Author: Chloe Wilson BSc (Hons) Physiotherapy
Burning shoulder pain can be extremely unpleasant. It may be there constantly or come and go, affect a small area or travel down the arm or even in to the neck or back. It often affects how well you sleep.
It may be caused by a problem in the shoulder joint or surrounding tissues, however in most cases, burning shoulder pain is actually related to a problem in the neck, even if there are no neck symptoms.
Here we will look at the most common causes of burning pain in the shoulder and the common features of each, such as associated symptoms and typical age groups affected.
This will help you identify which one is most likely to be the cause including how to tell whether it is a shoulder problem or actually something wrong in the neck, a common cause of burning shoulder pain.
So how can you tell if your burning shoulder pain is due to a shoulder problem or a neck problem. Here is a simple guide to help.
As most cases of burning pain in the shoulder tend to be due to an issue in the neck, we will start there, and then go on to look at possible shoulder problems or other medical conditions that can cause burning shoulder pain.
Often, burning pain in the shoulder is actually caused by a problem in the neck or surrounding nerves. Even if you haven’t noticed any pain or stiffness in the neck itself, it may be what is called “referred pain”, meaning that the pain is felt in a different location to the source of the problem.
The neck is made up of seven bones, known as vertebra, that sit on top of each other like a curved pillar - imagine a stack of cotton reels. In between the bones are flexible ring shaped structures known as discs, which have a thick outer layer of cartilage (annulus) and inner gel-like material (nucleus) - imagine a jam donut.
Running down the back of the spine, from the bottom of the brain, through a hole known as the spinal canal is a long cable known as the spinal cord – imagine a tree trunk. At each spinal level (each cotton reel), a pair of nerves (known as nerve roots) divide off the spinal cord and then branch out into long nerves which extend down various parts of the arm – imagine branches coming off the tree trunk.
Signals travel up and down the nerves (known as the peripheral nervous system), to and from the brain and spinal cord (the central nervous system). The central nervous system sends out instructions to the peripheral nervous system to control movement (e.g. tells muscles when and how to work) and interprets incoming sensory signals from the peripheral nervous system (e.g. touch – sharp, hot etc.).
If a nerve is irritated, for whatever reason, it can lead to abnormal sensations anywhere along the path of the nerve. A common symptom of nerve irritation is burning shoulder pain, but there may also be tingling, pins and needles, numbness and/or weakness. These abnormal sensations may be felt anywhere along the path of the nerve, known as referred pain or radiculopathy.
Burning shoulder pain is typically due to nerve irritation from one of the following:
Pressure on the nerve root due to problems in the disc is a common cause of burning pain in the shoulder. It may be caused by:
i) Disc Bulge
When the central gel-like portion of the disc (the nucleus) protrudes out placing pressure on the nerve root
ii) Disc Herniation
A tear develops in the discs outer layer (the annulus) allowing the nucleus to leak out, collecting around and irritating the nerve root – imagine squashing a donut until the jam escapes out.
This is commonly, and unhelpfully, referred to as a “slipped disc” - the disc itself does not pop in and out, it is firmly held in place, it is only the nucleus that leaks out
iii) Disc Degeneration
As we age, our discs dehydrate, becoming less plump, less flexible and weaker – think now of a stale donut. It provides less space between the vertebrae, less cushioning, doesn’t adapt as well to movement and it is more likely to get damaged, any of which can lead to pressure on the nerve root
Burning shoulder pain that is due to disc disease in the neck usually:
a) Affects one arm (occasionally it may affect both arms), spreading further down the arm over time
b) Worsens when you cough or sneeze as those movements increase the pressure in the discs
c) Worsens with certain neck movements as the disc gets squashed
d) Is accompanied by other symptoms such as pain, tingling/pins and needles, an “ant-like crawling" sensation or even numbness
e) Is worse first thing in the morning as discs “plump up” slightly overnight (due to less pressure on the discs when you lie down), increasing the size of the bulge
f) Is not affected by arm movements i.e. moving the arm doesn’t bring on the pain unless the movement places the nerve under tension
g) Comes on gradually (disc degeneration or disc bulge) or suddenly (disc bulge or herniation) from an injury such as heavy lifting
h) May or may not be accompanied by neck pain
i) Disc bulge/herniation usually affects people aged 30-50, disc degeneration typically affects those over 60
Spinal stenosis is another possible cause of burning shoulder pain. This is when there is abnormal narrowing of the spinal canal (the gap in the spine for the spinal cord) which places increased pressure on the spinal cord and nerve roots.
