Understanding Arm and Shoulder Pain: Causes, Symptoms, and When to Seek Help

Arm and shoulder pain are very common problems, particularly in older adults. The shoulder is a complex region where muscles, tendons, joints, nerves, and the neck all interact. Because of this complexity, shoulder and arm pain can present in many different ways and is sometimes misdiagnosed, especially in senior patients.This article explains common causes of shoulder and arm pain, including nerve-related symptoms, and outlines why accurate assessment is important for effective treatment.

Why Shoulder and Arm Pain Can Be Difficult to Diagnose

The shoulder has a wide range of movement and relies on several structures working together. Pain can originate from the shoulder joint itself, the surrounding muscles and tendons, nearby joints such as the neck, or from nerves that travel into the arm and hand. In older adults, age-related changes seen on scans may not always explain symptoms, which can lead to confusion or incorrect diagnosis. It is also common for people to describe pain anywhere from the neck to the hand as ‘shoulder pain’, even when the primary source lies elsewhere. A careful clinical assessment is therefore essential.

Rotator Cuff Problems

The rotator cuff is a group of four muscles and tendons that stabilise the shoulder and allow lifting and reaching. Rotator cuff-related pain is one of the most common causes of shoulder symptoms. In younger individuals this may develop after injury, but in older adults it is often degenerative, meaning the tendons gradually weaken over time.Degenerative rotator cuff tears are extremely common with increasing age and are frequently seen on scans, even in people without pain. This can lead to over-diagnosis or assumptions that pain is ‘inevitable’. In reality, many people with degenerative tears function well with appropriate rehabilitation, and pain is often more related to irritation, overload, or weakness than the tear itself.

Shoulder Impingement and Subacromial Pain

Shoulder impingement, now more commonly referred to as subacromial pain syndrome, describes pain when lifting the arm, particularly overhead. This pain is often linked to rotator cuff irritation, altered shoulder mechanics, or reduced strength and control rather than a single structure being ‘trapped’.In older adults, impingement-type symptoms often overlap with degenerative cuff changes, postural factors, and reduced thoracic or neck mobility. Management usually focuses on restoring movement, improving strength, and modifying aggravating activities rather than avoiding movement.

Osteoarthritis of the Shoulder

Osteoarthritis can affect the shoulder joint, leading to stiffness, deep aching pain, and reduced movement. Unlike hip or knee arthritis, shoulder OA is less common but can still significantly affect function, particularly with reaching, dressing, or sleeping on the affected side.In older adults, OA is sometimes over-attributed as the cause of pain simply because it appears on imaging. However, symptoms do not always correlate with X-ray findings, and many people with shoulder OA benefit from physiotherapy, activity modification, and strength work.

Adhesive Capsulitis (Frozen Shoulder)

Adhesive capsulitis, commonly known as frozen shoulder, causes progressive stiffness and pain with a marked loss of both active and passive movement. It is more common in people over 50 and those with diabetes or thyroid conditions.Frozen shoulder is frequently misdiagnosed in older adults as arthritis or rotator cuff problems. A key feature is the global restriction of movement in all directions, not just pain with lifting. Early identification is important, as management focuses on symptom control, gentle movement, and realistic expectations rather than aggressive exercise.

Nerve-Related Shoulder and Arm Pain

Not all shoulder or arm pain originates from the shoulder itself. Nerve-related pain can arise from the neck, spinal joints, or nerve compression and may present as sharp, burning, tingling, or electric-type pain.Cervical radiculopathy, where nerves are irritated or compressed in the neck, can cause pain that radiates into the shoulder, arm, or hand and may be accompanied by numbness or weakness. In older adults, degenerative changes in the neck are common and may contribute to these symptoms.Referred pain from the neck or upper back can mimic shoulder conditions, which is why assessing the cervical spine and neurological symptoms is essential when shoulder pain does not follow typical patterns.

Other Causes of Shoulder and Arm Pain in Older Adults

Other conditions that may contribute to shoulder or arm pain include acromioclavicular (AC) joint arthritis, biceps tendon irritation, postural strain, thoracic stiffness, and reduced general conditioning. Pain may also be influenced by reduced confidence, fear of movement, or compensatory movement patterns following previous injury or illness.In rare cases, shoulder or arm pain may be referred from non-musculoskeletal sources such as cardiac or abdominal conditions. Sudden, severe, or unexplained pain should always be assessed promptly.

Why Shoulder Pain Is Often Misdiagnosed in Older Adults

Misdiagnosis can occur when imaging findings are relied upon without considering the full clinical picture. Age-related changes such as tendon degeneration or arthritis are common and do not always explain symptoms. Additionally, older adults often have more than one contributing factor, such as a combination of rotator cuff weakness, neck stiffness, and reduced activity levels.A thorough assessment that considers movement, strength, nerve symptoms, posture, and daily function is essential to identify the true drivers of pain and guide appropriate treatment.

When to Seek Professional Advice

Shoulder or arm pain that is persistent, worsening, associated with neurological symptoms, or limiting daily activities should be assessed by a healthcare professional. Early assessment can help prevent unnecessary pain, loss of function, and fear of movement.

References

Lewis, J. (2016) Rotator cuff related shoulder pain: assessment, management and uncertainties. British Journal of Sports Medicine.Teunis, T. et al. (2014) Prevalence of rotator cuff tears in asymptomatic populations. Journal of Shoulder and Elbow Surgery.NICE (2020) Osteoarthritis: care and management.Hsu, J.E. et al. (2011) Adhesive capsulitis of the shoulder. Journal of the American Academy of Orthopaedic Surgeons.Rhee, J.M. et al. (2007) Cervical radiculopathy. Journal of Bone and Joint Surgery.