Shoulder Center Saar
Shoulder Pain and Its Various Causes
Pain in the shoulder area is very common. The complex structure of the shoulder, with its complex muscular guidance, complicated nerve supply, and close proximity to the cervical spine, can lead to shoulder pain.
Even for the most experienced examiner, it is not always easy to identify which structure is responsible for the pain. Patients who present with virtually identical symptoms can have completely different clinical pictures. For example, one patient may have a herniated disc in the lower cervical spine, another may have a calcification in a shoulder tendon (calcified shoulder), and the next may have shoulder arthrosis, and each patient may complain of virtually the same pain. This requires a very experienced examiner, ideally with X-ray and ultrasound imaging capabilities, to make the correct diagnosis.
It's also typical for the shoulder that the symptoms are often not perceived where the actual problem lies. Many patients complain of pain in the upper arm rather than the shoulder, even though the trigger is located in the shoulder.
The most common locations of shoulder pain
Pain on the side of the upper arm
Many patients who visit our consultation describe their pain on the outside of the upper arm, often slightly below the actual shoulder joint. These patients suspect a muscular problem in the upper arm rather than a shoulder disorder. Many are surprised that the cause of the pain is actually in the shoulder and that the pain in the upper arm is radiating pain from the shoulder. However, with simple examination methods such as palpation of the shoulder and upper arm, the suspicion that the shoulder is the cause of the pain can be confirmed. When palpating the upper arm, we usually find the pain points on the humeral head and the outer edge of the acromion, and not, as the pain is usually located, significantly deeper in the upper arm.
Auslöser dieser seitlichen Schmerzen ist oftmals eine Erkrankung der Sehnen und Schleimbeutel unter dem Schulterdach, wie es bei der Kalkschulter und Impingement-Syndrom der Fall ist.
Shoulder Pain
Shoulder pain that occasionally radiates upwards into the neck is often due to the acromioclavicular joint (AC joint). Here, too, a simple palpation can provide initial clues as to whether the suspicion is correct. Diseases of the acromioclavicular joint often result in the joint becoming swollen and enlarged. Since the acromioclavicular joint is not covered by muscle, it is very easy to feel through the skin. If swelling or lumps are palpable, this is a good indication of the cause of the pain. Pain when pressure is felt directly above the joint also indicates a disease of the acromioclavicular joint.
Pain in the front of the shoulder
Pain in the front of the shoulder radiating to the front of the upper arm (biceps) indicates disease and inflammation of the anterior capsule and the long biceps tendon. A common cause of inflammation is a pulley lesion. This leads to instability of the long biceps tendon and causes tendinitis. Wear and tear of the shoulder joint (gleneohumeral joint) also often causes pain in this area.
Pain from the cervical spine or disc damage
As already mentioned, diseases of the cervical spine, and especially disc damage that occurs in the cervical spine, can also lead to shoulder pain.
Referred pain can occur when an intervertebral disc presses on a nerve that extends into the arm. The image on the left shows the dermatomes of the cervical spine in the shoulder area. The respective dermatome has been highlighted in color. A dermatome is the area supplied by a nerve emerging from the cervical spine. If nerve damage occurs, pain or sensory disturbances typically occur in the associated dermatome (skin area of the nerve). For example, a disc injury between the 5th and 6th cervical vertebrae can compress the C6 nerve, which branches off from here, causing pain in the lateral upper arm and the lateral shoulder (blue marking).
Dark Blue: Dermatome C6
Green: Dermatome C5
Yellow: Dermatome Th1
Turquoise: Dermatome C8
Pink: Dermatome C4
Because the cause of shoulder pain is so variable and even similar or even identical symptoms can be triggered by different medical conditions, it is always best to consult an experienced physician specializing in shoulder disorders to obtain the correct diagnosis. This can prevent unnecessary discomfort or even worsen a condition.