The most mobile joint in the body, the shoulder joint is prone to injury and pain.[1] This pain may radiate down from the right shoulder into the arm, and at other times, upper arm pain may refer to the shoulder or originate in the neck.[2]
What are the symptoms of Right Shoulder and Arm Pain?
Symptoms include pain and tenderness around the shoulder that worsens with movement or lifting objects. Other common symptoms include stiffness, swelling, a sense of instability, loss of range, or weakness. Along with the shoulder pain, you may experience pain that radiates into your right arm.
What Causes Right Arm and Shoulder Pain?
Many factors contribute to the development of right shoulder and arm pain. In many cases, the pain may be the result of muscle overuse or injury. Other causes include fractures, dislocations, arthritis, inflammation, rotator cuff syndrome, nerve injuries, and neck injuries.
Common Causes of Right Shoulder and Arm Pain
1. Rotator Cuff Syndrome
Rotator cuff syndrome refers to irritation or inflammation of the rotator cuff. The rotator cuff is a group of tendons and muscles that support the shoulder joint. These structures hold the arm bone firmly into the shoulder socket. Often these tissues become inflamed because of overuse or injury. Rotator cuff syndrome may lead to other issues, including:
-
Shoulder Impingement: Impingement occurs when the front part of the shoulder blade (acromion) rubs against the tendons of the shoulder. This often causes pain and swelling with any overhead movements.
-
Shoulder Bursitis: Bursae are the fluid-filled sacs that cushion your shoulder joint. Damage to the rotator cuff may lead to inflammation and thickening of the tendons and bursa, taking up more space causing further inflammation and swelling.
-
Shoulder Tendinopathy: Swelling and inflammation of the tendons of the shoulder joint.
2. Rotator Cuff Tears
Rotator cuff tears occur when there is a partial or complete tear of the tendons and muscles of the rotator cuff. Rotator cuff tears can result from injuries or wear and tear over time.
3. Dislocations
Dislocations occur when your shoulder is pulled back or rotated too far to the point that it pops out of the socket. Dislocations often happen with a fall onto an outstretched arm resulting in swelling, numbness, bruising, and severe pain. Shoulder dislocations also often result in ligament injuries.
4. Ligament injuries
These occur when the ligaments that support the shoulder joint are stretched or torn. Common causes of ligament injuries are falls onto an outstretched arm, direct blows to the shoulder joint, or trauma such as a car accident.
5. Arthritis
Shoulder arthritis occurs with wear and tear of the cartilage that lines the joint. A degenerative condition, arthritis develops over time and can eventually lead to the bones within the shoulder joint rubbing against one another, causing pain and inflammation.
6. Bone spurs
Also known as “osteophytes”, bone spurs are small sharp pieces of bone that begin to form on the surfaces of the bones that make up the shoulder joint. These bone spurs rub on the tendons of the rotator cuff and can result in tendinitis or a rotator cuff tear.
7. Labral injuries
Labral injuries are tears in the cartilage that surround the entire shoulder joint.
8. Frozen shoulder
Frozen shoulder often affects older people. It is characterised by stiffness and pain that prevents movement of the shoulder. There is no known cause of frozen shoulder, although it is thought to develop from inflammation in the joint. Frozen shoulder usually resolves on its own.
9. Calcific tendinitis
Calcific tendinitis is a condition where calcium deposits build up on the muscles and tendons around the shoulder joint causing pain and stiffness. Like a frozen shoulder, the exact cause is not known.
10. Fractured (broken) collarbone
The collarbone (clavicle) is the bone that connects your shoulder to your sternum (or breastbone). Collarbone fractures are common with falls or accidents.
11. Upper arm fractures
Upper arm fractures occur when there is a break in your humerus (upper arm bone). As with collarbone fractures, they are common with falls or accidents.
12. Cervical radiculopathy
Cervical radiculopathy is a condition where nerve pain shoots down into the arm. It occurs when one of the nerves in the neck becomes inflamed or damaged, resulting in numbness, weakness, pins and needles, or shooting pains in the arm. Common causes of cervical radiculopathy include herniated discs, wear and tear of the neck joints, and accidents.
13. Brachial Plexus injuries
The brachial plexus is a network of nerves located under your arm that carry movement and sensory signals to your arm and hand. Brachial plexus injuries are caused by trauma to the neck and shoulder and cause pain, weakness, pins and needles, and weakness in the arm and hand.
How is Shoulder Pain and Arm Pain Diagnosed?
To diagnose what may be causing right shoulder and arm pain, your GP or physiotherapist will ask you questions about your symptoms and medical history. They will also perform a detailed physical examination to assess any structural issues and rule out any problems with your neck or spine.
Next, the examiner will move your arm in all directions to determine whether there are any limitations in your movement. They will also test your shoulder and arm strength.
If the pain in your arm is coming from your neck or spine, the examiner may ask you to move your head from side to side and up and down to see if it increases your symptoms. They may also test your reflexes with a special hammer and ensure that your sensation is intact.
Often, other imaging tests are necessary to understand what is causing the pain. These include X-rays, MRI scans, CT scans, electromyography (EMG), and arthroscopy.
How is Shoulder and Arm Pain Treated?
There are various treatment options for shoulder and arm pain, depending on the cause. Severe conditions such as fractures, dislocations, ligament, and muscle tears require emergency care. Dislocations without ligament damage will be relocated and put in a sling while the shoulder heals. Fractures and complete ligament or muscle tears may require surgery and must be kept in a sling for up to 4 – 6 weeks.
Severe shoulder pain that does not require surgery may be treated with corticosteroid injections and prescription medications such as pain killers and oral corticosteroids.
Suppose your arm and shoulder pain is caused by compression of the nerves in your neck. In that case, your doctor will determine the degree of damage and recommend conservative treatment such as medications and physiotherapy.
Physiotherapy interventions include:
-
Manual therapy: Gentle movements of the shoulder, arm, and neck joints. Physiotherapists will also release any tightness of the muscles in the area.
-
Taping: Your physiotherapist may apply adhesive tapes to the area to provide support.
-
Electrotherapy: Electrotherapeutic modalities such as ultrasound help reduce swelling.
-
Gentle stretching and strengthening exercises: Your physiotherapist may prescribe exercises that help improve the strength and mobility of your shoulder, arm, and neck muscles.
The goal of physiotherapy is to reduce shoulder and arm pain and restore strength and mobility.
Outlook
Many different conditions can cause pain in the right shoulder and arm. Sometimes the pain stems from an injury to the shoulder itself, and other times the pain radiates from the neck down into the shoulder and arm. Common causes of shoulder and arm pain include rotator cuff issues, arthritis, ligament and tendon injuries, bone spurs, bursitis, frozen shoulder, and calcific tendinitis.
Pain can also radiate down from the neck and cause pain that shoots into the arm, common in cervical radiculopathy and brachial plexus injuries. Some conditions will heal with more conservative treatment such as physiotherapy and over-the-counter medications, while more severe injuries may require surgery.
Anatomy of the Shoulder
The shoulder joint is a ball and socket joint formed by the upper arm bone (humerus) and the shoulder blade bone. The upper arm bone is shaped like a ball that fits into the socket of the shoulder blade, which is shaped like a cup. Above the joint lies the acromion, which provides the joint with stability. The joint is held together and surrounded by ligaments and muscles, which are secured onto the bones by tendons.
