Pain in Shoulder When Lifting Arm to Side

The sensation of pain when lifting the arm out to the side, a motion medically known as abduction, is a common issue. This specific type of discomfort can be a diagnostic clue, pointing toward a range of underlying conditions affecting the complex mechanics of the shoulder joint. For patients experiencing pain during shoulder abduction, understanding the potential causes, the diagnostic process, and the comprehensive treatment pathways available is a key step toward recovery and restoring function.

• Many cases of shoulder abduction pain are attributed to subacromial impingement syndrome (often involving tendinitis or bursitis) and rotator cuff tears (partial or full-thickness).
• Treatment for most conditions begins with conservative measures, including rest, anti-inflammatory medications (NSAIDs), physical therapy, and injections. Surgery is considered when non-operative treatment fails.
• Consulting with an orthopedic specialist early can be helpful to differentiate between conditions like tendinitis, bursitis, tears, and frozen shoulder, supporting a targeted treatment plan.

The shoulder joint is comprised of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The primary structures involved in lifting the arm to the side are the rotator cuff, deltoid muscle, and subacromial space. Pain during abduction often arises when one or more of these structures become inflamed, damaged, or mechanically compressed within the subacromial space.

The rotator cuff is a group of four muscles and their tendons (supraspinatus, infraspinatus, teres minor, and subscapularis) that originate on the scapula and insert on the head of the humerus. Their collective role is to stabilize the shoulder joint and to initiate and control the movement of the arm.

The deltoid muscle is the large, powerful muscle that covers the shoulder and is the primary mover for abduction, taking over from the rotator cuff beyond the initial phase. Subacromial space refers to the narrow space located directly beneath the acromion (the bony projection of the scapula) and above the head of the humerus. This space houses the rotator cuff tendons and the subacromial bursa.

There are many shoulder conditions that can cause pain during abduction. In the following subsections, we’ll review some of the most common conditions that may lead to this type of pain.

Subacromial impingement occurs when the rotator cuff tendons, most commonly the supraspinatus, and the subacromial bursa are compressed or “pinched” between the acromion and the head of the humerus during arm elevation.

The compression can lead to inflammation, a condition known as tendinitis (of the rotator cuff) or bursitis (of the subacromial bursa). It often develops gradually from repetitive overhead activities (e.g., swimming, tennis, painting) or from age-related changes in the acromion bone (such as the development of a bone spur).

Pain that is most intense when the arm is lifted between 60 and 120 degrees of abduction is a potential symptom of subacromial impingement. Below 60 degrees and above 120 degrees, the pain may lessen. Pain is typically felt on the outer side of the shoulder and may radiate down the arm, sometimes as far as the elbow.

The subacromial bursa is a fluid-filled sac that acts as a cushion to reduce friction between the rotator cuff tendons and the acromion. Bursitis is the inflammation of this bursa. Bursitis rarely occurs in isolation; it is usually a component of subacromial impingement syndrome. However, it can be the dominant source of pain.

The pain is often described as a constant, dull ache, which can become sharp during movement, especially abduction. Patients also commonly report tenderness to the touch over the tip of the shoulder.

Rotator cuff tears can result from a traumatic event (e.g., a fall onto an outstretched arm) or, more commonly, from chronic degeneration. Tears are classified as either partial-thickness (the tendon is damaged but not completely severed) or full-thickness (the tendon is completely torn, separating it from the bone).

Similar to impingement, pain can be present during abduction. While pain is a prominent feature, another prevalent symptom of a rotator cuff tear is significant weakness when attempting to lift or rotate the arm. Patients may be able to lift the arm with assistance but may not be able to hold it up against gravity. A grinding or catching sensation (crepitus) may also be felt during movement.

Adhesive capsulitis is a condition characterized by progressive pain and stiffness, typically leading to a severe restriction in both active (patient-initiated) and passive (doctor-assisted) range of motion. This condition involves the thickening and contraction of the shoulder joint capsule, often with the formation of scar tissue (adhesions). It progresses through three distinct phases:

• Freezing Phase (Painful): Gradual onset of pain with progressive loss of motion. Pain may be worse at night.
• Frozen Phase (Stiff): Pain may start to subside, but stiffness remains severe. Abduction is severely limited.
• Thawing Phase (Recovery): Gradual return of motion.

A precise diagnosis supports effective treatment. An evaluation may involve three components: a medical history, physical examination, and imaging. Your doctor may begin by taking a detailed history, focusing on the onset, duration, and nature of the pain (sharp, dull, constant, intermittent). They may inquire about activities that aggravate and alleviate the symptoms.

The physical examination often includes assessments for range of motion, tenderness, stiffness, and weakness. Specific tests may be performed to load or compress different structures, helping to pinpoint the source of the pain.

