Woman Pain In Left Shoulder And Neck – Doctors Advice on What to Do…

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Medically reviewed

Written by

Dr Paul Watson

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Dr Han Simpson

Published

April 6, 2026

Medical review date

September 8, 2026

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September 8, 2026

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September 8, 2027

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When a woman presents with pain in her left shoulder and neck, it’s one of the most common complaints we see in clinical practice. The immediate thought for both the patient and clinician is often a simple muscle strain or a tweak in the cervical spine. But here’s the crucial part: it can sometimes be a subtle, atypical warning of something far more serious, like a cardiac event.

Getting to the root cause is everything.

Decoding Pain in a Woman’s Left Shoulder and Neck

Pain radiating across the left shoulder and neck is a frequent—and surprisingly complex—complaint in women. It’s best to think of this pain not as a diagnosis in itself, but as a signal the body is sending. The message might be about a straightforward mechanical issue, like a pulled muscle from sleeping awkwardly or a day spent hunched over a laptop. Or it could be a referred signal, an alert originating from an entirely different, and sometimes more critical, part of the body.

This is far from a trivial issue. The numbers are staggering: epidemiological data shows that roughly 18.6% of women have shoulder pain at any given moment, and the lifetime prevalence is as high as 70%. What’s more concerning is that for 40% to 50% of these individuals, the pain lingers or comes back within a year, which tells us just how challenging it can be to find a lasting solution.

To make sense of that signal, it helps to group the potential causes into three main buckets:

• Musculoskeletal Issues: This is our most common culprit. It covers everything directly involving the muscles, tendons, ligaments, and bones in the neck and shoulder girdle. Think rotator cuff injuries, bursitis, or simple myofascial trigger points.
• Spine-Related Problems: Sometimes the problem isn’t in the shoulder joint at all, but originates in the neck. A classic example is cervical radiculopathy, where a pinched nerve in the cervical spine shoots pain down the arm and into the shoulder.
• Referred Pain: This is the trickiest category. It’s where a problem with an internal organ—like the heart, lungs, or spleen—is perceived as pain in the shoulder and neck. The brain gets its wires crossed because these areas share common nerve pathways, creating a diagnostic puzzle.

The concept of referred pain is absolutely critical when evaluating a woman with left-sided shoulder and neck pain. Because of shared innervation, particularly from the phrenic nerve (C3-C5), irritation of the diaphragm from a cardiac, pulmonary, or even an abdominal issue can present as shoulder-tip pain. This is a classic trap for the unwary.

Sorting through these possibilities is the core of our diagnostic challenge. Is this a simple strain that needs rest and physical therapy, or is it a red flag that demands an immediate trip to the emergency department? This guide will walk you through the key differentiators, helping you spot the clues that separate a benign ache from a true medical emergency.

Red Flag Symptoms vs Common Benign Features

When a patient presents with these symptoms, a rapid mental triage is essential. This table is designed to be a quick-reference tool, helping you contrast the urgent, potentially life-threatening “red flags” with the more common, less critical features you’d expect from a straightforward musculoskeletal problem.

Symptom Category	Red Flag (Requires Urgent Evaluation)	Common Benign Feature (Likely Musculoskeletal)
Associated Symptoms	Shortness of breath, chest pain/pressure, sweating, nausea, dizziness, palpitations.	No systemic symptoms. Pain is isolated to the neck/shoulder area.
Pain Character	Crushing, heavy, tearing, or burning sensation. Often diffuse and poorly localized.	Sharp, stabbing, or a dull ache. Usually well-localized to a specific muscle or joint.
Triggers / Relievers	Worsens with exertion (e.g., walking uphill), unrelieved by rest or position change.	Worsens with specific movements (e.g., reaching overhead). Relieved by rest or changing position.
Neurological Signs	Sudden weakness in the arm/hand, slurred speech, facial droop, confusion.	Gradual onset of tingling or numbness in a clear dermatomal pattern (radiculopathy).
General Health	Fever, unexplained weight loss, night sweats, history of cancer, recent infection.	Patient is otherwise well. No fever or systemic signs of illness.

Of course, clinical judgment is paramount, and these categories aren’t always mutually exclusive. A patient can have a rotator cuff tear and an underlying cardiac issue. However, using this framework helps ensure you don’t miss the signs that truly matter and can act decisively when seconds count.

