Shoulder Pain Does Not Always Mean the Problem Is in the Shoulder — Where Could the Pain Be Coming From?

By Teresa Shen, BHSc (Acupuncture), ACC Registered Treatment Provider, Registered Chinese Medicine Practitioner (NZ)

Many patients sit down in my clinic and begin with the same sentence:

“Teresa, my shoulder hurts.”

Some think they have frozen shoulder. Others believe they have strained a muscle. Some arrive with an ultrasound or MRI report showing a rotator cuff problem.

But before I think about treatment, I remind myself of something important:

Shoulder pain is a symptom, not a diagnosis. And pain felt in the shoulder does not necessarily mean the problem begins there.

So my first question is:

Where is this pain actually coming from?

First, I Look at the Shoulder Itself

Most shoulder pain should, of course, first be assessed around the shoulder.

Frozen shoulder, rotator cuff injuries, subacromial bursitis, biceps tendon problems, shoulder instability, and injuries involving muscles, tendons or ligaments can all cause pain.

But they do not behave in exactly the same way.

One patient may gradually lose movement in almost every direction. Another may experience pain only through a particular part of lifting the arm. Someone else may still move reasonably well but notice significant weakness. Another may manage during the day but struggle with severe pain at night.

That is why “my shoulder hurts” is only the beginning.

I want to know: Where exactly is the pain? How did it start? Which movements aggravate it? Is there weakness? Does it disturb sleep? Is active movement different from passive movement?

These details gradually help me narrow down the possible source.

Sometimes the Problem Comes From the Neck or Nerves

This is something I pay particular attention to.

Some patients have had their shoulder treated for months. They may have tried physiotherapy, massage, acupuncture or even local injections, yet the improvement remains limited.

At that point, I have to reconsider the diagnosis:

Are we treating the shoulder when the real problem is somewhere else?

Cervical radiculopathy, irritation of the brachial plexus, thoracic outlet syndrome and other nerve-related problems can produce pain around the shoulder, shoulder blade or upper arm.

Some patients also experience radiating pain, numbness, tingling, burning sensations or weakness.

But nerve symptoms are not always obvious.

Sometimes the patient simply says:

“My shoulder feels uncomfortable deep inside, but I can’t really explain where.”

This is why I do not examine only the place where the patient points.

Where pain is felt and where pain originates are not always the same place.

“Shoulder Pain” May Actually Come From Around the Shoulder Blade

Another common source is the muscles surrounding the scapula.

The rhomboids, levator scapulae and other muscles that help control the shoulder blade can become overloaded, tight or dysfunctional.

Long hours at a desk, repetitive upper-limb work, heavy lifting and sustained postures may all contribute.

The patient may simply describe the whole area as “my shoulder.”

My job is to make that description more precise and identify which tissues are actually involved.

Sometimes the Source Is Even Further Away

Medicine uses the term referred pain when pain is felt in one area but originates somewhere else.

Certain heart conditions, for example, can cause chest discomfort that radiates into the shoulder, arm, back, neck or jaw.

Some problems involving the chest, diaphragm or internal organs may also produce pain felt around the shoulder.

Shingles and post-herpetic neuralgia can cause burning, stabbing or highly sensitive pain around the shoulder and upper back. In some cases, pain may even begin before the rash appears.

This is an important reminder:

Not all shoulder pain is musculoskeletal.

Fortunately, most shoulder pain is not caused by serious disease. But if pain is progressively worsening, does not settle with rest, or is accompanied by chest pain, shortness of breath, fever, unexplained weight loss or significant weakness, I become much more cautious.

Further investigation, GP assessment or specialist referral may be necessary. If an acute cardiac or other medical emergency is suspected, urgent medical care takes priority.

Knowing when to treat and when not to treat is also part of clinical judgement.

Why Doesn’t Traditional Chinese Medicine Simply Treat Where It Hurts?

Traditional Chinese Medicine also encourages us to look beyond the painful spot.

Shoulder pain may involve a local muscle or tendon injury, but it may also be understood through disruption of the channels and the circulation of Qi and Blood.

Different patients may show patterns such as Cold-Damp obstruction, Qi Stagnation, Blood Stasis or deficiency of Qi and Blood.

This is why acupuncture for shoulder pain does not always mean needling only the shoulder.

Treatment may involve local points, distal points along the affected channel, warming methods such as moxibustion, or techniques intended to promote the movement of Qi and Blood. The approach depends on the individual patient.

For me, modern clinical assessment and Traditional Chinese Medicine answer different but complementary questions.

Modern assessment helps me ask:

Is the pain coming from the shoulder joint, muscle, tendon, nerve, or somewhere outside the shoulder?

Traditional Chinese Medicine encourages me to ask:

Why is this particular patient experiencing pain in this way, and what may be preventing recovery?

So when a patient tells me,

“Teresa, my shoulder hurts,”

I do not immediately treat the place they point to.

Shoulder pain is the body’s message, not the final diagnosis.

Where it hurts is not always where the problem is.

Finding the source comes first.

Once the direction is right, treatment can truly begin.

Related Articles

Teresa’s TCM Clinical Reflections | Traditional Chinese Medicine Perspectives on Health, Recovery and Healing

 Teresa’s TCM Clinical Reflections All

Why Does My Shoulder Hurt More at Night?

Why Is My Shoulder Pain Still Not Getting Better?

Why Can’t I Lift My Arm? Is It Frozen Shoulder or a Rotator Cuff Injury?

Where Could the Pain Be Coming From?

Book Online:
https://booking.mananotes.co.nz/PHD-WIN/v2

Disclaimer

This Clinical Reflection is provided for general health education and is based on clinical experience and professional observation. It is not personal medical advice and does not replace an individual medical assessment.

Shoulder pain can have many causes. Seek appropriate medical assessment if your pain is progressively worsening or associated with chest pain, shortness of breath, significant weakness, fever, unexplained weight loss or other concerning symptoms. Suspected acute cardiac or other medical emergencies require urgent medical care.