Burning shoulder pain is a distinct and often alarming symptom, characterized by feelings described as sharp, electrical, hot, or searing. This discomfort signals irritation of the body’s sensory pathways, ranging from localized inflammation to complex systemic issues. Determining the precise cause relies on differentiating whether the burning originates from nerve damage, structural joint problems, or pain referred from distant internal organs.
Neuropathic Causes of Burning Shoulder Pain
Burning pain is frequently a direct manifestation of nerve compression, irritation, or damage, known as neuropathy. Sensory nerves transmit signals about temperature and pain; when compromised, the brain misinterprets the faulty signal as intense heat or an electrical sensation. This mechanism differs from common aches arising from muscle strain or joint stress.
Cervical Radiculopathy
One common source of radiating discomfort is cervical radiculopathy, or a pinched nerve in the neck. When a nerve root is compressed as it exits the spinal column, the pain signal travels down the nerve pathway. This often results in burning pain that radiates across the shoulder and down the arm. Compression is frequently caused by a herniated disc or degenerative bone changes that narrow the space around the nerve root.
Thoracic Outlet Syndrome (TOS)
Another potential cause involves the complex bundle of nerves, blood vessels, and muscles passing between the collarbone and the first rib. Compression in this area, known as Thoracic Outlet Syndrome (TOS), can irritate the brachial plexus, the main nerve network supplying the shoulder and arm. This irritation leads to a chronic burning or tingling sensation, often accompanied by numbness or weakness in the hand.
Shingles and Post-Herpetic Neuralgia
Infectious causes can also lead to intense neuropathic shoulder pain, most notably the reactivation of the Varicella-zoster virus, which causes Shingles. The virus travels along a specific nerve pathway (dermatome), leading to a painful, burning sensation that precedes the characteristic blistering rash. Even after the rash subsides, some individuals may experience persistent, severe burning pain known as post-herpetic neuralgia.
Musculoskeletal and Local Inflammatory Conditions
While nerve issues cause classic burning sensations, severe structural damage and localized inflammation within the shoulder joint can also generate intense discomfort. This pain results from mechanical friction or the release of inflammatory chemicals that irritate local pain receptors. These causes focus on damage to the joint’s soft tissues and bones, distinct from nerve root compression originating from the spine.
Bursitis and Tendinopathy
One frequent source is bursitis, the inflammation of the bursa, a small fluid-filled sac that cushions the joint. When the subacromial bursa becomes inflamed, it swells and creates friction against the rotator cuff tendons. This results in sharp, localized pain that can feel hot during movement. Similarly, tendinopathy, the degeneration or acute inflammation of the rotator cuff tendons, can cause sharp, inflammatory pain.
Impingement and Osteoarthritis
Repetitive overhead motions can lead to shoulder impingement, where soft tissues are pinched between the bones of the joint. Chronic impingement causes persistent inflammation and micro-trauma, resulting in a deep, aching pain that flares up with movement. When the joint cartilage wears down, as in osteoarthritis, the resulting bone-on-bone friction and joint inflammation can also produce a deep, burning discomfort.
Rheumatoid Arthritis
Systemic inflammatory conditions like Rheumatoid Arthritis can target the shoulder joint, causing the immune system to attack the joint lining (synovium). This autoimmune response results in significant swelling, heat, and pain within the joint capsule. The localized heat and swelling associated with active synovitis are often described as a deep, radiating burn.
Referred Pain from Internal Organs
Referred pain occurs when discomfort originates in a visceral organ but is perceived by the brain as coming from the shoulder. This happens because the nerves supplying certain internal organs share spinal cord segments with the sensory nerves of the shoulder area. The brain misinterprets the distress signal, projecting it to the somatic area.
Cardiac Ischemia
One concerning cause of referred pain is cardiac ischemia, such as angina or a heart attack, where pain is commonly perceived in the left arm, jaw, or shoulder. The phrenic nerve, involved in the sensory pathway for the heart, shares spinal nerve roots (C3-C5) with the nerves supplying the shoulder and neck. This shared pathway explains why heart problems can manifest as left shoulder pain.
Diaphragm Irritation
Irritation of the diaphragm, the muscle separating the chest and abdominal cavities, is another common source of referred shoulder pain. Conditions like a ruptured ectopic pregnancy, internal bleeding, or an abscess beneath the diaphragm can irritate its surface. Since the phrenic nerve supplies the diaphragm, this irritation is frequently perceived as pain at the tip of the shoulder, known as Kehr’s sign.
Gallbladder Disease
Gallbladder disease, specifically acute cholecystitis, can cause referred pain to the right shoulder blade or the tip of the right shoulder. The sensory nerves for the gallbladder join the spinal cord near the nerves that supply the right shoulder area. When the gallbladder becomes acutely inflamed, the resulting strong pain signal is mislocalized to the shoulder.
Symptoms Requiring Immediate Medical Evaluation
While many causes of burning shoulder pain are manageable, certain accompanying symptoms signal a severe or life-threatening condition requiring immediate medical attention. Any shoulder pain accompanied by signs of systemic distress should be treated as an emergency.
If the burning pain is accompanied by chest pressure, shortness of breath, profuse sweating, or dizziness, it may indicate a cardiac event and warrants an immediate emergency response. These systemic symptoms suggest the referred pain originates from a major organ system, rather than a localized musculoskeletal issue.
Sudden, profound weakness or an inability to move the arm, especially if the pain started after a trauma, requires urgent evaluation to rule out severe nerve damage or a massive rotator cuff tear. Furthermore, the presence of fever, chills, or unexplained weight loss alongside the shoulder pain may indicate a serious infection or an underlying systemic inflammatory disease.