Exploring Musculoskeletal and Spine-Related Causes

When a woman comes in with pain in her left shoulder and neck, our diagnostic thinking almost always starts with the most straightforward explanation: the musculoskeletal system. This is our body’s incredible architecture of muscles, bones, tendons, and joints. It gives us our range of motion, but it’s also where things most commonly go wrong through injury, overuse, or simple wear and tear.

More often than not, the pain is a direct signal from the shoulder itself. The most frequent issues we see involve the rotator cuff, a group of four muscles and their tendons that wrap around the shoulder joint like a cuff, holding everything stable. Repetitive overhead work, a sudden injury, or just age-related changes can lead to rotator cuff tendinopathy, which feels like a deep, nagging ache that often gets worse when you lift your arm or try to sleep on that side.

Unraveling Common Shoulder Conditions

Of course, it’s not just about the rotator cuff. We also frequently diagnose shoulder bursitis, where the bursa—a tiny, fluid-filled sac that acts as a cushion in the joint—gets inflamed. This condition often travels with tendinopathy and typically causes a sharp, catching pain, especially when you try to raise your arm out to the side.

Then there’s adhesive capsulitis, better known as “frozen shoulder.” This condition is particularly relevant here, as studies show a remarkable 70% to 75% of cases affect female patients, usually between the ages of 40 and 60. The shoulder capsule itself thickens and tightens, severely restricting movement and causing significant pain.

Imagine your shoulder joint is wrapped in a loose, flexible film. In frozen shoulder, this film (the capsule) mysteriously becomes stiff, thick, and sticky, literally “freezing” the joint in place and causing significant pain with even the slightest movement.

Is the Neck the Real Problem?

But what happens when the shoulder joint itself checks out as perfectly healthy? This is where a clinician’s detective work really comes into play, because the pain signals might be traveling from an entirely different location: the cervical spine, or neck. It’s a classic clinical scenario where a neck problem is masquerading as a shoulder problem.

The prime example is cervical radiculopathy. Think of the nerves leaving your spinal cord in the neck as a complex electrical wiring system that runs all the way down your arm. If a disc between your vertebrae bulges or an arthritic bone spur forms, it can “pinch” one of those nerve roots.

Interestingly, this compression doesn’t always cause much neck pain. Instead, it can send referred pain signals shooting along the nerve’s pathway. If the C5 or C6 nerve root is involved, the pain often lands squarely in the shoulder, perfectly mimicking a rotator cuff tear. This is why we have to be so careful to figure out if the problem is in the shoulder “joint” or the neck “wiring.”

A few key physical exam tests are invaluable for telling these two apart.

• Spurling’s Test: Gently tilting the patient’s head toward the painful side and applying a bit of downward pressure can reproduce that radiating pain, which strongly points to the cervical spine as the culprit.
• Shoulder Abduction Relief Sign: If having the patient rest the hand of their affected arm on top of their head actually relieves the pain, that’s a classic sign of cervical radiculopathy. It works by taking tension off the pinched nerve root.
• Painful Arc Test: On the other hand, if pain is triggered specifically when the patient lifts their arm between 60 and 120 degrees, that points right back to a problem within the shoulder joint itself, like rotator cuff impingement.

Getting this right is the most critical first step. Misdiagnosing a neck issue as a shoulder problem leads to ineffective treatment, months of unnecessary pain, and immense frustration for the patient. For clinicians wanting to dive deeper into musculoskeletal diagnostics, you might find value in our articles on our resources on orthopedics and traumatology, which offer free access to peer-reviewed research.

When Shoulder Pain Isn’t About the Shoulder at All

Most of the time, shoulder and neck pain is exactly what it seems: a strained muscle, a stiff joint, or a pinched nerve. But every so often, this common complaint is a warning sign from somewhere else entirely—a problem lurking deeper in the chest or abdomen. This is where clinical intuition can be lifesaving, especially when assessing woman pain in left shoulder and neck.

This phenomenon is called referred pain, and it happens when the brain gets its wires crossed about where a pain signal is coming from.

