Why Does the Front of My Shoulder hurt?

Introduction to Anterior Shoulder Pain

Pain at the front of the shoulder is a very common presentation. It often shows up in active people, those engaging in strength training, Olympic lifting, CrossFit, or various racket or club-based sports.

Why is my shoulder so aggravated?!

Clinically, pain in the front of the shoulder is something we see a lot. It often needs to be unravelled a bit, as there are many structures involved tendons, ligaments, joints, and muscles can all be culprits. With stubborn anterior shoulder pain, we often have to dig a little deeper to understand why the front structures are getting aggravated and becoming painful. Sometimes the cause is more layered than you’d expect.

Common Causes of Anterior Shoulder Pain

• Acromioclavicular (AC) Joint Pain: This tends to give pinpoint pain, especially with lifting, pulling, pushing, or cross-body movements. It may follow trauma (like a fall) or result from specific overuse.
• Subacromial Bursitis: Often causes a deep, aching or nagging pain in the front of the shoulder. Subacromial impingement syndrome, though this term is a bit outdated presents similarly, particularly with overhead movements or reaching out to the side.
• Rotator Cuff Tendinopathy: Similar pain presentation to bursitis, often associated with increase load or intensity of pressing exercises or movement patterns.
• Long Head of Biceps Tendinopathy: The role of the proximal biceps tendon is still debated, but it definitely can produce anterior shoulder pain, especially with overhead or repetitive lifting.

For more serious contusions, keeping the knee bent to about 120° (using a brace or pillow) has been shown to reduce bleeding and preserve range of motion (2). Avoid heat, massage, and aggressive stretching too early they can make the bleeding worse. After the acute phase, treatment can shift towards restoring function.

Introducing Subacromial Pain Syndrome (SAPS)

There’s been a lot of debate in recent years, both clinically and in the literature, about how specific we can really be in diagnosing front shoulder pain.

This region is “structure rich,” containing tendons, ligaments, joints, and bursae. Even with imaging and clinical investigation, it can be tough to pinpoint a single cause. In fact, some argue that finding the exact structure isn’t always necessary. That’s where the term Subacromial Pain Syndrome (SAPS) comes in (1). It’s a broad classification for patients who present with similar anterior shoulder pain, without clear trauma or deeper injury like a labral tear or joint damage.

Key Symptoms of Front Shoulder Pain

• Pain at the front of the shoulder

• Discomfort with bench press, overhead press, or military press

• Pain when lying on the affected side, particularly at night

• Pain when reaching across the body

• Throbbing or aching after long periods of sitting or desk work

• Occasional referral into the arm (deep ache or throb)

Anterior Shoulder Pain: Culprit or Victim?

The “culprit or victim” analogy is popular in musculoskeletal pain & injuries, especially for the shoulder.

In other words, we need to ask: are the structures at the front of the shoulder the cause of the issue, or are they the victim of something else going wrong in the kinetic chain?

Common Contributing Factors:

1. Increased Load or Activity: A new gym plan or ramp-up in pressing movements (e.g., bench press, overhead press) without sufficient adaptation time can overload the front shoulder

2. Postural Load: Desk workers who round their shoulders and slouch may develop anterior shoulder pain from chronic postural strain.

3. Mid-Back (Thoracic) Mobility Limitations: The shoulder relies heavily on the thoracic spine for proper movement. Poor extension through the mid-back can make the shoulder work overtime, especially during overhead activities.

4. Rotator Cuff and Scapular Muscle Weakness: Weakness in these deep stabilisers can lead to overload in the front shoulder muscles, tendons, and ligaments.

How Do We Assess Pain in the Front of the Shoulder?

1. History & Subjective Assessment: We’ll ask questions like – where does it hurt? When did it start? Any recent changes in training or posture? Past injuries or relevant medical history?
2. Range of Motion Assessment: This includes both active and passive movements through the shoulder, and potentially the mid-back, neck, and trunk.
3. Orthopaedic/Special Tests: These help us rule out specific causes or injuries.
4. Functional Testing: This may involve pressing movements (overhead or horizontal), push-ups, or observing shoulder/trunk coordination.

What Does Treatment Look Like for Shoulder Pain?

There’s definitely no one-size-fits-all approach. The shoulder is complex and treatment depends on your individual presentation.

A Typical Treatment Plan Might Include:

• • Soft tissue therapy around the shoulder and surrounding areas, such as massage, dry needling or cupping

  • Instrument-assisted soft tissue mobilisation (e.g., Graston)

     

  • Active release or pin-and-stretch techniques

     

  • Joint mobilisation or adjustments, this could involve the thoracic spine, glenohumeral joint, scapulothoracic articulation, and occasionally the neck

     

  • Postural retraining focused on thoracic mobility and repetitive postural strain

     

  • Rotator cuff strengthening, especially the external rotators

     

  • Improving overhead mobility by addressing the lats and thoracic spine

     

  • Scapular stabilisation exercises

     

  • Taping to offload tissues or cue muscle engagement

     

  • Advice around load management and training modifications to keep you active

     

Should I Get a Cortisone Injection?

‘Do I need a cortisone injection?’ is a common question that we get from patients. With respect to our medical colleagues, while GPs can do a great job, their assessment and understanding of complex shoulder conditions may not be as thorough as that of a chiro, physio, osteo or myo.

We’re not anti-cortisone, but in our experience, injections often don’t provide long-lasting relief, especially when used as a standalone treatment.

Research on this topic generally suggests a short-term benefit with cortiso-steroid injections for shoulder pain. Although it remains unclear as to whether patients benefit long term from an injection compared to conservative treatment and rehabilitation alone (2).

Before Considering a Cortisone Injection, Try This:

1. 1. Get assessed by an allied health professional.
   2. Commit to 4–8 weeks of treatment plus a home rehab plan.
   3. Actually do your exercises.
   4. Work with your provider to adjust aggravating activities or postures.
   5. Don’t just keep pushing through pain.
   6. Consider lifestyle or dietary changes that promote healing and reduce inflammation.

If things still aren’t improving, and you’re thinking about an injection, further imaging or investigation such as an MRI, xray or ultrasound can help clarify if there’s a more significant structural issue.

Need Help Moving Forwards Through Shoulder Pain?

Whether you are looking for Shoulder Pain Treatment Perth or simply need to book in for an assessment, we are here to help! Book an appointment with our team at Fortitude Chiropractic and get a proper assessment to start moving in the right direction. Book online instantly in under 2 minutes or contact us for more information.

References:

1. Witten, A., Mikkelsen, K., Wagenblast Mayntzhusen, T., Clausen, M. B., Thorborg, K., Hölmich, P., & Barfod, K. W. (2023, April 28). Shoulder pain – you need to know the past to understand the present. British Journal of Sports Medicine Blog. https://blogs.bmj.com/bjsm/2023/04/28/shoulder-pain-you-need-to-know-the-past-to-understand-the-present/

2. Littlewood, C., Bateman, M., Connor, C., Gibson, J., & Horsley, I. (2019). Rotator cuff–related shoulder pain: To inject or not to inject? Journal of Orthopaedic & Sports Physical Therapy, 49(5), 289–292. https://doi.org/10.2519/jospt.2019.0607

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