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What is causing my shoulder pain?

We can make a very educated guess on the cause of your shoulder pain based entirely on your age. 

If you are older than 45, odds are your shoulder diagnosis is due to a rotator cuff tear, osteoarthritis or frozen shoulder. 

Patients younger than 30 tend to have “instability” as the cause of shoulder pain in the vast majority of cases. This can either be of traumatic or atraumatic causes. Atraumatic causes are often attributed to hypermobility disorders such as Ehlers-Danlos syndrome. 

Patients between the ages of 31 and 45 tend to be more diverse in the causes of their shoulder pain. The most common causes are atraumatic instability, traumatic instability, frozen shoulder and rotator cuff tear. 

Other rarer causes of shoulder pain include rheumatoid arthritis, avascular necrosis and injuries to the sternoclavicular or acromioclavicular joints. 

Further, we can differentiate “active” versus “passive” structures in the shoulder. Active tissues are defined as bodily structures responsible for moving the arm. This includes muscles and tendons. Passive structures are tissues not responsible for movement, such as joint capsules and ligaments. If your arm only hurts with movement, but is pain-free when someone else tries to move it, “active” tissue is more likely to be the culprit.


  1. Seitz, PT, PhD, DPT, OCS;, A., Christaian, PT, DPT, OCS, SCS, H., Lutz, PT, DPT, PhD, A. and Shanley, PT, PhD, OCS, E., 2021. Current Concepts of Physical Therapy, 5th Edition-The Shoulder: Evidence-Informed Physical Therapy Patient Management. 5th ed. Academy of Orthopaedic Physical Therapy.

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