Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board
Pain on top of the shoulder is a common problem that affects many people.
It may stop you from doing the things you love, or may even stop you getting a good night’s sleep.
If you are one of those people who gets shoulder pain right on top of the joint, chances are the problem is coming from somewhere in the shoulder joint itself. If the pain spreads more into the shoulder there may be a problem with the soft tissues.
If you get pain along the top of the shoulder that extends up to the neck or down the arm, chances are there is a neural element to it with some degree of nerve compression. Or you might have top of shoulder muscle pain due to muscle tension from stress or poor posture.
The most common causes of pain on top of the shoulder are:
Here we will look at each of these causes of pain on top of the shoulder, how to tell the difference between them, and how to treat them and get back to the things you love.
A common cause of pain on top of the shoulder is impingement syndrome, affecting 1 in 5 people at some point in their lives. Shoulder impingement syndrome is where the soft tissues at the top of the shoulder get pinched, squashed or trapped. This may be for a variety of reasons.
What Causes It: There is a crucial area at the top of the shoulder known as the subacromial space which forms a sort of tunnel structure. A number of muscles, tendons, ligaments and bursa fit through this tunnel, and anything that reduces the space in this tunnel stops the arm moving properly and is known as impingement syndrome. There may be inflammation, tearing, bone spurs or weakness and instability.
Common Symptoms: Impingement syndrome causes pain on top of the shoulder which may extend down the side of the arm to the elbow, but no further. The pain gets worse when raising your arm above head height as the subacromial space narrows. It usually causes a sharp, toothache type pain along the top of the shoulder rather than an aching or burning pain.
Sleep is often affected with impingement syndrome, particularly if you lie on the affected side, and whilst shoulder movement isn’t normally limited, the arm may start to feel weak making it difficult to lift anything heavy.
Who Does It Affect: Impingement syndrome tends to develop gradually, particularly affecting people between the ages of 45-65.
Find Out More: Shoulder Impingement Syndrome – Causes & Treatment
Another common cause of top of shoulder pain is an injury at the collar bone. The two most common culprits are:
What Causes Them: Clavicle fractures and ACJ injuries are usually the result of a fall or direct impact through the shoulder. With this type of injury, the clavicle may fracture or the ACJ ligament may be over stretched and tear, causing the ACJ to become misaligned
Common Symptoms: Sudden, sharp pain along top of the shoulder. Visible deformity with an obvious bump on top of shoulder. Shoulder movement is usually limited and may be accompanied by a grinding sensation or noise.
Find Out More: Collar Bone Injuries: Causes & Treatment
Another common cause of pain on top of the shoulder is a rotator cuff tear. The rotator cuff is a group of four muscles which surround the shoulder joint, help it to move and keep the shoulder joint stable.
What Causes It: Repetitive friction and/or pressure on the rotator cuff can lead to small tears in the tendon which may get inflamed, causing increased pain. There are three grades of rotator cuff tear, depending on how large the tear is.
Common Symptoms: Dull, aching pain on top of shoulder which may feel deep inside the joint. The pain usually gets worse when twisting or lifting your arm and with activities like brushing your hair or scratching your back. Arm weakness is very common and you may notice strange cracking or popping noises as you move the arm.
Who Does It Affect: Acute rotator cuff tears develop suddenly from an injury e.g. a fall and are most common in the under 30’s. Chronic tears develop gradually from wear and tear, generally either in people aged 30-60 who do a lot of overhead work e.g. racket sports or DIY, or people over the age of 60 due to degenerative changes in the tendons.
Find Out More: Torn Rotator Cuff – Causes & Treatment
Another possible cause of pain across the top of the shoulder is supraspinatus tendonitis. Supraspinatus is one of the rotator cuff muscles and is prone to tearing and inflammation where it passes under the acromial arch on top of the shoulder.
