Shoulder and arm pain are common complaints that can interfere with both daily life and work life. The intensity of the pain may vary from mild to severe, transient or chronic. Many factors such as desk work, heavy lifting, sports injuries, joint and nerve compression can lead to shoulder or arm pain. Below you will find a comprehensive overview of possible causes, diagnostic procedures and treatment approaches for shoulder and arm pain:

1. Common Causes of Shoulder and Arm Pain

1.1 Musculoskeletal Causes

1. Rotator Cuff Diseases (Tendonitis, Bursitis, Tears)
   • The muscle group that provides movement to the shoulder joint is called "rotator cuff".
   • Inflammation (tendonitis) or tears can occur in the tendons due to overuse, repetitive movements or trauma.
   • The pain is usually felt in the lateral part of the shoulder and is aggravated when lifting the arm up or moving it at certain angles.
2. Frozen Shoulder (Adhesive Capsulitis)
   • It is characterised by thickening of the capsule of the shoulder joint and adhesions.
   • Both limitation in shoulder movements and pain occur. It becomes difficult to move the shoulder day by day.
   • Diabetes, thyroid diseases or prolonged immobilisation (e.g. wearing a cast on the arm) increase the risk of frozen shoulder.
3. Muscle strains and fibre breaks
   • Injuries, strains or tears can occur in the shoulder and arm muscles due to heavy lifting, improper training or falls/strikes.
   • It may be accompanied by pain, oedema and sometimes bruising, which increases with movement or pressure.
4. Calcification of the joint surfaces (osteoarthritis)
   • With aging, wear and tear occurs in the articular cartilage.
   • It may cause limitation of movement especially in the shoulder and elbow joints and may cause pain and stiffness.

1.2 Nervous Causes

1. Neck Hernia (Cervical Disc Hernia)
   • The pressure of the discs in the neck on the nerve roots can cause pain, numbness, tingling or weakness in the arm and shoulder.
   • The pain can be aggravated by neck movements or certain positions.
2. Thoracic outlet syndrome
   • Numbness, tingling and pain radiating from the shoulder to the arm may occur as a result of compression of the nerves and vessels between the neck and collarbone.
   • Symptoms are usually aggravated by lifting the arm up or holding it in the same position for a long time.
3. Peripheral Nerve Entrapment
   • Nerve compression such as carpal tunnel syndrome (in the hand) and cubital tunnel syndrome (in the elbow) can cause pain and numbness radiating to the hand and arm.
   • Pinched nerves at the elbow or wrist level cause a feeling of discomfort, which can sometimes radiate to the shoulder.

1.3 Causes related to the circulatory system

1. Vascular Blockages or Inflammations
   • Blockages (e.g. clots) or inflammation in the arm veins can reduce the blood supply to the arm, leading to pain and swelling.
   • Rarely, pain of cardiac origin (e.g. angina) can radiate to the left arm; in this case, there are additional symptoms such as chest pain and shortness of breath.

1.4 Other Causes

1. Bone Fractures and Cracks
   • In the event of a fracture or crack after a fall, traffic accident, sports injuries, severe pain, swelling and immobility occur.
   • Shoulder dislocation or fractures around the elbow/shoulder can leave persistent pain and limitation of movement despite a long healing process.
2. Rheumatic Diseases (Rheumatoid Arthritis, Polymyalgia Rheumatica etc.)
   • Inflammatory processes in the joints and muscles cause morning stiffness and pain.
   • Chronic pain, swelling and loss of function may occur in the shoulder, elbow or wrist joints.
3. Fibromyalgia
   • Chronic widespread pain syndrome with tenderness and pain points in the shoulder and arm areas.
   • It is accompanied by accompanying symptoms such as fatigue, sleep disturbance and depression.
4. Wrong Posture and Ergonomic Problems
   • Sitting hunched at a desk for a long time, not placing the computer at eye level, using an inappropriate desk can cause tension and pain in the shoulder-arm area.

2. Diagnostic Methods

1. Medical History and Physical Examination
   • When the pain starts, how it develops, with which movements or positions it increases, if any, additional symptoms (numbness, loss of strength, etc.) are listened to.
   • Shoulder joint and arm area examination, muscle strength tests, range of motion measurements, nerve stretching tests are performed.
2. Imaging Techniques
   • X-ray: It is the first step for the detection of fractures, dislocations, calcifications and disorders in bone structure.
   • Magnetic Resonance (MR): It can show soft tissue damage such as tendon, muscle tears or nerve compression in detail.
   • Ultrasound: Mobile visualisation of tendon and muscle tissue is useful for suspected tears or tendonitis.
   • Computed Tomography (CT): It can be preferred when it is necessary to examine the bone structure more clearly.
3. Nerve Conduction Studies and EMG
   • Especially in cases where cervical hernia or peripheral nerve compression is suspected, nerve conduction velocity and muscle activity are evaluated.
4. Blood Tests
   • Additional investigations that may shed light on the picture, such as rheumatism indicators, infection, thyroid function, diabetes (risk of nerve damage).