Think of it like a jumbled-up electrical panel. Nerves from various parts of the body converge into shared pathways on their way to the brain. When an internal organ like the heart or diaphragm gets into trouble, its distress signal travels up these common routes. Since the shoulder and neck share some of the same nerve roots (specifically from the cervical spine, C3-C5), the brain can misinterpret the signal, broadcasting it as pain in the shoulder.

The Cardiac Connection in Women

The most dangerous imposter to rule out is a heart attack, known clinically as Acute Coronary Syndrome (ACS). We’re all familiar with the classic image of a man clutching his chest, but women are far more likely to present with atypical symptoms. For many women, the main—or only—complaint might be a nagging ache in the left shoulder, neck, or jaw.

This isn’t just a fun fact; it’s a critical diagnostic clue. The pain might be described as a persistent ache or pressure that doesn’t go away with rest or changing positions. It could get worse with exertion, like climbing the stairs, but be easily dismissed as muscle fatigue.

When a woman over 40 presents with new, unexplained left shoulder and neck pain, especially if she has risk factors for heart disease, ACS must be at the very top of the differential diagnosis until proven otherwise. Chalking it up to a simple strain without considering the heart can have catastrophic consequences.

Other Abdominal Imposters

It’s not just the heart. Several other organs can send pain signals up to the left shoulder. These issues often involve irritation of the diaphragm, the large muscle separating your chest from your abdomen. The phrenic nerve, which controls the diaphragm, originates in the neck (C3, C4, and C5). Any irritation to the diaphragm can travel right up that nerve and be felt as sharp pain at the shoulder tip.

• Ruptured Spleen: A blow to the abdomen can cause the spleen, located in the upper left, to rupture. As blood collects and irritates the diaphragm, it triggers Kehr’s sign—a classic finding of acute pain in the tip of the left shoulder.
• Pancreatitis: While inflammation of the pancreas usually causes back pain, a severe case can irritate the diaphragm and refer pain to the left shoulder.
• Post-Surgical Pain: It’s common for patients to report shoulder pain after chest or abdominal surgeries, like a mastectomy. This can be from how they were positioned during the procedure, but it can also be referred pain from internal inflammation as the body heals.

Recognizing these imposters means we have to think beyond the obvious musculoskeletal causes. We have to connect the woman pain in left shoulder and neck to the whole clinical picture. Are there other symptoms, like nausea, shortness of breath, or a tender abdomen? Was there a recent injury or surgery?

Asking these questions is the key to figuring out whether the pain is a local problem or a distant warning from a deeper organ in distress.

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How Systemic and Compressive Conditions Cause Pain

While pain from internal organs can masquerade as a shoulder problem, another group of conditions causes genuine, physical pain in the neck and shoulder—not from a simple strain, but from body-wide inflammation or direct, physical compression. When you’re evaluating a woman with left shoulder and neck pain, it’s essential to look past purely mechanical causes and keep these less common, but critical, diagnoses on your radar.

These conditions are often harder to pin down because they don’t play by the usual rules of an injury. The pain can seem to appear from nowhere, feel unusually severe, or bring along friends—symptoms like profound fatigue or finger tingling—that don’t seem related to the shoulder at all.

When Inflammation Affects the Whole Body

One of the most classic examples of a systemic inflammatory condition presenting as shoulder pain is Polymyalgia Rheumatica (PMR). This disorder almost exclusively affects people over 50 and is significantly more common in women. Its hallmark is a sudden, dramatic onset of severe pain and stiffness, most notably in the shoulder and hip girdles.

Patients with PMR often describe waking up feeling as if they’ve aged decades overnight. The pain and stiffness in their shoulders can be so intense that simple tasks like combing their hair or pulling on a shirt become monumental efforts. This isn’t just a minor ache; it’s a profound, disabling stiffness that’s typically worst in the mornings and affects both sides of the body symmetrically.

Think of PMR as a “false alarm” from the immune system. The body mistakenly attacks the linings of the joints and the bursae (the fluid-filled sacs that cushion the joints) around the shoulders and hips, sparking widespread inflammation. A simple blood test for inflammatory markers like ESR and CRP can give you crucial clues.

The Problem of Compression

Sometimes, the issue isn’t inflammation but a simple traffic jam. This is what happens in Thoracic Outlet Syndrome (TOS), a complex condition where the nerves and blood vessels traveling from the neck down to the arm get squeezed. This compression occurs in the “thoracic outlet”—a narrow space bordered by the collarbone, the first rib, and the neck muscles.

