Back Of Shoulder Pain

Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board

Back Of Shoulder Pain: Causes, Symptoms, Diagnosis & Treatment of pain behind the shoulder

Back of shoulder pain is common with lots of possible causes, and different symptoms will indicate different problems.

There might be pain behind the shoulder blade which may indicate a scapula problem or there may be tingling in the back of the shoulder which could indicate nerve involvement. 

There might be a small, localised area of pain behind the shoulder which is easy to pinpoint, but more often the pain is quite diffuse making it difficult to tell where exactly it is coming from.

It might even stretch downwards causing back of arm pain. And in some cases, the problem isn't actually in the shoulder, the pain is actually referred from somewhere else.

So it's not always easy to work out what is causing pain behind the shoulder. Here we will look at the common causes of back of shoulder pain, how they present and how to treat them.

Common Causes of Back Of Shoulder Pain

Pain behind the shoulder is usually caused by a problem in the:

  1. Shoulder Joint: e.g. impingement, arthritis, frozen shoulder, labrum tear, fracture/dislocation
  2. Shoulder Muscles: e.g. rotator cuff tear, tendonitis (triceps and infraspinatus), myofascial trigger points, muscle strain
  3. Neural System: e.g. nerve compression (disc protrusion/degeneration), thoracic outlet, brachial neuritis, stenosis
  4. Medical Condition: e.g. tumor, heart problems
  5. Shoulder Blade Region: e.g. scapulothoracic bursitis

We will start off by looking at the possible causes of back of shoulder pain that come from the shoulder joint itself and then go on to look at other possible problems that can refer pain behind the shoulder.

1. Shoulder Joint Problems

Pain at the back of the shoulder is often caused by a problem in the shoulder joint itself, either affecting the bones, joint capsule or the labrum. The most common problems at the shoulder joint that cause back of shoulder pain are:

Impingement Syndrome

A common cause of back of shoulder pain is posterior shoulder impingement syndrome

Common Causes Of Back Of Shoulder Pain: Posterior Impingement Syndrome

Shoulder impingement syndrome is caused by narrowing of the subacromial space at the top of the shoulder due to:

  • Bony Abnormalities: anything which changes the shape or angle of the acromion (part of the shoulder blade) e.g. bone spurs
  • Inflammation: of one of the tendons or the bursa e.g. subacromial bursitis

Narrowing of the subacromial space leads to increased friction and pressure on the tendons, particularly when the arm is above head height as that position further reduces the subacromial space. 

Posterior shoulder impingement syndrome typically causes compression on the supraspinatus and infraspinatus tendons which leads to:

  • Back Of Shoulder Joint Pain: Deep, poorly localized aching pain at the back of the shoulder, may extend to back of arm pain, but rarely any pain below the elbow
  • Worse With Throwing Activities: particularly the late cocking phase of throwing when the shoulder is abducted, extended and externally rotated (twisted backwards) 

Posterior shoulder impingement syndrome typically affects people who do repetitive activities with their arm above shoulder height such as overhead throwing sports and DIY.

Find Out More: Shoulder Impingement Syndrome: Causes & Treatment

Labrum Tear

Another possible cause of back of shoulder pain is a tear in the glenoid labrum, the ring of cartilage that sits round the edge of the shoulder socket to increase stability.

Pain Behind The Shoulder: Labrum Tears. From shoulder-pain-explained.com

There are two types of shoulder labrum tear:

  1. SLAP Tear: affects the top part of the labrum
  2. Bankart Lesion: affects the bottom part of the labrum

Labrum tears are typically a result of sporting injuries, falls, awkward heavy lifting or shoulder dislocation.

Shoulder labrum tears usually cause:

  • Pain Behind Shoulder: dull, aching back of shoulder joint pain that gets worse when lifting things or raising the arm above shoulder height
  • Weakness & Instability: it may feel like the shoulder is going to “pop-out”
  • Difficulty Throwing: due to pain, weakness and muscle fatigue
  • Catching Sensation: when moving the arm

Back of shoulder pain from a labrum tear is more commonly from a SLAP tear whereas a Bankart lesion typically causes front shoulder pain.

Find Out More: SLAP Tears & Bankart Lesions

Frozen Shoulder

Another possible cause of pain behind the shoulder is adhesive capsulitis, more commonly known as a frozen shoulder. 

Back Of Shoulder Pain: Adhesive Capsulitis. From shoulder-pain-explained.com

With adhesive capsulitis, there is inflammation, thickening and tightening of the shoulder joint capsule.

The cause is often unknown but may be linked to shoulder injuries, surgery or certain medical conditions.

Adhesive capsulitis is most common between the ages of 40-70 and is more prevalent in females.

The common symptoms of a frozen shoulder are

  • Shoulder Pain: increasing pain at the front, side and back of the shoulder
  • Shoulder Stiffness: increase stiffness and reduced range of motion at the shoulder which can be profound

A frozen shoulder typically goes through three phases. In phase one, the pain gradually gets worse and worse but with little restriction of movement. In phase two, the pain reduces but the shoulder becomes increasingly stiff. In phase three, the shoulder gradually thaws out until you regain full pain-free range of motion.

