical therapy: may include gentle cervical traction and mobilization, exercises, and other methods to reduce pain
• Frozen shoulder (adhesive capsulitis)
  • Physical therapy 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
  • Corticosteroid injections
  • Surgery
• Thoracic outlet syndrome
  • Physical therapy 
  • Injection of anesthetics or steroids
  • Anticoagulation
  • Surgery
• Referred shoulder pain
  • Treat the underlying condition