The shoulder trades stability for range of motion. That is why shoulder injury and pain follow so easily from crashes and falls.
How does a crash or fall injure the shoulder?
In a crash, the seat belt loads the shoulder directly. A fall onto an outstretched hand drives force right through it.
Rotator cuff tears, impingement, labral injury and bursitis all cause pain patterns that overlap.
Shoulder pain can also come from the neck. That is why we examine the neck in every shoulder assessment here.
See every joint and tendon we treat with PRP, bone marrow or fat on our PRP injections in St. Louis page.
What does a shoulder injury feel like?
- Pain on the outer upper arm, not on the joint itself.
- Worse reaching overhead or behind the back.
- Night pain, especially when lying on that side.
- Weakness lifting or holding the arm out.
How is shoulder pain treated?
- An exam that tells a true shoulder problem apart from pain coming from the neck.
- Joint or bursa injection under guidance.
- Physical therapy for the rotator cuff and scapular control.
- Surgical referral for significant structural tears.
To be assessed, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
Imaging finds rotator cuff tears in a large share of people over sixty who have no pain at all. So finding a tear does not show it is the cause of pain. A tear that hurts and a tear that does not look identical on a scan.
The cause most often missed is pain coming from the cervical spine (the neck). Say someone else can move your arm through its full range without pain. Or you have numbness anywhere in the arm. Either way, the neck deserves an exam before any shoulder injection.
What to expect over time
Many full-thickness cuff tears are managed well without surgery, especially in older patients, because the rest of the cuff and the deltoid make up for it well with proper rehab.
Adhesive capsulitis — frozen shoulder — runs its own course of freezing, frozen and thawing over roughly eighteen months to two years. And it does go away. Spotting it matters mainly to avoid pointless surgery during the frozen phase.
How can I tell if my shoulder pain is serious?
Being unable to lift the arm at all after an injury may mean a large cuff tear or a dislocation. It needs prompt assessment. Shoulder pain with fever, or a hot swollen joint, needs emergency review. Left shoulder pain with chest discomfort, shortness of breath or sweating is a heart question until proven otherwise.
What causes shoulder pain?
The shoulder trades stability for range, and that trade explains its problems. They include rotator cuff tendon degeneration (the tendon breaking down) and tears, and impingement in the subacromial space under the top of the shoulder. Add biceps tendon pain, labral injury, and adhesive capsulitis. In that last one, the joint capsule itself tightens and range is lost in a typical pattern.
What it gets confused with
Pain sent down from the neck is the common trap. Pain from the neck settles over the shoulder and upper arm and gets treated as a cuff problem for months. The test that sorts it out: do symptoms change with neck position, or with shoulder movement while the neck stays still? Rotator cuff findings on imaging are also extremely common in people without symptoms.
What the imaging can and cannot tell us
Imaging is good at ruling out serious disease and poor at finding the source of pain. Degenerative findings are close to universal past middle age. They show up in large numbers of people with no symptoms at all. So a report listing several problems rarely settles which one hurts. Where a scan will not change the plan, we will say so instead of ordering it.
Frequently asked questions
Do rotator cuff tears always need surgery?
No. Many partial and even full-thickness tears are managed well without it, especially in older patients.
Is my rotator cuff tear the cause of the pain?
Not automatically. Cuff changes are common in people with no shoulder symptoms. The exam shows whether it is causing your pain.
Why does my shoulder hurt when I turn my head?
Because the source may be the cervical spine, not the shoulder joint. This is one of the more common mix-ups here.
That is the subject of Cervical Radiculopathy.
What are the warning signs of a rotator cuff tear?
Weakness when you lift the arm or hold it out. Pain on the outer upper arm that is worse reaching overhead or behind your back, and at night, especially lying on that side. Being unable to lift the arm at all after an injury can mean a large tear or a dislocation and needs prompt assessment. A tear on a scan alone does not prove it is the cause.
Why does my shoulder hurt when I lift my arm?
Pain on lifting usually comes from the rotator cuff or from impingement, where the cuff tendons are pinched in the space under the top of the shoulder. Weakness holding the arm out points further toward the cuff. The neck is always checked as well, because pain from the cervical spine settles over the shoulder and upper arm and is easy to mistake for a cuff problem.
What would cause shoulder pain without an injury?
Wear rather than a single event: rotator cuff tendon degeneration, impingement, biceps tendon pain, and frozen shoulder, where the joint capsule tightens and range of motion is lost. Frozen shoulder runs through freezing, frozen and thawing phases over roughly eighteen months to two years. It does go away. Pain referred from the neck is the other common source.
Sources
- Weber S et al. Management of Rotator Cuff Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 2020. PubMed 31599763
- Desmeules F et al. Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline. The Journal of orthopaedic and sports physical therapy, 2025. PubMed 40165544
- Page MJ et al. Manual therapy and exercise for rotator cuff disease. The Cochrane database of systematic reviews, 2016. PubMed 27283590
- Matlak S et al. Postoperative Rehabilitation of Rotator Cuff Repair: A Systematic Review. Sports medicine and arthroscopy review, 2021. PubMed 33972488
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.