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Understanding your shoulder pain

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Understanding Your Shoulder Pain

Understanding Your Shoulder Pain will help you to isolate which common shoulder injury you might have. Shoulder injuries are common in all different ages. These injuries can occur from sporting and other accidents as well as from repetitive actions (e.g. factory workers and certain everyday activities where repeated movements lead to wear of the structures around the shoulder) and thirdly in older people where minimal force can damage degenerated structures.

In an effort to help you understand your shoulder pain, we have created an infographic. You can select the area of pain and rollover the possible causes of pain, you can find out more information by selecting to learn more about the cause of the pain. From there you can assess if you would like to request an appointment or submit a question in our Q&A section. 

Please note, our infographic is for educational purposes only and in no way should be seen as a final diagnosis, only an appointment with an Orthopaedic Shoulder Surgeon can diagnose a shoulder injury. 

Select your pain area below.

Select one of the most common “TOP Shoulder” pains:

AC Joint Dislocation
AC Joint Degeneration

Select one of the most common “FRONT Shoulder” pains:

SLAP Tears
Shoulder Osteoarthritis

Select one of the most common “OUTSIDE Shoulder” pains:

Rotator Cuff Tears
Frozen Shoulder
Calcific Tendonitis

The pain felt most common “ALL OVER” the shoulder:

Shoulder Dislocation

To start, select your shoulder pain area above.

A high percentage of treated AC Joint problems occurs in active contact sporting males.

Learn more about AC Joint Dislocations


Occurs more in males and is often related to sport where repeated falls on the shoulder may lead to direct impact and damage of this small joint on the top of the shoulder. It is common to see this condition in sportsmen in the 20-30 age group. Other upper body sports, like weight lifting, is also known to cause this and one type of this condition is referred to as (“Weight Lifter’s Shoulder”).

This usually seen in sportsmen (throwing and rugby athletes) and sometimes in weightlifters.

Learn more about SLAP Tears.


Also known as Arthritis, the osteo-arthritic joint becomes painful with limited range of motion and night pain can be an experienced in the joint and this may even be audible. A feeling of catching or slipping may also be felt due to rough surfaces moving over each other. This is usually seen in males and females 60 years and older.

Pain is usually experienced in the shoulder and down the outer aspect of the upper arm, often worse at night. There may be an increase in the pain and a weakness experienced when elevating the arm. Occassionally a “hooking”feeling is experienced, especially bringing the arm down to waist level from an overhead position.

It is most common in females (40-50 years) but could affect males and other age groups. It may follow injuries, operations or be associated with medical conditions like diabetes mellitus. It is referred to as “adhesive capsulitis” suggesting that the capsule is inflamed and adhering (clinging) to the joint, causing pain and limitation of motion.

A calcium deposit accumulates in one of the tendons of the shoulder. The cause is unknown and not related to injury, diet or osteoporosis.The patient most commonly affected is female 40-50 years of age, but other age groups and males are regularly affected.


Occurs in contact sports like rugby, sometimes a piece of bone is also pulled off the glenoid (socket) as well. Can occur at a relatively young age (16-18) and is a bit more common in girls. They may also have other problems due to the loose ligaments e.g. unstable knee caps, etc. The first dislocation may occur due to minimal trauma in contrast to the traumatic type.

Please note, our infographic is for educational purposes only and in no way should be seen as a final diagnosis, only an appointment with an Orthopaedic Shoulder Surgeon can diagnose a shoulder injury.

Additional Information on Shoulder Pain


Falling directly onto the shoulder may cause

Tears of the rotator cuff
AC joint injuries (AC joint is the joint between the collar bone and shoulder bone)
Fractures of the collar bone or the shoulder bones (ball and socket) themselves

Indirect forces onto the shoulder

Falls where the arm is forced outwards and backwards can lead to a dislocation of the shoulder. If this happens the stabilising ligaments can be torn and this may result in repeated (recurrent) dislocations.

Specific sports shoulder injuries

In certain sports shoulder injuries are more common than in other sports. For instance, in rugby and football direct contact and indirect forces causing shoulder dislocations are not uncommon. In rugby the most common shoulder injuries are to the AC (acromio-clavicular) joint. This can usually be treated conservatively without surgical intervention.