Because the nerves of the brachial plexus and the subclavian artery and vein all have to pass through this tight corridor, any compression can create a strange and confusing mix of symptoms. A woman with TOS might present with:

• Neurological Symptoms: Aching pain in the neck and shoulder, often accompanied by numbness or tingling that radiates down the arm into the fingers.
• Vascular Symptoms: A feeling of heaviness or fatigue in the arm, a weak pulse, coldness, or even swelling and a bluish discoloration if a blood vessel is significantly compressed.

TOS can be notoriously difficult to diagnose because its symptoms overlap with so many other conditions, particularly cervical radiculopathy. It requires a high index of suspicion and specific physical exam maneuvers to unmask.

Research confirms that neck and shoulder pain often travel together. One study found that 13% of women experience both concurrently. The connection is frequently tied to underlying systemic factors, as women with this co-occurring pain are more likely to have comorbid conditions like arthritis and cardiovascular disease. You can explore the full study on these correlates of co-occurring neck and shoulder pain.

Rare but Critical Causes

Finally, we have to consider the rare but life-threatening causes, like a Pancoast tumor. This is a type of lung cancer that grows at the very top of the lung. Because of its specific location, the tumor doesn’t usually cause the typical lung cancer symptoms we think of, like a persistent cough.

Instead, as it grows, it can invade nearby structures, including the nerves of the brachial plexus and the sympathetic chain. This invasion leads to a very specific set of symptoms known as Pancoast syndrome, which often starts with severe, unrelenting shoulder pain that radiates down the inside of the arm. It can be a true diagnostic puzzle, as the initial complaint is purely musculoskeletal. Recognizing this pattern is absolutely essential for early diagnosis and intervention.

The Clinical Path to an Accurate Diagnosis

When a woman presents with pain in her left shoulder and neck, arriving at the right diagnosis is less about high-tech scanners and more about old-fashioned detective work. The single most powerful tool you have isn’t an MRI—it’s the patient’s story. A detailed, thoughtful history will almost always give you more clues than any other part of the evaluation, pointing you down the right path for examination and investigations.

The diagnostic journey begins by simply listening. We need to move past just charting “left shoulder pain” and really dig into the specifics. Asking the right questions builds a clinical picture that starts narrowing the vast field of possibilities right away, from a simple muscle strain all the way to a life-threatening cardiac event.

The Art of Focused Questioning

To start untangling the cause of the pain, your initial conversation should be structured around a few key areas. Every answer is a piece of the puzzle, helping you differentiate between musculoskeletal, neurological, and referred pain.

Key questions to explore include:

• Pain Character: Is it a sharp, stabbing pain, or is it more of a dull, heavy pressure? Sharp, localized pain often points to a musculoskeletal cause. A heavy, crushing sensation, on the other hand, is a major red flag for a cardiac origin.
• Timing and Onset: Did the pain start suddenly after an obvious injury, or did it creep up over weeks? Sudden, severe pain could mean a tear or even a vascular event, while a gradual onset is more in line with tendinopathy or arthritis.
• Associated Symptoms: This is absolutely critical. Are there other things going on like shortness of breath, nausea, sweating, or dizziness? The presence of these systemic symptoms immediately raises suspicion for a non-musculoskeletal emergency.
• Triggers and Relievers: What makes the pain better or worse? If specific arm movements make it hurt, you’re likely looking at the shoulder joint itself. But if the pain gets worse with exertion like walking and doesn’t ease with rest, you have to be highly concerned about the heart.

This initial sorting helps you prioritize what to do next, a thought process visualized in the decision tree below.

This flowchart shows a simplified way to categorize the pain, helping you quickly sort between issues driven by body-wide inflammation and those caused by more localized compression.

The Power of the Physical Exam

Armed with the insights from your patient’s history, a focused physical exam can further pinpoint the source of the pain. This is a hands-on process of testing specific movements, palpating for tenderness, and assessing nerve function to either confirm or rule out your initial hypotheses.

The physical exam is not just a series of random movements; it’s a targeted investigation. Each maneuver is a question you’re asking the body. The body’s response—whether it’s pain, weakness, or relief—provides the answer.

