Burning shoulder pain can be an unusually uncomfortable and even painfully unpleasant experience. Some patients have that burning feel all the time; whereas for others this feeling can be there sometimes only. It can be in a very tiny pinpoint area; or over a large area.

Many of these patients who suffer from burning shoulder pain cant sleep well at night as the sensation wakes them up or keeps them up, making them tired throughout the waking day (we all have work and responsibilities).

Causes

The #1 question that patient ask is “what’s the cause of this weird burning pain in the shoulder”, and it can be a few different possible causes (which can happen at the same time too)

1. soft tissue around or in the shoulder
2. shoulder joint itself
3. possibly even neck-related (though patients dont report any neck issues)

So is it a neck or a shoulder problem?

Sometimes it can be confusing because is it a neck, or shoulder OR neck-and-shoulder problem – here’s a simple guide:

Neck and nerve-related pains or issues

Whenever we hear any sensory issues such as

• burning, tingling
• numbness, less feeling
• weakness

The first we usually think about is neck involvement where there’s a pinching of nerve that caused those sensory issues. The thing is that sometimes patients dont have any neck issue such as neck pain or neck stiffness but they have nerves that are pinched at the neck level.

If that’s not the case, it could be “traveling” pain caused by tight spots in muscles called trigger points.

The abnormal sensory experience can happen anywhere along the path of the nerve from the neck level that’s affected, all the way down to the tip of the finger. In our opinion, burning shoulder pain happens usually due to nerve irritation from one (or more) of the following:

Spinal disc disease

Burning shoulder pain can be caused by pressure on the nerve root due to problems in the disc such as

1. Disc bulge happens when part of the spinal disc presses onto a nerve rool
2. “Slipped disc” (herniation) happens when the inner nucleus of the disc spills out and presses onto the nerve root (a more severe version of disc bulge)
3. “DDD” (degenerative disc disease) happens when our spinal disc shrink with use and time, and doesn’t function or protect as well as before, leading to higher chances of pressure on nerve root eventually

Burning shoulder pain that’s caused by disc disease in the neck usually:

• gets worse with neck movements that squishes the already-compromised disc
• can happen gradually (such as in disc degeneration); but can also be sudden such as with disc herniations from sports injury or lifting
• isnt affected by shoulder / arm movements usually
• may not have neck pain (patients often think it’s not possible that their burning pain in the shoulder can be caused by a neck issue…until we treat their neck)
• tends to have pains, pins and needles, numbness

Spinal stenosis

Spinal stenosis is the narrowing of the spinal canal (its like a hole or drain in the spine that allows the spinal cord to go through), especially when the canal space has shrunk about 30%.

Because of the location of the spinal canal, these types of issues tends to be more central narrowing with different sensory affected:

• takes time to happen (gradual)
• can / tend to affect BOTH arms
• gets worse when looking downwards
• usually affect hand functions such as writing, eating, dressing, handling food / eating
• may have hand and finger weakness, numbness and “feeling thick skin or no power”
• severe cases may have impaired balance or bladder or bowel function
• tends to affect those above 50 years old

Warning: Cervical stenosis can a very serious medical condition especially if there’s too much narrowing of the spinal canal and the spinal cord is affected. For such severe cases, surgery may be needed urgently

Brachial Neuritis

Brachial neuritis means inflammation of the brachial plexus, a very important bundle of nerves that comes from the lower neck, shoulder, arm pit and front of chest. These types of inflammations / infections will cause BOTH

• motor (muscle weakness, coordination, balance) annd
• sensory issues (pains that can be sharp, burning)

at the shoulder all the way down to fingers.

Some patients get it because its in their genes (inherited) or an immunity issue after severe illness, surgery or immunisation.

Burning shoulder symptons and pains pain from brachial neuritis:

• 24/7, always present
• may travel down towards the hand and fingers
• typically affects one side (there’s a brachial plexus under each armpit)
• worsens with arm / nerve movements
• no warning: can happen very suddenly, with very sharp pain in the shoulder
• pain tends to be worse in the evening or night
• some patients find it hard to breath at times (shortness of breath)
• may have arm heaviness or weakness

Cervical Spondylosis

Cervical spondylosis (a type of neck arthritis) can also cause burning pain in the shoulder due to the spinal disc shrinking and placing pressure on the surrounding spinal nerves. The good news is that even though neck arthritis is a very common condition affecting up to 80% of the people above 60, but many do not experience cervical spondylosis or burning shoulder pain. 

Shoulder problems that causes burning pains and sensations

For those cases of burning pains and sensations in the shoulder that’s not caused by neck-related issue, then it’s possibly caused by and within the shoulder itself.

There’s 2 common shoulder problems that can cause that:

Shoulder Bursitis

We have bursas all over our body, and they are basically little pockets of fluid that is located between soft tissues and bones, and they act to allow smooth, friction-less movement.

In some cases, the bursa can get inflamed or damaged due to repetitive strain or large direct force such as in a motor vehicle accident or fall can cause inflammation in the shoulder that causes sensory-like burning shoulder pain.

Burning shoulder symptoms and pain from bursitis:

• starts off dull and achy, but gets worse with time and use
• tends to be very specific location (ie that particular bursa) hence the pain doesnt travel
• worsens whenever there is movement that strains that particular bursa
• painful enough to affect rest and sleep
• takes months to resolve and easily to get worse

Bursitis responds well to rest, shoulder physiotherapy, injections and anti-inflammatory pain medication.

Shoulder tendonitis

Tendinitis in the shoulder (tendinitis is used interchangeably with tendonitis; and it means degeneration and inflammation in the tendons) can cause burning shoulder pains and sensations as well.

These types of injuries are typically caused / aggravated with

• too much tendon loading such as carrying very heavy load
• too much tendon repetitive strain such as overhead throwing or racquet serving or work related
• bone spurs
• poor posture
• muscle weakness

Symptoms of shoulder tendonitis:

• general ache and burning sensation in shoulder
• specific localized sharp pain when moving the shoulder / arm
• no radiating / traveling pain
• pain tends to get worse when lifting arm over the head or shoulder as especially with resistance (load)
• sometimes there’s cracks and clicks which are called crepitus
• specific pain / tenderness with pressure

Responds well to rest, shoulder physiotherapy and strengthening exercises.

Other possible causes of shoulder pain and burning sensations

1. Fibromyalgia is a chemical imbalance in the body that signals widespread pain, ache, hypersensitivity, tiredness and burning pain
2. Shingles is a possibility if your burning pain also comes with a rash. Shingle pains we hear are quite unusual and can be very intense, usually on one side of the body.
3. Heart attack can manifest with burning shoulder pain together with a tight chest discomfort (together with other symptoms such as shortness of breath, dizziness etc). This is a medical EMERGENCY, need immediate medical attention.
4. Awkward posture, such as sleeping with arm draped over bed, or chair, or heavy pressure over shoulder can irritate the nerves, joint and tendons in the shoulder, leading to weird burning sensations. These types of burning sensation should clear out within a couple of days.

Where To Next?

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