Shoulder Pain by Location: Front, Top, Side or Back

When your shoulder is hurting, the spot that hurts is one of the most useful clues. Pain on top of the shoulder often comes from the AC joint. Pain at the front often involves the biceps tendon or the front of the rotator cuff. Pain on the outer side of the upper arm is most often the rotator cuff. Deep pain with stiffness points to frozen shoulder or arthritis. Some shoulder pain starts in the neck.

This page goes through each area in turn: what it tends to feel like, what makes it worse and what usually sets the possible causes apart. It narrows things down. It does not diagnose. A physical therapist or doctor who examines your shoulder can do that.

First: the signs that skip the line

Call your local emergency number now: shoulder pain with chest pressure or tightness, breathlessness, sweating, nausea or lightheadedness, or pain that spreads to the jaw, neck or arm. This is especially important when the left shoulder is involved.
Go to the emergency department: after a fall or a blow, if the shoulder looks out of shape, you cannot move the arm at all, or the arm is cold, pale or numb.
Get medical care today: a hot, red, swollen shoulder with fever or feeling unwell, especially after a recent injection, surgery or skin infection.
See a doctor within days: a sudden loss of strength so you cannot lift the arm after a fall or a heavy lift, or pain at the tip of the shoulder with pain under the ribs on the right or upper belly pain.

Top of the shoulder

Pain sits at a point on top of the shoulder where the collarbone meets the shoulder blade. You can often cover it with one fingertip. Reaching across your body, lying on that side, push-ups and bench pressing tend to make it worse.

AC joint sprain: usually follows a fall onto the point of the shoulder, common in cycling and contact sport. There may be a bump on top of the shoulder. Mild sprains often settle within a few weeks; more severe ones take longer.
AC joint arthritis: a gradual ache in people over about 40 or those with years of heavy lifting. It is tender to press and sore with arms crossed or reaching across the body.
Upper trapezius tension or neck pain: a broader ache sloping from the neck. It changes with neck movement, not with reaching across.

Front of the shoulder

The ache sits at the front of the shoulder and sometimes runs a short way down the front of the upper arm. Lifting with the palm up, carrying shopping bags with bent elbows, reaching behind to a back seat and throwing tend to bring it on.

Biceps tendon irritation (biceps tendinopathy): tender along a groove at the front of the upper arm. Worse lifting with the elbow bent and palm up. It often appears alongside rotator cuff problems.
Front of the rotator cuff (subscapularis): pain and weakness pressing the hand into the belly or reaching behind the back.
Labral tear or instability: a deep catching, clicking or a feeling the shoulder may slip, often in younger, active people or after a dislocation. Worse with the arm up and turned out, as in throwing.

Sudden pain at the front with a pop, then a bulge low in the upper arm (sometimes called a Popeye muscle), suggests a ruptured biceps tendon. See a doctor within a few days.

Outer side and upper arm

This is the most common place for shoulder pain. It often feels like it is in the upper arm rather than the shoulder, partway down the outside. Lifting the arm out to the side or overhead, reaching into a cabinet, putting on a jacket and lying on that side at night tend to make it worse.

Rotator cuff pain (rotator cuff tendinopathy): an ache with lifting, worst in a middle part of the range, often about shoulder height. Night pain is common. Many people improve over about 6 to 12 weeks with the right exercise, and some take longer.
Bursitis (subacromial bursitis): the fluid-filled sac above the rotator cuff is irritated. It feels much the same as rotator cuff pain and often comes with it.
Impingement (subacromial pain): a name for pain when lifting the arm, often between about shoulder height and overhead. It overlaps heavily with the two above, and many clinicians now group all three as subacromial shoulder pain.
Rotator cuff tear: pain plus weakness, especially lifting or turning the arm out. After a fall or a heavy pull, sudden weakness raises the chance of a tear.

Back of the shoulder

Pain at the back of the shoulder can be hard to separate from the shoulder blade. Reaching across the body, throwing and some pulling exercises tend to aggravate it.

Back of the rotator cuff (infraspinatus and teres minor): pain turning the arm out, such as reaching for a seatbelt or throwing.
Tight back of the shoulder (posterior capsule): stiffness reaching across the body or behind the back, common in throwing sports.
Pain referred from the neck: an ache over the shoulder blade and back of the shoulder that changes with neck movement more than arm movement.

Which movement brings the pain on often says more than where it sits.

Deep, all over, with stiffness

The pain feels deep inside the joint rather than at one point, and the shoulder is stiff in every direction. Reaching behind your back, doing up a bra clasp or tucking in a shirt, and reaching out to the side all become hard. Night pain is common.

Frozen shoulder (adhesive capsulitis): most common between about 40 and 60, and more common in people with diabetes or thyroid problems. Pain comes first, then stiffness, especially turning the arm outward. The stiffness is the same whether you move the arm or someone else moves it for you. It often runs one to three years, and many people regain most of their movement.
Shoulder arthritis (glenohumeral osteoarthritis): more common after 60 or after an old injury. Grinding or crunching with movement, gradual stiffness, and pain that tends to build over months to years rather than in phases.
Stiffness after rotator cuff pain: someone who has avoided using a painful shoulder for weeks can lose movement. Reaching overhead is usually more affected than turning out.

Shoulder pain that comes from the neck

The neck can send pain to the shoulder, the shoulder blade and down the arm. It often feels like a shoulder problem.

Referred neck pain: turning, tilting or looking up changes the shoulder pain. Arm movements may not hurt much at all.
Pinched nerve in the neck (cervical radiculopathy): pain that runs past the elbow, with tingling, numbness or weakness in the arm or particular fingers.
Both at once: neck and shoulder problems are common and often occur together, especially after 50. Treating one may leave the other.

Where else this could be coming from

Heart: pain in the left shoulder or arm with exertion, chest pressure or breathlessness needs emergency care.
Lungs and diaphragm: pain at the tip of the shoulder that is worse breathing in deeply can come from the lining of the lung or the diaphragm.
Gallbladder and liver: pain at the right shoulder blade or right shoulder tip, often after fatty meals, with pain under the right ribs.
Upper back and shoulder blade: stiffness in the upper back and poor shoulder blade control can feed pain at the back and top of the shoulder.

Still not sure

Get assessed by a physical therapist or doctor if your shoulder pain is not clearly easing after about one to two weeks, if it is waking you most nights, if you are losing movement or strength, or straight away for any of the signs at the top of this page.

Before you are seen, note where the pain sits, which movements bring it on, whether neck movement changes it, how you are sleeping and anything you can no longer do, such as reaching a high shelf or fastening a seatbelt.