Connecting what you find on exam to a likely diagnosis is a core clinical skill. The table below helps link common physical exam findings with their most probable underlying causes, which can really help streamline the diagnostic pathway.

Linking Physical Exam Findings to Potential Diagnoses

Physical Exam Finding	Primary Suspected Diagnosis	Secondary Considerations
Pain with overhead arm movement (Painful Arc)	Rotator Cuff Impingement/Tendinopathy	Subacromial Bursitis
Positive Spurling’s Test (pain radiates down arm)	Cervical Radiculopathy	Brachial Plexus Irritation
Profound, global loss of active and passive motion	Adhesive Capsulitis (Frozen Shoulder)	Severe Glenohumeral Arthritis
Tenderness over the AC joint; pain with cross-body adduction	Acromioclavicular (AC) Joint Arthritis	Distal Clavicle Fracture
Arm weakness, tingling, and a positive Tinel’s sign at the clavicle	Thoracic Outlet Syndrome (TOS)	Pancoast Tumor

This is by no means an exhaustive list, but it covers some of the most common connections you’ll make when examining a patient with this presentation.

A Smart Approach to Investigations

The final step is to use investigations wisely. Ordering a huge battery of tests for every patient is not only inefficient but often completely unnecessary. Your choice of investigation should be directly guided by what you found in the history and physical exam.

A smart, tiered approach keeps things safe and cost-effective:

1. Rule Out Emergencies First: If you have even a sliver of suspicion for a cardiac cause based on risk factors or associated symptoms, an urgent ECG and cardiac enzyme blood tests are non-negotiable. Don’t hesitate.
2. Start with Simple Imaging: For most suspected musculoskeletal problems, a simple X-ray is a great starting point to rule out fractures or significant arthritis. An ultrasound is an excellent, dynamic tool for visualizing soft tissues like the rotator cuff tendons and bursae right there in the clinic.
3. Reserve Advanced Imaging: An MRI is not a first-line test for most shoulder pain. It’s best reserved for times when the diagnosis is still unclear after initial tests, when you need to confirm a large rotator cuff tear before surgery, or to investigate a potential tumor or complex cervical spine issue.

By following this logical path—starting with the patient’s story, confirming with a focused exam, and choosing investigations judiciously—we can navigate the complexities of a woman’s left shoulder and neck pain to arrive at an accurate diagnosis efficiently and safely. To explore more about the evidence behind clinical decision-making, you can check out the regular journal club updates on the Free Medical Journals blog.

Effective Management and Knowing When to Refer

Once you’ve worked through the differentials and settled on a working diagnosis, your focus naturally shifts to management. This is a two-part skill: initiating the right first-line treatments for common problems, and, just as importantly, knowing the hard lines that tell you when to escalate care. The art of safe practice is confidently handling the straightforward cases while getting the complex or urgent ones to the right place, fast.

The initial game plan hinges entirely on what you suspect is going on. For the vast majority of women presenting with this pain profile, the cause is musculoskeletal — think rotator cuff issues or myofascial trigger points. Here, a conservative, patient-centred approach is almost always the right place to start.

First-Line Treatments for Mechanical Pain

For simple mechanical pain, the goals are straightforward: settle down the inflammation, get function back, and stop it from happening again. This isn’t a one-size-fits-all prescription; it’s about combining a few key strategies for that specific patient.

• Pain and Inflammation Control: A short course of nonsteroidal anti-inflammatory drugs (NSAIDs) can provide significant relief. Alongside this, simple ice packs applied for 15-20 minutes a few times a day are great for taking the edge off acute inflammation and pain.
• Activity Modification: This is where patient education really shines. It’s about helping them connect the dots between their pain and certain activities — like repetitive overhead reaching or slumping at a computer — and breaking that cycle.
• Physical Therapy: This is the cornerstone of recovery for most musculoskeletal pain. A good physio will do more than just give out exercises; they’ll provide hands-on treatment and guide the patient through a specific program to strengthen the rotator cuff and scapular stabilisers, restore range of motion, and correct any underlying biomechanical problems.

The goal of initial management isn’t just about temporary relief; it’s about empowerment. When you teach a patient proper movement patterns and self-management strategies, you’re helping them shift from being a passive recipient of care to an active partner in their own recovery.

