This or That: Lateral Shoulder Pain

Would you rather... do all of the exercises you see on Instagram for “shoulder pain” OR learn to understand your body and what you’re feeling so that you can do the 2 or 3 most important things to get better?

If you’re anything like us, you chose the latter. If so, our This or That segments are exactly what you’re looking for.

What does it mean when the side of my arm hurts? It’ll just go away, right? How do I know if it’s serious? When do I ask for help? Should I stretch it? Did you just catch yourself nodding, like, “yeah that’s totally me.”? If so, here are some of the answers that you’re probably looking for.

Let’s dig in.

There are a few causes for pain on the outer part of the upper arm. Some are treatable by a physical therapist, and others require attention from a different specialist. In order to find the right solution and the best next step, it is helpful to identify, relatively speaking, what tissues are involved.

Generally speaking, there are two things that are most likely producing symptoms in the upper arm, either your shoulder or your neck. But there is a third that is incredibly important, and the next paragraph is the most important of this entire piece…

Red flags should always be considered first. In the case of pain in the upper arm, we must ensure that symptoms are not related to potential heart attack (or cardiac infarction). If you are having pain, pressure or a squeezing sensation in the arm or chest, shortness of breath, high levels of fatigue and malaise and/or lightheadedness and dizziness, please seek medical assistance and inform them of your symptoms so that a thorough cardiac screen can be performed prior to anything else. 1

So red flags are clear, now where do we go? You might think that the easiest and most crude way to determine where your symptoms are coming from is to move the limb and see if it causes pain. While this is not incorrect, odds are, if you are having symptoms in the upper arm that are being generated by structures in the neck, moving your arm will in fact cause pain. This will lead to a misdiagnosis of “true” shoulder pain, incorrect treatment plan, and ultimately yield poor outcomes. This is why we have to dig a little deeper using a top down approach.

If the neck is causing symptoms in the arm, it’s most likely the result of an irritated nerve. There are a few things that can cause nerve irritation. You might commonly see words like pinching or compression or entrapment, but truthfully, nerves are built to withstand some degree of compression. Whether you have pain or not, some degree of nerve compression is a very normal and regular part of movement. Here’s 5 things you can expect if you have a symptomatic level of nerve compression.

• Pain, numbness, tingling, or burning in the shoulder that may travel as far as the hand

• Increased sensitivity in the region of pain (especially cold and hot)

• Decreased sensation in area of pain

• Pain that seems to move up and down the arm depending on the activity

• Pain increases at night and improves with movement and through day

So what about the shoulder? Again, there are several structures in the shoulder that can generate pain. For now, we will put them all into one category of “true” shoulder pain. We can talk later about what some of these various conditions are, what they look like, and how their impact on your life can be minimized. Here are 5 things you can expect with “true” shoulder pain.

• Shoulder pain that does not extend beyond the elbow

• Pain with carrying items with an arm extended

• Pain when reaching to grab something behind you

• Pain when pushing out or rotating arm

• Pain with overhead movements

Now, it’s important to understand that these are not the only potential symptoms for true shoulder or neck pain. However, in the interest of differentiating neck related and “true” shoulder pain, these lists, to us, prove most valuable.

Next, we will talk about some different causes for “true” shoulder pain, and then we will let you know what you can do about it.

Now, this information isn’t enough to determine the best treatment approach, but it gets us in the ballpark. Next, we want to zoom in on some specific shoulder pathologies and how they can be remedied.

If you’re a provider, let us know your thoughts and insights. Together, we can build a better future. For everyone.