Shoulder Pain: Causes of Right and Left Shoulder Pain and Treatment

Shoulder pain is primarily caused by musculoskeletal disorders affecting the rotator cuff, tendons, ligaments, and joint structures, often resulting from overuse, trauma, inflammation, or degenerative changes that impair normal shoulder function and mobility.

Rotator cuff injuries and tendon inflammation frequently lead to shoulder pain through repetitive strain, microtears, or acute trauma, causing localized discomfort, weakness, and restricted range of motion, particularly during lifting or overhead activities.

Degenerative joint conditions such as osteoarthritis contribute to chronic shoulder pain by progressively damaging cartilage, leading to joint stiffness, crepitus, and reduced flexibility, especially in older adults or individuals with long-term joint stress exposure.

Referred pain and systemic conditions including cervical spine disorders, bursitis, or inflammatory diseases may also manifest as shoulder pain, reflecting underlying neurological or pathological processes that require comprehensive clinical evaluation and targeted management.

Why is the structure of the shoulder joint so prone to pain?

To understand the shoulder joint, one can make an analogy: this joint resembles a golf ball resting on a golf tee. We are not talking about a structure like the hip joint, which sits deeply within a socket, is very solid from a bony perspective, but has limited mobility. In the shoulder, the priority is movement. In order to move your arm upward, sideways, backward, forward, and rotate it around its own axis, the contact between joint surfaces is kept limited.

So, who holds this “golf ball” on that small socket without letting it fall? This is where the answer lies—and where the source of pain is found: soft tissues. What keeps the shoulder in place and moves it are not the bones, but the capsule, the ligaments, and the famous “rotator cuff” muscle group. The load placed on these soft tissues is enormous. Every movement you make during the day, every load you lift, and even your posture while sitting at a computer puts stress on these tissues.

The main structures that provide stability to the shoulder joint are:

• Supraspinatus muscle
• Infraspinatus muscle
• Teres minor muscle
• Subscapularis muscle
• Labrum cartilage
• Joint capsule
• Bursal cushions

The fact that these structures are entirely soft tissue makes them prone to wear, injury, and tearing. Due to the lack of strong bony support, the shoulder holds the title of being the joint that dislocates most frequently and causes pain most often in the body.

Is there a difference between the causes of right and left shoulder pain?

When patients come to our clinic, they usually have different concerns depending on which side the pain is on, and they are not unjustified. Although the basic mechanical causes of shoulder pain are the same on both sides, the side of the pain gives us clues about underlying causes or risk factors.

Right shoulder pain, since the majority of the population uses the right hand (the dominant side), generally indicates “use-related” wear and tear. You write, use a mouse, lift heavy objects, do housework, or hold a racket with your right hand. This constant activity predisposes the right shoulder tendons to fatigue more quickly, sustain microscopic damage, and eventually tear over time. However, there is another insidious cause of right shoulder pain: referred pain. The nerve networks of certain abdominal organs share common pathways with the shoulder region.

Conditions that may cause right shoulder pain include:

• Rotator cuff tears
• Shoulder impingement
• Bursitis
• Calcific tendinitis
• Gallstones
• Liver abscesses
• Right lung disorders

Left shoulder pain, on the other hand, requires a more cautious approach. Of course, mechanical causes still rank first for left-handed individuals or those who have experienced trauma. However, when left shoulder pain is mentioned, the first “red flag” that comes to every physician’s mind is heart-related problems. Pain resulting from insufficient oxygen supply to the heart muscle can spread to the left arm, jaw, and left shoulder through nerve pathways.

Points to consider in left shoulder pain include:

• Risk of heart attack
• Angina pectoris
• Spleen injuries
• Pancreatic disorders
• Mechanical tendon problems
• Frozen shoulder

The most important distinction here is this: if the pain in your shoulder increases when you move your arm and decreases with rest, it is 99% likely to be related to the musculoskeletal system. However, if the pain is independent of movement, accompanied by a feeling of pressure in the chest, and increases with exertion, cardiac evaluation should be performed before focusing on the shoulder.

Does Impingement Syndrome cause shoulder pain?

One of the most common causes of shoulder pain is medically known as “Impingement Syndrome,” or shoulder impingement. There is a narrow tunnel between the bone forming the roof of the shoulder (the acromion) and the upper arm bone (the humerus). Through this tunnel pass the main tendon responsible for lifting the shoulder and the lubricating fluid sac known as the “bursa.”