Repetitive throwing in sports

In throwing sports like baseball and cricket, the repetitive nature of the injury leads to failure of certain structures like the rotator cuff and labrum (cartilage in the joint). This may lead to “acquired instability” of the joint and “SLAP lesions”

Repetitive shoulder injuries

In certain occupations and sports a repeated motion may lead to wear and tear, swelling and even failure (tearing) of structures. An example would be a person that is a painter having to reach up all day during overhead motion. The rotator cuff might swell and become severely inflamed resulting in a condition referred to as rotator cuff “tendonitis” for “bursitis”. Certain gym exercises may also injure structures like the AC joint, rotator cuff and biceps tendon.

Degenerative shoulder injuries

In older people when the tendons and ligaments start becoming weak injuries may occur with minimal force. It is well known that rotator cuff tears may develop with almost no force at all and in fact tear spontaneously. This is due to poor blood supply to the tendon making the tendon more vulnerable. In some instances there may slight degenerative arthritis not causing any symptoms and the activity may them bring the pre-existing condition to the fore.

Many of the above mentioned shoulder injuries can be treated conservatively but some, especially rotator cuff tears, may require surgical repair.

Shoulder Pain

  1. Young girls (14 to 20 years old) – consider thoracic outlet syndrome. Young athletic males participating in sport (14 to 21 years old) – consider shoulder instability due to previous dislocations.
  2. There is often a previous injury where the shoulder was dislocated the first time.
  3. Young active males and females (18 to 30 years old) – consider os-acromiale.
  4. Males and females 40 years and older – rotator cuff impingement syndrome
  5. Females 45 to 55 years old – could have frozen shoulder (adhesive capsulitis).
  6. Females and males 40 to 60 years old – consider calcific tendonitis.
  7. Active sporting males with pain on top of the shoulder – consider acromio-clavicular pain.
  8. Males and females 50 years and older – consider rotator cuff tears.
  9. Males and females 60 years and older – consider osteoarthritis of the shoulder.

The above information indicates commonly occurring conditions in certain gender and age groups. Additional factors that may help in making the diagnosis is the nature and localisation of the pain.


  1. Pain on top of the shoulder: May be caused by acromio-clavicular (AC joint) problems
  2. Pain in the shoulder and outside of the upper arm: Rotator cuff problems may have this pattern.
  3. Pain at the back of the shoulder: Consider arthritis.
  4. Pain in the neck and upper part of the shoulder: May be caused by referred problem from the neck.
  5. Pain in the neck, shoulder and radiating down the arm into the hand: Consider neurological problems like disc problems in the neck or thoracic outlet syndrome.
  6. Night pain: Pain at night occurs with most shoulder problems. Usually shoulder instability does not affect sleep but most other conditions do when a person lies down at night. The reason is that any inflammation is worse when the position of the structure is lower due to the pressure effect of gravity – in the upright position the shoulder is elevated.
  7. Constant or intermittent pain: Most mechanical reasons for pain (e.g. rotator cuff tears) mostly cause pain with certain movements like lifting the arm. On the other hand certain conditions cause constant pain unrelated to movement – these would be pain from nerve conditions like referred from the neck or thoracic outlet syndrome.
  8. Severity of the pain: Acute “blinding” pain usually occurs with calcific tendonitis when the calcium is being absorbed. Other conditions may cause intermittent pain depending on position of the arm and the activity. If the pain is constant and running from the neck down to the shoulder and hand it is most likely from a nerve problem in the neck or thoracic outlet. If the pain is more mechanical (occurring with movements only) it would suggest a damaged structure in the shoulder.

Understand Your Shoulder Pain

In an effort to help you understand your shoulder pain, we have created an infographic. You can select the area of pain and rollover the possible causes of pain,..

Shoulder Conditions

Various shoulder conditions Dr Joe de Beer has treated. These articles from Dr Joe de Beer are a great resource on commonly found shoulder conditions.

See Our Locations

Locaitons: Plattekloof Libstar House, Mediclinic Cape Town, Mediclinic Winelands Orthopaedic Hospital and at The Cape Eye Hospital in Bellville.

Meet The Staff

Dr Joe de Beer has a proud family of staff,
who practice with him in Cape Town, Plattekloof and Stellenbosch.

See Our Sports Gallery

Dr Joe de Beers’ practice is confined to the care of shoulder problems of all types, and he does both open and arthroscopic surgery.

Meet Dr Joe de Beer

Dr Joe de Beers’ practice is confined to the care of shoulder problems of all types, and he does both open and arthroscopic surgery.