Sudden Shoulder Pain Without Injury: Causes Revealed

It is often difficult to identify the exact cause of sharp shoulder pain, which may result from rotator cuff tendonitis, AC degeneration, or frozen shoulder. This blog outlines the possible causes of sudden shoulder pain without injury, depending on the location. We also define the available treatment options and assess their suitability for you.

What Makes Up the Shoulder?

The shoulder is a complex joint consisting of three bones: the upper arm (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The shoulder joint is a ball-and-socket joint, allowing greater movement across all ranges. However, this increased movement also increases the risk of instability or dislocation. The shoulder joint is complex, with many causes of shoulder pain.

Sudden Shoulder Pain without Injury Causes

Generally, the location of your shoulder pain can help with the diagnosis.

Sudden Shoulder Pain without Injury: Top of Shoulder

The AC joint is the most common cause of pain at the top of the shoulder. Problems with the AC joint include AC degeneration and distal clavicular osteolysis.

AC joint arthritis

AC joint arthritis can cause the joints to wear away and narrow. Pain with AC joint degeneration is localised to the AC joint and worsens with movement across the body and overhead.

Distal calavicualr osteolysis

Distal clavicular osteolysis is associated with bone swelling at the end of the collarbone. Swelling of the clavicle causes pain, particularly during weightlifting. It is common in weightlifters and bodybuilders.

Sudden shoulder Pain without Injury: Outside of the shoulder

Several shoulder conditions can cause pain on the outside of the shoulder.

Rotator cuff problems

Rotator cuff pain can result from subacromial bursitis, rotator cuff tendonitis, and rotator cuff tears. Generally, rotator cuff problems cause pain during overhead or lateral activities. In more severe cases, pain can occur at night. Usually, shoulder movement is not significantly restricted unless you have severe problems.

Frozen shoulder

Also known as adhesive capsulitis, a frozen shoulder starts with pain outside the shoulder. Subsequently, the range of motion becomes limited. Initially, rotating the shoulder outwards is difficult. After that, however, restriction develops in all movements. Generally, there is a restriction in both the active and passive range of motion in a frozen shoulder.

Sudden shoulder pain without Injury: Front of shoulder

Generally, pain at the front of the shoulder is related to problems with the biceps tendon.

Biceps tendonitis

Biceps tendonitis causes pain at the front of the shoulder. Typically, pain develops with activities such as repetitive movements and overhead work.

SLAP tears

A superior labrum anterior-posterior tear (SLAP) is a specific type of labral tear that occurs at the top or prominent part of the labrum. Usually, this type of labral tear occurs after a fall onto an outstretched hand. Symptoms typically appear after overhead activities with associated popping or clicking of the shoulder.

Shoulder arthritis

Shoulder arthritis can cause deep-seated pain or pain at the front of the shoulder. Often, there is a restricted range of active and passive motion.

Rare Causes of Sudden Shoulder Pain without Injury

Although rare, you need to think about these possible causes of your shoulder pain:

Acute brachial neuritis

Acute brachial neuritis is an inflammation of the nerves affecting the brachial plexus nerves. Generally, individuals report severe neck or shoulder pain, followed by muscle weakness and wasting.

Most cases improve with physical therapy.

Paralabral cysts of the shoulder

Paralabral cysts in the shoulder often develop from a tear of the labrum or cartilage of the shoulder. Most cysts do not cause problems. However, if the cysts increase in size, they cause shoulder pain with movement.

Diagnosis of Sudden Shoulder Pain without Injury

Given the many potential causes of sharp pain in the shoulder, you need to assess your symptoms, perform a careful physical examination, and undergo imaging to diagnose correctly.

Generally, shoulder examination involves moving the shoulder and testing strength across various planes. Your doctor will also press on your shoulder to check for tender areas. In addition, examination of the neck and chest is often necessary to rule out other causes.

Imaging will help to get a diagnosis. For example, a shoulder x-ray can confirm AC joint or shoulder arthritis. Often, we use ultrasound to look at the health of the rotator cuff. Finally, MRI can visualise the status of the shoulder joint and cartilage.

Treatment of Sudden Shoulder Pain without Injury

Most cases of shoulder pain will get better with simple treatment. Nevertheless, a more accurate diagnosis will help manage your shoulder pain better.

Modify sports

First, you should modify your current exercise activity. In general, we recommend reducing or eliminating the most provocative activities for shoulder pain. For example, we recommend reducing your racquet sports and modifying your weighted overhead gym activities.

Physiotherapy

Physical therapy will improve your shoulder pain, strength, and range of motion. Regardless of other treatments, we recommend that you see a physiotherapist to help with your shoulder pain.

Medications

Often, anti-inflammatory medication such as ibuprofen eases shoulder pain and swelling. Medications such as ibuprofen will help reduce pain and swelling. However, you must be careful as drugs like ibuprofen can cause side effects.

Shoulder Injections

ultrasound-guided cortisone shot in shoulder - ultrasound image with needle going into shoulder

Shoulder injections help to reduce pain and make your rehab more effective. Injections should be done under ultrasound guidance to improve accuracy and effectiveness.

Generally, we use corticosteroids, potent drugs, to reduce inflammation-induced swelling. The placement of a cortisone shot depends on the cause of shoulder pain. For example, in rotator cuff tendonitis, we inject cortisone into the bursa just above the tendon. Whereas for shoulder arthritis, we inject deeper into the joint. Steroid injections for the shoulder are essential for treatment, but you must be aware of potential problems.

In addition to cortisone, we use other drugs to help with shoulder pain. For example, hyaluronic acid is a natural substance in tendons and joints. We inject hyaluronic acid into shoulder joints, such as the AC or shoulder joint.

Finally, PRP injections have been used for knee arthritis. We get PRP from whole blood. We spin the blood to separate the plasma from the red cells. Then, we inject the plasma into the joints. While PRP has shown beneficial effects in knee arthritis, we lack strong evidence for shoulder arthritis.

Surgery

Surgery is offered for some cases of persistent shoulder pain. However, the evidence for surgery in most causes of shoulder pain is similar to that for physiotherapy. Therefore, shoulder surgery should be performed only if other measures fail.

Frequently Asked Questions on Sudden Shoulder Pain without Injury

What causes night pain?

Generally, night pain is relatively common in shoulder pain. For example, people report night pain from rotator cuff tendonitis and frozen shoulder. Night pain is more common because the shoulder area is compressed more than during the day.

Is a cortisone injection safe?

Generally, a cortisone shot for the shoulder is safe. However, you must be aware of potential cortisone flare and infection problems.

What causes frozen shoulder?

Most cases lack a cause. However, frozen shoulder is more common after trauma or surgery. Additionally, medical conditions such as diabetes or thyroid problems can increase the risk of developing sharp shoulder pain associated with frozen shoulder.

Sudden Pain in the Shoulder Without Injury: What are the Causes?