Under normal conditions, this tunnel is wide enough for the tendon to glide comfortably. However, in some individuals, the acromion may be structurally hooked, or degenerative changes may develop within the tunnel with age. Sometimes postural disorders (forward-rounded shoulders) also narrow this tunnel. As a result, every time you lift your arm, the tendon and bursa are compressed between these two bones like a sandwich.

This impingement eventually turns into a vicious cycle. The compressed tendon swells (edema develops). The swollen tendon occupies more space in the tunnel and becomes even more compressed. If left untreated, the tendon fibers wear down as if sanded and eventually begin to tear.

Typical symptoms of impingement syndrome include:

• Difficulty lifting the arm
• Pain while dressing
• Sudden stabbing pain
• Night pain
• Tenderness at the front of the shoulder

Is shoulder pain that wakes you up at night a sign of a Rotator Cuff Tear?

The complaint that most dramatically reduces our patients’ quality of life is night pain. During the day, you may forget about your shoulder while busy with work, but once you put your head on the pillow at night, it starts to throb. Especially lying on the painful side becomes impossible, and your sleep is frequently interrupted.

Night pain is a very strong signal of a “Rotator Cuff Tear” for us. The rotator cuff is a band formed by four muscles that surround the shoulder. The tendons of these muscles weaken, especially in individuals over the age of 50, due to reduced blood supply and years of wear. Sometimes a tear can occur with a sudden “snap” while lifting a heavy load, or even while simply putting on a jacket. In other cases, it develops gradually over time, like the slow fraying of rope fibers.

When lying down at night, the position of the shoulder joint changes as the effect of gravity is eliminated, and the inflamed tissues at the torn area are stretched. Additionally, the natural decrease in the body’s cortisol levels at night increases pain perception. If you have night pain, instead of waiting for it to “pass,” you should have it evaluated as soon as possible with imaging methods (MRI or Ultrasound). Because saving a tendon that has not yet fully torn is much easier.

Symptoms of a rotator cuff tear include:

• Night awakenings
• Weakness when lifting the arm
• Difficulty reaching behind the back
• Difficulty combing hair
• Pain radiating from the shoulder to the arm

Why does calcification or stone formation occur in the shoulder?

When people refer to “calcification in the shoulder,” they usually mean one of two different conditions. One is the wear of joint cartilage, and the other is what we call “Calcific Tendinitis,” which is the actual formation of stone-like deposits within the tendon. Calcific tendinitis is one of the most severe and painful causes of shoulder pain.

In this condition, for unknown reasons (usually due to reduced oxygen supply or metabolic factors), the body begins to deposit calcium crystals inside the tendon. These deposits may have a toothpaste-like consistency or resemble chalk powder. The disease generally progresses in three stages. In the initial stage, calcium accumulates and pain is mild or absent. However, during the “resorption” phase—when the body recognizes the calcium and attempts to dissolve it—the inside of the tendon becomes highly pressurized, like a volcano.

The pain during this phase can be so severe that the patient cannot move the arm even a millimeter and may need to visit the emergency department. This pain is much sharper and more unbearable than that of frozen shoulder or tendon tears. Calcific tendinitis is more common in middle-aged individuals, women, and people with diabetes.

Risk groups for calcific tendinitis include:

• Individuals aged 40–60
• Women
• People with diabetes
• People with thyroid disorders
• Sedentary individuals

What is frozen shoulder and why does it occur?

Although its name sounds frightening, it describes the condition very well: Frozen Shoulder, medically known as “Adhesive Capsulitis.” The joint capsule surrounding the shoulder—normally flexible and expansive like a balloon—becomes inflamed, thickens, contracts, and adheres to the bone. As a result, the shoulder joint becomes locked.

In this disease, the problem is not just pain; the main issue is loss of movement. No matter how much the patient wants to lift the arm, they cannot. Even if someone else tries to lift it (passive movement), the arm will not rise. It is as if a braking mechanism has been activated inside the joint. You become unable to place your hand behind your back, wash your hair, or reach for something on a shelf.

Frozen shoulder can be triggered by immobilization of the shoulder after trauma, but the biggest culprits are metabolic diseases. In particular, diabetes significantly increases the risk of frozen shoulder.