What Causes It: Repetitive friction on the tendon in the subacromial space leads to inflammation and degeneration and eventual tearing. This may be from repetitive overhead activities, anything which reduces the subacromial space e.g. bursitis or bone spurs, heavy lifting or shoulder instability.
Common Symptoms: mild discomfort or pain on top of the shoulder when the arm is above head height which gets progressively worse over time. Tends to be a deep burning, aching top of shoulder pain which limits sustained overhead activities, and there is often arm weakness. Shoulder stiffness is rare although pain may limit movement
Who Does It Affect: Supraspinatus tendonitis tends to affect people over the age of 60, although can affect younger people who do a lot of manual work or play racket sports
Find Out More: Supraspinatus Tendonitis – Causes & Treatment
A SLAP tear is one of the less common causes of top of shoulder pain where there is damage to the glenoid labrum, a special ring of cartilage that encircles the shoulder socket.
What Causes It: Acute SLAP tears are usually caused by a fall onto an outstretched hand, sporting injury, heavy lifting or a shoulder dislocation. Chronic SLAP tears are usually caused by repetitive overhead activities or repetitive heavy lifting
Common Symptoms: Dull, aching pain on top of shoulder, worse with shoulder movement or when lifting things above head height. The shoulder typically feels weak and unstable, and like it might “pop-out” of place. Throwing activities are usually affected and there may be a catching sensation with arm movements
Who Does It Affect: Acute tears are most common in the under 40 age group, while chronic tears are most common in the over 40s.
Find Out More: SLAP Tear – Causes & Treatment
Burning pain across the top of the shoulder that extends down the arm or is accompanied by altered sensation is often caused by nerve pain rather than a problem in the shoulder itself
What Causes It: Compression or irritation of one of the nerves in the neck region, which may be due to disc disease, spinal stenosis or cervical arthritis
Common Symptoms: stabbing or burning top of shoulder pain that may extend down the arm and into the hand, tingling, numbness, arm weakness. Shoulder pain tends to be worse with neck movements rather than arm movements and symptoms are often worse in the morning. Heaviness in the arm
Who Does It Affect: Disc bulging/herniation most common ages 30-50, disc degeneration, stenosis and arthritis most common aged 60+
Find Out More: Nerve Pain - Causes & Treatment
Top of shoulder muscle pain is a common problem, particularly in people who spend a lot of time sitting. The main muscles across the top of the shoulders that causes problems is the trapezius, particularly the upper traps, and levator scapulae. Both of these muscles run between the neck and the shoulder blades.
What Causes It: Stress, tension, or poor posture, particularly prominent in people with desk jobs who spend long periods hunched over causing the shoulders and neck to round forwards. This leads to tightness in the front of the chest and weakness in the upper back and shoulder blade region, all of which lead to aching across the top of the shoulders
Common Symptoms: Aching pain along top of shoulders, slumped posture, protruding chin. Tightness and tension in neck and across the shoulders
What Can Help: Improve sitting posture, neck and shoulder stretches, upper back stretches and traps strengthening exercises
The best top of shoulder pain treatment will depend on what is causing your pain but the aim is to
Physical therapy is often really helpful for top of shoulder pain as not only can they fully assess your shoulder and work out what is causing your pain giving you an accurate top shoulder pain diagnosis, they can advise on rehab and provide any manual therapy and electrotherapy treatment that might help such as ultrasound with top of shoulder pain relief
In most cases, non-surgical top of shoulder pain treatment is sufficient and your pain should improve within 6-12 weeks.
Here’s a quick checklist to help you with your top of shoulder pain diagnosis
Here we have looked at the most common causes of pain on top of the shoulder and the classic features of each. However accurate top shoulder pain diagnosis can be difficult, particularly if there isn’t just shoulder pain right on top and there are a range of other symptoms. The best way to get an accurate diagnosis is to see your doctor or physical therapist.
You can also check out our shoulder pain diagnosis guide or you may be interested in the following articles
Page Last Updated: 16/05/2022
Next Review Due: 16/05/2024
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