Symptoms usually start to appear when the spinal canal space has decreased by around 30%. Limited space at the side of the canal affects the nerve root, whereas central narrowing affects the spinal cord. Burning shoulder pain due to spinal stenosis usually:
a) Starts gradually rather than suddenly
b) May refer down the arms and legs
c) Affects both arms
d) Worsens when flexing the neck (looking down) or standing
e) Affects hand function making activities such as writing or cutting food difficult
f) May be accompanied by weakness, pins and needles, numbness, pain and heaviness in the arms
g) In severe cases may affect bladder and bowel function, cause balance problems or paralysis
h) Affects those over the age of 50
Cervical stenosis can be extremely serious if there is too much narrowing of the spinal canal and the spinal cord is affected. In severe cases, surgery may be needed.
Brachial neuritis causes weakness and a sharp, burning pain in the shoulder, shoulder blade, arm and hand. It is caused by inflammation of the brachial plexus, a collection of nerves that travel from the lower neck, across the front of the chest, to the arm pit.
This can be a hereditary condition (from a gene mutation), or due to a problem in the immune system e.g. following an illness, surgery or immunisation. Burning shoulder pain from brachial neuritis typically:
a) Comes on suddenly, usually at night, with immediate severe, sharp, stabbing, burning pain in shoulder
b) Is constant – never settles
c) May spread down the arm as far as the hand
d) Usually only affects one arm
e) Gets worse with arm movements
f) Is worse at night time
g) Arm weakness may develop after a few weeks making it hard to move the arm
h) May be accompanied by tingling or numbness in the arm or occasionally shortness of breath
i) Affects more men than women
j) Most common in young/middle aged adults, can affect children
Treatment usually involves a combination of strong painkillers, physical therapy and exercises. Find out more about the causes, symptoms and treatment options in the Brachial Neuritis section.
Cervical (neck) arthritis is another possible cause of burning pain in the shoulder caused by wear and tear of the neck bones and discs. Discs start drying out, become weaker and lose height, and the smooth surface on the bones gradually wears away and bone spurs form, narrowing the space around the vertebrae which can place pressure on the surrounding nerves. Neck arthritis is extremely common affecting around 80% of people over the age of 60, but many of those don’t experience any noticeable symptoms.
Cervical spondylosis typically presents with the following picture:
a) Neck pain that radiates to the shoulder and/or shoulder blades often described as a nagging ache or toothache type pain. If there is pressure on the surrounding nerves there may also be burning shoulder pain
b) Neck stiffness e.g. may not be able to turn your head as far to one side
c) Symptoms usually worse in the morning, ease with initial movement, but may then get worse towards the end of the day
d) Symptoms ease with rest
e) Aggravated by neck movements
f) Grinding noise with neck movement
g) May be accompanied by headaches
h) Most common over the age of 60
Most cases of cervical spondylosis respond well to medication and physical therapy.
Whilst most cases of burning shoulder pain come from the neck, it may also be indicative of a problem in the shoulder itself. The two most common shoulder problems that cause burning pain in the shoulder are bursitis and tendonitis:
Burning pain in the shoulder that is fairly localised may be from bursitis. Bursa are small fluid-filled sacs that sit between soft tissues (such as muscles and tendons) and bones, allowing smooth, friction-free movement.
Irritation of the bursa from excessive pressure, injury or repetitive friction can lead to inflammation which can cause burning shoulder pain. There are a number of different bursae located around the shoulder and shoulder blade which may be affected.