The stages of frozen shoulder are:

• Inflammatory stage
• Freezing stage
• Thawing stage

If left untreated, this process can last 2–3 years, which is an unacceptable duration in terms of quality of life for modern individuals.

Can a cervical disc herniation cause shoulder pain?

In a significant proportion of patients who present with shoulder pain, the shoulder joint itself is completely healthy. The problem originates one level above—namely, the neck. Herniation of the discs between the cervical vertebrae compresses nerve roots and creates a condition known as “referred pain.”

The nerves emerging from the neck (especially the C5 and C6 roots) carry sensation to the shoulder region. When these nerves are compressed in the neck, the brain perceives the pain as if it were coming from the shoulder. Distinguishing this is actually possible with careful observation. If your pain increases not when you move your shoulder, but when you turn your neck side to side or tilt your head backward, the problem is most likely cervical in origin.

Characteristics of neck-related pain include:

• Electric shock–like pain radiating down the arm
• Numbness in the fingers
• Pain radiating to the back
• Increase with neck movements
• Muscle weakness

Do lung diseases and Pancoast tumors cause shoulder pain?

Although rare, this is a vital condition that should not be overlooked. Certain tumors located at the apex of the lung (Pancoast tumors), due to their position, can compress the nerve networks (brachial plexus) that extend to the shoulder region.

These patients typically do not experience restriction in shoulder joint movements but describe an “atypical,” non-mechanical, deep, gnawing shoulder pain that does not subside with rest. Especially in individuals with a long history of smoking, unexplained weight loss, and persistent shoulder pain that does not respond to treatment, lung imaging should definitely be considered.

Symptoms of a Pancoast tumor include:

• Persistent shoulder pain
• Pain along the inner arm
• Drooping eyelid
• Sweating disturbances
• Muscle wasting in the hand

How is shoulder pain diagnosed?

Success in treating shoulder pain depends on accurate diagnosis. Using medication indiscriminately or performing random exercises just because “my shoulder hurts” not only fails to solve the problem but may worsen it. The first step in diagnosis is listening to the patient’s history. When the pain started, its character, and whether it wakes the patient at night tell us a great deal.

This is followed by a physical examination. However, to clearly visualize the internal structure of the shoulder—the condition of muscles, tendons, and bursae—imaging methods are essential. X-rays show only bone structures; you can see calcifications or fractures, but you cannot see tendon tears. Therefore, MRI (Magnetic Resonance Imaging) and Ultrasound (USG) are our greatest allies.

Diagnostic tools include:

• Physical examination
• X-ray
• MRI imaging
• Ultrasonography
• Computed tomography
• Diagnostic injections

Ultrasound, in particular, is like a stethoscope for us. While the patient is sitting in the outpatient chair and moving the shoulder, we can observe in real time how the tendons function and whether impingement occurs. MRI, on the other hand, is superior for visualizing deep tissues and bone marrow edema.

What does Interventional Radiology do in the treatment of shoulder pain?

Traditionally, two paths were known for shoulder pain: either wait for improvement with medication/physical therapy or undergo surgery. However, in recent years, with advances in technology, “Interventional Radiology” has emerged as a third and very powerful option. Our philosophy is this: “Do not touch what you cannot see, and achieve the greatest healing with the least harm to the body.”

As interventional radiologists, we perform treatments without surgical incisions, without putting the patient to sleep, and by entering only through needle punctures. High-tech ultrasound and angiography devices provide us with a map-like view of the inside of the body. This allows us to reach the source of pain with millimetric precision.

Advantages of interventional radiology methods include:

• Non-surgical solutions
• Local anesthesia
• Same-day discharge
• Rapid recovery
• Low complication risk
• Targeted treatment

Why is ultrasound-guided injection important for shoulder pain?

Many patients say, “I had an injection in my shoulder, but it didn’t help at all.” The main reason for this failure is that the injection was performed “blindly.” The physician injects based on anatomical landmarks, but the interior of the shoulder is complex. Whether the medication reaches the tendon, the bursa, or the fatty tissue may be left to chance. Scientific studies show that the success rate of blind injections ranges between 30% and 70%.

In contrast, during ultrasound-guided procedures, we see the tip of the needle live on the screen. We observe its passage through the skin, its glide between muscles, and its entry into the targeted 1–2 millimeter space. We confirm the distribution of the medication at that exact location. This “targeted” technique increases the success rate close to 100% and minimizes the risk of side effects.