Find Out More: Frozen Shoulder: Causes, Treatment & Recovery

Shoulder Fractures

One of the more serious causes of back of shoulder pain is a fracture, aka broken shoulder bone. It takes a great deal of force to break the shoulder, and fractures are typically caused by a fall or a direct blow to the shoulder. Any one of the three shoulder bones can break, the collarbone, humerus or shoulder blade. 

Shoulder fractures can be extremely painful and may limit arm movement, but don’t always require surgery. 

Find Out More: Shoulder Fractures: Causes, Types & Treatment

2. Shoulder Muscle Problems

Pain behind the shoulder can also be caused by problems in the shoulder muscles and tendons. There may be inflammation, degeneration, weakness or tightness in the soft tissues causing back of shoulder pain.

Rotator Cuff Tear

The rotator cuff is a group of four muscles that encircle the shoulder joint providing strength, stability and power in the shoulder. The rotator cuff muscles each arise from the front of the shoulder blade and attach on to the top of the humerus at the front of the shoulder. 

Rotator cuff injuries to infraspinatus or teres minor are more likely to cause back of shoulder pain than supraspinatus or subscapularis injuries due to their position.

Rotator cuff tears usually develop:

  • Suddenly: usually due to a fall or awkward lifting
  • Gradually: over time due to repetitive wear and tear

Posture and age can also play a part. Rotator cuff tears typically cause:

  • Shoulder Pain: dull ache deep inside the shoulder, gets worse when lifting arm above your head. May also be some shoulder pain back of arm
  • Shoulder Weakness: particularly when lifting or twisting the arm

Find Out More: Torn Rotator Cuff: Causes & Treatment

Shoulder Tendonitis

If the back of your shoulder hurts, it could be from tendonitis, inflammation of one of the shoulder tendons.

The most common type of shoulder tendonitis to cause back of shoulder pain is triceps tendonitis. Triceps tendonitis may be caused by repetitive overuse or an injury. Typical symptoms of triceps tendonitis include:

  • Back Of Shoulder Pain: and tenderness over the long head of triceps tendon
  • Worse With Activity: anything that uses the triceps e.g. carrying, pushing or pulling heavy items
  • Weakness: in the upper arm

Find Out More: Triceps Tendonitis: Causes, Symptoms & Treatment

Trigger Points

Myofascial trigger points are a common cause of pain behind the shoulder, particularly in people who spend a lot of time sat at a desk. 

Trigger points are small, tight areas of muscle fascia which can be extremely painful. They are often described as knots of muscle and are particularly prevalent at the back of the shoulder, along the lower neck and in shoulder blade region in the trapezius muscle.

The best way to get rid of trigger points is a combination of heat, posture re-education, stretches and massage.

Find Out More: Trigger Points & Trapezius Pain

3. Neural Problems

A lot of the time, back of shoulder pain isn’t caused by a problem in the shoulder itself but is actually referred pain from the neck or the spinal nerves. 

Nerve damage typically causes:

  • Pain: sharp, shooting, burning shoulder pain that may extend down the back of the arm, below the elbow and even into the hand
  • Tingling: in back of shoulder, down arm and possibly into the hand
  • Numbness: decreased sensation both relating to hot/cold and touch
  • Weakness: in the shoulder, arm and hand muscles.

A nerve may be damaged anywhere along its path from the neck down to the hand. Typically nerve pain behind the shoulder is caused by:

Find Out More: Nerve Pain In Shoulder: Causes, Diagnosis & Treatment

4. Medical Conditions

Back of shoulder pain can also be a sign of an underling medical condition. Conditions that can cause pain behind the shoulder include:

  • Heart Problems: e.g. heart attack or aortic dissection
  • Lung Problems: e.g. pleurisy or pneumothorax
  • Abdominal Problems: e.g. gall bladder disease or pancreatitis
  • Cancer: e.g. bone metastases

Some medical conditions which cause back of shoulder pain can be very serious. If you have any of the following symptoms, seek urgent medical attention

  • Shortness of breath
  • Rapid pulse
  • Sweating and/or dizziness
  • Chest pain or tightness
  • Feeling generally unwell or fatigued
  • Unexplained weight loss
  • Nausea or lack of appetite

5. Shoulder Blade Problems

Pain Behind Shoulder Blade: Causes, Symptoms & Treatment

Problems in and around the shoulder blade can also cause back of shoulder pain.

Usually there will be pain behind the shoulder blade and you might find your back of shoulder hurts too.  

Common problems in the shoulder blade that cause pain behind the shoulder include:

Find Out More: Shoulder Blade Pain: Causes, Diagnosis & Treatment

Treating Pain Behind The Shoulder

Treatment for back of shoulder pain will depend on what the underlying cause it but may involve:

What Else Can Help?

Here we have looked at the most common causes of back of shoulder pain and how to identify which one is causing your pain. If your pain is more around the shoulder pain region than at the back of the shoulder joint, have a look at the following articles:

If you need more help working out why the back of your shoulder hurts, visit the shoulder pain diagnosis section or choose from the following articles:

Page Last Updated: 15/02/2022
Next Review Due: 15/02/2024


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References

  1. Shoulder Posterior Internal Impingement In The Overhead Athlete: International Journal Of Sports Physical Therapy
  2. Posterior Shoulder Tightness: Archives Of Physical Therapy