Burning shoulder pain from bursitis tends to:
a) Be a low level aching and burning pain in shoulder which gets progressively worse
b) Develop gradually over time unless there was a specific injury
c) Be fairly localised (i.e. over a specific spot) – may start to spread as the condition worsens but will not refer pain below the elbow
d) Get worse with arm movements particularly when the arm is raised above shoulder height
e) Get worse when there is pressure on the bursa e.g. lying on your side
f) Affect sleep causing frequent waking
g) Lead to weakness and stiffness in the arm over time
h) Take several weeks/months to settle
i) Can occur at any age
Burning shoulder pain from bursitis usually responds well to rest, physical therapy, exercises, injections and anti-inflammatory pain medication. Find out more about the causes, symptoms and treatment options in the shoulder bursitis section.
Another cause of burning shoulder pain is tendonitis when there is degeneration and or inflammation in one of the muscle tendons, such as the rotator cuff or biceps tendon. This is usually caused by repetitive friction on the tendon (usually from repetitive activities such as throwing, racket sports or manual labor), excessive pressure from the surrounding structures (e.g. bone spurs), muscle weakness and/or poor posture.
Symptoms of shoulder tendonitis usually include the following:
a) Diffuse aching/burning shoulder and upper arm pain with a localised sharp pain when moving the arm. Does not refer symptoms below the elbow
b) Worse when raising the arm above shoulder height or when moving the arm against resistance (try moving your affected arm out to the side while stopping the movement with your other hand – if there is pain, it may well be tendonitis)
c) Develops gradually over time due to repetitive wear and tear and gets progressively worse
d) There may be accompanying crepitus with arm movements (grating, clicking, grinding noises)
e) Tender to touch over the affected tendon – location will vary depending on which tendon is affected
f) Can occur at any age
Burning pain in the shoulder usually responds well to rest, physical therapy and strengthening exercises – visit the shoulder exercises guide for exercises that can help.
There are a few other conditions that can cause burning shoulder pain:
A condition where a chemical imbalance in the brain and problems in the way the central nervous system processes pain signals lead to widespread aching/burning pain, hypersensitivity, stiffness and fatigue.Fibromyalgia commonly affects people between the ages of 30-50. Burning shoulder pain from fibromyalgia will usually be accompanied by pain in a number of other joints as well as shown on the diagram here.
2) Restless Arm Syndrome
A condition where there is a problem in the central nervous system which causes abnormal movements (e.g. spontaneous jerking movements) and strange sensations such as crawling, tingling and burning shoulder pain. Usually affects both arms and may also affect the legs. Find out more in the Restless Arm Syndrome section.
3) Gall Bladder Problems
The gall bladder is a small sac that stores bile from the liver. Problems in the gall bladder such as inflammation or gallstones can cause burning pain in shoulder. Symptoms include intense abdominal pain which may refer to the shoulder, particularly around the right shoulder blade, chest pain, nausea and heart burn and often feel worse after eating.
If your burning shoulder pain is accompanied by a rash, it may be that you have shingles. The pain may be quite intense. Only one side of the body will be affected.
5) Heart Attack
Burning shoulder pain accompanied by chest pain (usually a tight, crushing pain), shortness of breath, dizziness, nausea and sweating may indicate a heart attack. A heart attack is a medical emergency – seek medical assistance immediately.
6) Sleeping Awkwardly
Burning shoulder pain that starts when you wake up may be due to having slept awkwardly. One of the shoulder muscles or nerves in the neck may have been irritated causing burning pain in shoulder. The pain will usually settle down after a few hours/days – gentle stretching exercises can help – visit the arm stretches section.
7) Muscle Fatigue
Delayed onset muscle soreness (DOMS) can cause burning pain in the shoulder. If you have suddenly increased you activity level or taken up a new sport, this may be the problem.
Any new incidence of burning shoulder pain should be checked out by your doctor to enable a clear diagnosis and effective treatment. If the burning pain in your shoulder is due to a neck problem, physical therapy is often advised to work on strengthening and stretching exercises as well as postural advice.
If your burning shoulder pain is due to a problem in the shoulder itself, you may benefit from a combination of strengthening and stretching exercises - visit the shoulder exercises for a whole range of exercises that can help.
Go to Shoulder Pain Guide
Page Last Updated: 21/03/19
Next Review Due: 21/03/21