Substances applied under ultrasound guidance include:

• Corticosteroids
• Local anesthetics
• Hyaluronic acid
• PRP
• Stem cells
• Prolotherapy solutions

Especially in regenerative treatments such as PRP, delivering the healing cells precisely to the tear line is of vital importance. Doing this blindly is almost impossible.

What is the Barbotage method in the treatment of calcific tendinitis?

In the condition known as “stone formation in the shoulder” (calcific tendinitis) mentioned above, surgery used to be the only solution to scrape out the calcium deposits. Now, with the “Barbotage” (Lavage) method, this problem can be resolved within minutes.

The procedure works as follows: using ultrasound, we locate the calcium deposit. After numbing the skin, we enter the calcium deposit with a thin needle. By injecting and aspirating saline solution, we wash out the hardened, toothpaste-like calcium (lavage). The calcium breaks down, liquefies, and is aspirated back into the syringe. Once the pressure-causing material is removed, the patient’s pain decreases dramatically.

Features of the barbotage procedure include:

• Does not require surgery
• No sutures
• Provides immediate relief
• Repeatable
• Safe

How are Hydrodilatation and Nerve Block performed for frozen shoulder?

To open the contracted and adhered capsule in frozen shoulder, the “Hydrodilatation” procedure is highly effective. Under ultrasound guidance, we enter the joint and inject a pressurized fluid mixture (saline, local anesthetic, sometimes corticosteroid). This fluid mechanically releases adhesions and expands the capsule from the inside. You can think of it like inflating a balloon.

However, because frozen shoulder is very painful, patients often cannot participate in physical therapy. To break this vicious cycle, we perform a “Suprascapular Nerve Block.” We locate the main nerve that carries pain sensation from the shoulder and inject long-acting analgesics around it or temporarily interrupt pain transmission using the “Radiofrequency” (PRF) method.

Benefits of this combined treatment include:

• Painless physical therapy
• Increased range of motion
• Improved sleep quality
• Shortened recovery time

What is Angioembolization for persistent shoulder pain?

The latest innovation of interventional radiology in shoulder pain is “Angioembolization.” Research conducted in chronic shoulder pain that has persisted for months and does not respond to physical therapy or injections (such as frozen shoulder or osteoarthritis) has revealed an interesting fact: pathological capillaries and accompanying pain nerves form in the painful area, where they normally should not exist.

In this treatment, we access the vascular system through the groin or wrist, as in angiography, and advance to the vessels supplying the shoulder region. We identify the abnormal vascular network (neovascularization) responsible for the pain and occlude it with embolic agents. When these “pathological” vessels are eliminated, pain signals are silenced as well.

Advantages of angioembolization include:

• Permanent pain control
• Preservation of musculoskeletal structures
• No need for general anesthesia
• Rapid onset of effect

Frequently Asked Questions

Prof. Dr. Özgür KILIÇKESMEZ

Prof. Dr. Özgür Kılıçkesmez is one of Türkiye’s leading interventional radiology and neuroradiology specialists, focusing on minimally invasive endovascular treatments. His primary areas of expertise include aneurysm and stroke treatments, embolization procedures, non-surgical treatments of thyroid and parathyroid diseases, interventional oncology, and peripheral vascular interventions. He currently serves as the Head of the Interventional Radiology and Neuroradiology Department at Istanbul Memorial Göztepe Hospital.
Graduating from Istanbul University Cerrahpaşa Faculty of Medicine in 1997, Prof. Dr. Kılıçkesmez received advanced training in interventional radiology and oncology as a Clinical Fellow at London Guy’s & St Thomas’ and King’s College Hospital between 2012 and 2013. He earned the title of Professor in 2020 and, in the same year, became the Founding Interventional Radiologist at SBÜ Çam and Sakura City Hospital. He also holds the EBIR (European Board of Interventional Radiology) certification.
Prof. Dr. Kılıçkesmez has 94 international and 40 national publications and over 2500 citations. He serves as a reviewer for prestigious journals such as the American Journal of Roentgenology (AJR) and Diagnostic & Interventional Radiology. With his clinical and academic expertise, he is a nationally and internationally recognized authority in stroke treatment, brain aneurysm, embolization, tumor ablation, and minimally invasive treatments of thyroid/parathyroid diseases.