What are the risk factors for developing shoulder pain?

Authors: Jaashing He , Hannah Goodings | Reviewer: Darryl Caves | Published: 7 June 2023 | Updated: ~

There are certain risk factors that increase your likelihood of developing shoulder injury or pain. Many of these risk factors also exist for the general population but there are some risk factors specific to the SCI population. Some of these factors can be changed and some cannot.

Non-modifiable risk factors for all populations

Non-modifiable factors are things that can increase risk of shoulder injuries but cannot inherently be changed. These include:

  • Higher age
  • Being female
  • Prior shoulder injury
  • Metabolic diseases leading to poor connective tissue capacity (e.g. diabetes, vascular diseases)

Non-modifiable risk factors specific to SCI

  • Higher level and complete injury
  • Longer duration of injury
  • Muscle imbalances due to paralysis of specific muscles
  • Reduced functional strength around the joint due to SCI-related muscle weakness/paralysis
  • Relying heavily on upper body movement for everyday life tasks
  • Postural issues due to SCI-related muscle weakness/paralysis

Risk Factors: Tetraplegia vs Paraplegia

While shoulder pain is more common in persons with tetraplegia and in those with complete injuries (Dyson-Hudson 2004), the cause of that shoulder pain can differ:

  • In paraplegia, overuse-related shoulder pain is more common and is seen in later years after injury (Mulroy et al., 2020), a result of using the shoulders for mobility over a long period.
  • In someone with tetraplegia where shoulder muscles are affected by paralysis, an imbalance in the shoulder muscles can result and there may be spasticity that pulls the shoulder capsule. Then, just moving the shoulder can result in pain due to subluxation and impingement.

Modifiable risk factors for all populations

Modifiable factors are things that may be able to be changed with lifestyle adjustment. The risk for shoulder injury can be reduced by:

  • Improving shoulder flexibility or range of movement deficit.
  • Increasing shoulder muscle strength and/or balance.
  • Improving posture, especially of shoulders hunched forward which can increase impingement.
  • Reducing occupational exposure: percentage of time spent working at or above shoulder height, high loads or force demands, repetitive tasks, exposure to vibration, sustained or awkward postures.

Modifiable risk factors specific to SCI

  • Reduce spasticity
  • Reduce body weight if obese
  • Improve balance or stability of the body for upper extremity tasks
  • Improve home or workplace set-up to reduce shoulder height movements and weight transfers without equipment support

It is important to note that some of the factors within the modifiable lists may actually be non-modifiable for some individuals.

Refer to our article on Spasticity for more information!