For a deeper dive into evidence-based orthopaedic treatments, you can explore the excellent peer-reviewed resources on the Free Medical Journals blog section.

Defining the Lines for Referral

Knowing when to manage in-house and when to refer is a critical judgement call. Some findings are absolute red flags that demand immediate escalation to keep your patient safe and secure a good outcome. The right referral path, of course, depends on what you suspect is the real problem.

Immediate Emergency Department Transfer:
Any inkling of an acute coronary syndrome or another life-threatening vascular event is a non-negotiable, straight-to-A&E situation. Don’t think twice if a woman with left shoulder and neck pain also has:

• Chest pain, pressure, or a sense of tightness
• Shortness of breath
• Nausea, feeling lightheaded, or breaking out in an unexplained sweat
• Pain that gets worse with any exertion and doesn’t get better with rest

Referral to Orthopaedics:
An orthopaedic referral makes sense when clear mechanical shoulder pain simply isn’t getting better after a dedicated 4-6 week course of conservative management. This is especially true for:

• Suspected large, full-thickness rotator cuff tears.
• A classic “frozen shoulder” (adhesive capsulitis) that is failing to thaw.
• Debilitating pain that continues to crush daily function despite good physical therapy.

Referral to Neurology or Neurosurgery:
If the clinical picture is pointing to a primary neurological cause, it’s time to involve neurology or neurosurgery. The key triggers for this referral are:

• Progressive motor weakness in the arm or hand.
• Symptoms of spinal cord compression (myelopathy), like an unsteady gait or changes in bowel/bladder control.
• Relentless radicular pain that just won’t respond to conservative measures.

Referral to Rheumatology:
When your clinical suspicion leans towards a systemic inflammatory condition, a rheumatologist is your best port of call. You’ll want to make this referral if:

• The patient has signs of Polymyalgia Rheumatica, especially severe, bilateral shoulder stiffness and markedly elevated inflammatory markers (ESR/CRP).
• You see other clues of a systemic autoimmune disease, like joint swelling elsewhere or a tell-tale rash.

Frequently Asked Questions

Even after exploring the potential diagnoses, a few key questions almost always come up when discussing this kind of pain. Let’s tackle some of the most common ones.

Can This Pain Just Be From Stress?

Without a doubt. Psychological stress is a powerful driver of physical pain. When we’re stressed, many of us unconsciously tighten our upper back and neck muscles—specifically the trapezius—leading to persistent strain, stiffness, and even painful knots known as trigger points.

This chronic muscle tension can easily present as that nagging ache in your left shoulder and neck. But while stress is a very common culprit, it should never be the default assumption. It’s crucial to rule out other medical causes, especially if the pain is severe, unrelenting, or accompanied by other red flags like dizziness or shortness of breath.

When Is Left Shoulder Pain a Sign of a Heart Attack?

This is the critical question, and the answer is about context. You should seek immediate emergency medical help if your left shoulder pain is sudden, unexplained, and arrives with other classic heart attack symptoms.

Pay close attention to these red flags:

• Discomfort in the chest (often described as pressure, squeezing, or fullness)
• Shortness of breath
• Feeling lightheaded, dizzy, or nauseous
• Pain that radiates into the jaw, back, or down the arm

It’s vital to remember that women often present with atypical heart attack symptoms, and sometimes, isolated shoulder or neck pain can be the main or only sign. Never dismiss these symptoms, particularly if you have underlying risk factors for heart disease.

For clinicians wanting to dive deeper into the latest cardiology research, the discussions on our Free Medical Journals blog offer a great peer-reviewed resource.

How Can I Tell If the Pain Is Coming From My Neck or My Shoulder?

Differentiating between neck and shoulder-driven pain is a classic diagnostic puzzle. A good starting point is to notice which movements make the pain worse.

Pain that originates in the neck, like cervical radiculopathy (a pinched nerve), typically flares up when you move your neck—like turning your head to check a blind spot or tilting your head back. You might also feel tingling, numbness, or weakness that travels down your arm.

In contrast, pain that’s truly from the shoulder joint itself usually gets worse with specific arm movements. Think of pain when lifting your arm out to the side and overhead (a “painful arc”) or when trying to reach behind your back. A thorough physical exam with a clinician is the best way to pinpoint the true source of the problem.