3. Treatment Methods

Shoulder and arm pain requires different treatment approaches depending on the underlying cause:

3.1 Drug Therapy

• Anti-inflammatory Drugs (NSAIDs): It can reduce pain and inflammation in cases of tendonitis, bursitis or joint inflammation.
• Painkillers (Analgesics): Simple analgesics such as paracetamol can be used for mild to moderate pain.
• Muscle Relaxants: Provides short-term relief in cases accompanied by muscle spasm.
• Corticosteroid Injections: For severe inflammation or intra-articular problems (rotator cuff tendonitis, frozen shoulder, etc.), it can be applied into the joint or soft tissue under the supervision of a doctor.

3.2 Physical Therapy and Rehabilitation

• Exercise Programme: Exercises that strengthen, stretch and increase endurance of shoulder, arm and neck muscles under the guidance of a physiotherapist.
• Manual Therapy: Techniques applied in expert hands to increase the range of motion in the shoulder joint and reduce the tension in the muscles.
• Ultrasound, Hot-Cold Therapy, Electrotherapy: Promotes tissue healing and relieves pain by increasing blood circulation.
• TENS (Transcutaneous Electrical Nerve Stimulation): It is useful in reducing the perception of pain by stimulating the nerves.

3.3 Surgical Interventions

• Arthroscopic Repair: Minimally invasive surgery for rotator cuff tear, structural problems of the shoulder joint or capsular release in frozen shoulder.
• Open Surgery: It may be required in cases such as large-sized tears, bone dislocations or fractures, hernia.
• Hernia Operation: If the cervical hernia severely compresses the nerve roots, surgery can be planned to relieve the disc compression.

3.4 Alternative and Complementary Approaches

• Acupuncture: It may provide symptomatic relief in some patients, especially in chronic shoulder pain.
• Massage and Manual Therapy: It helps to relieve muscle tensions, increase blood circulation.
• Kinesiological Taping (Kinesio Tape): It can be applied to support muscles and joints and relieve oedema.

4. Precautions to be taken in daily life

1. Ergonomic Arrangements
   • Shoulders relaxed in front of the computer, elbows bent 90 degrees, screen at eye level.
   • Doing short stretching movements with frequent breaks, relaxing the shoulder and neck muscles.
2. Correct Posture and Posture
   • Using a chair with back support in an upright position when sitting.
   • When standing, the head and shoulders should be back and the body should not be tilted too far forward.
3. Avoiding Heavy Lifting
   • If lifting is necessary, take care to lift the load with the leg muscles instead of the waist.
   • Distributing the weight in both hands or using a bag that will be evenly distributed on the back instead of a shoulder bag.
4. Regular Exercise
   • Swimming, pilates, light weight training to strengthen the shoulder and back muscles.
   • Do not be sedentary throughout the day, and if possible, take breaks for stretching and walking.
5. Hot / Cold Compress
   • Hot compresses in muscular pain and cold compresses in inflammatory conditions (swelling, redness) can usually provide relief.
6. Weight Control
   • Excess weight can put additional strain on the shoulder and other joints. Keeping body weight in the appropriate range with a healthy diet and regular exercise can reduce pain.

5. When to consult a doctor?

In the following cases, it is important to consult a health professional immediately:

• If the pain is severe and does not go away with restif it has been going on for more than a few days.
• Significant limitation of arm and shoulder movementsdifficulty lifting the arm, a feeling of "locking" or sounds from the joint (click, clatter) if any.
• Numbness, tingling or loss of strength has become pronounced (especially spreading to the hands and fingers).
• After trauma or fall the pain is very severe, there is a deformity or you cannot move the arm at all.
• Pain that wakes you up at night or intense pain that persists even at rest.
• Common symptoms of inflammation (redness, swelling, high fever).

Summary

Shoulder and arm pain can occur for many different reasons; muscle-tendon injuries, nerve compression, joint disorders or rheumatic problems are among the most common. The characteristics of the pain (location, intensity, duration), accompanying symptoms such as numbness or loss of strength play a key role in the diagnosis. In the treatment, physical examination and imaging methods aim to detect the underlying problem. Then, medication, physiotherapy, ergonomic measures, surgical interventions and complementary approaches come into play.

Regular exercise, maintaining correct posture, ergonomising the working environment and avoiding excessive loads are the basic principles for maintaining shoulder and arm health. Seeking medical help at an early stage before the pain becomes chronic or severe is extremely important for rapid and lasting recovery.