Imaging may be used to support the clinical suspicion and rule out other pathologies. X-rays are frequently used to visualize bony structures, while magnetic resonance imaging (MRI) is helpful for visualizing soft tissues. Ultrasound is a dynamic tool that allows your doctor to visualize structures in real-time as the arm moves.

Treatment for pain when lifting arm to side is highly individualized and depends entirely on the underlying diagnosis, the severity of the condition, and the patient’s activity level and goals. The approach is often conservative initially, progressing to surgical intervention when non-operative methods have failed. An experienced orthopedic surgeon can evaluate the condition and recommend a treatment path. 

The goal of conservative treatment is to reduce pain and inflammation, restore range of motion, and strengthen the surrounding musculature.

Avoiding activities that cause the painful arc can help to break the cycle of inflammation. This does not mean complete immobilization, but rather modifying lifting, reaching, and overhead movements.

Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and inflammation associated with tendinitis and bursitis. Pain relievers like acetaminophen may also be used for pain control.

Physical therapy is a cornerstone of non-operative treatment for nearly all shoulder pathologies. A structured program typically focuses on restoring range of motion, strengthening the rotator cuff and surrounding muscles, and postural correction.

A local injection of a corticosteroid can provide significant, yet short-term, pain relief. This can be used as a tool to facilitate more effective physical therapy. Emerging therapies such as platelet-rich plasma (PRP) injections are also being explored as non-operative options.

When conservative treatments fail to provide adequate relief, surgical intervention may be considered. The goal of surgery is to restore shoulder function, alleviate pain, and correct structural abnormalities that cannot heal on their own.

Modern shoulder surgery has advanced significantly with the development of arthroscopic techniques, which allow surgeons to treat a wide range of shoulder problems through small incisions. Using a miniature camera (arthroscope) and specialized instruments, the surgeon can visualize the inside of the joint in high detail and perform precise repairs while minimizing trauma to surrounding tissues.

Arthroscopic procedures can address many issues within the shoulder joint. Compared to traditional open surgery, these minimally invasive methods may result in less postoperative pain, reduced scarring, and faster rehabilitation. In some cases, open procedures may still be required for more complex injuries or reconstructive needs. Regardless of the approach, the overarching objective is to restore normal joint mechanics and stability, promote healing, and enable patients to return to daily activities and sports with improved comfort and function.

While some shoulder issues are unavoidable, individuals can promote shoulder health through several prevention strategies:

• Maintain Good Posture: Slouching can narrow the subacromial space. Maintaining an upright posture helps keep the shoulder blades in an optimal position.
• Regular Strengthening and Stretching: Incorporate exercises that specifically strengthen the rotator cuff and the scapular stabilizers. Focus on balanced strength between internal and external rotators.
• Proper Technique in Sports and Work: Learn and utilize correct form for overhead activities, whether in sports (e.g., pitching, serving) or in occupational settings (e.g., construction).
• Ergonomic Adjustments: Ensure your workspace is set up to minimize repetitive strain on the shoulder, keeping frequently used items within easy reach.
• Listen to Your Body: Do not ignore persistent shoulder pain. Early intervention may prevent the progression to a more serious injury.

Pain in the shoulder when lifting the arm to the side can significantly affect daily activities, but many treatment options are available. Accurate diagnosis is key, as this symptom can stem from several common conditions, including impingement, rotator cuff tears, bursitis, or adhesive capsulitis (frozen shoulder). Many cases can be managed with non-surgical options such as targeted physical therapy, rest, and anti-inflammatory treatments. When non-surgical options fail to provide adequate relief, surgery may be recommended.

It depends on the condition and severity. A majority of shoulder pain conditions respond well to non-operative treatment. This typically involves a combination of rest, anti-inflammatory medication, and a dedicated course of physical therapy. Surgery is generally reserved for cases where conservative methods fail to provide relief or for severe injuries that require immediate repair.

This depends on the diagnosis and the type of exercise. You should avoid any activity that reproduces the painful arc (lifting the arm out to the side or overhead). Depending on the condition, low-impact exercises and activities that keep the arm below shoulder level may be acceptable. A physical therapist can provide a tailored exercise program that focuses on maintaining fitness while protecting the injured shoulder.

In some cases, yes, poor posture, especially rounded shoulders or a forward head position, can narrow the subacromial space, increasing pressure on the rotator cuff tendons and bursa. Strengthening the muscles around the shoulder blades and maintaining proper posture can help prevent or reduce shoulder discomfort.

Consider seeking professional evaluation if shoulder pain lasts longer than a few weeks, interferes with sleep or daily activities, or is accompanied by weakness or limited motion. Early diagnosis helps guide effective treatment.