Pain In The Back Of Your Shoulder

ByKevin Kruse

Pain in the back of your shoulder can come from a posterior labral tear, infraspinatus or teres minor strain, cervical radiculopathy, scapular dyskinesis, muscle trigger points, or glenohumeral arthritis. Dr. Kevin Kruse and our experienced clinical team specialize in evaluating shoulder pain, identifying the underlying cause, and creating individualized treatment plans to restore comfort, mobility, and function.

This page explains the anatomy of the back of the shoulder, common causes of posterior shoulder pain, diagnostic options, treatment solutions, and when to schedule an evaluation with a shoulder specialist.

Key Takeaways

  • Pain in the back of the shoulder may be caused by a posterior labral tear, infraspinatus or teres minor strain, cervical radiculopathy, scapular dyskinesis, muscle trigger points, or glenohumeral arthritis.
  • Pain that stays near the shoulder often suggests a shoulder condition, while burning pain, tingling, numbness, or weakness that travels from the neck into the shoulder blade, arm, hand, or fingers may suggest nerve involvement.
  • Pain that persists, worsens, disrupts sleep, limits lifting or reaching, or causes weakness should be evaluated by a shoulder specialist.

Anatomy Of The Back Of The Shoulder

The back of the shoulder, or posterior shoulder, includes several structures that sit behind the ball-and-socket joint and help control rotation, stability, and shoulder blade movement:

  • The posterior rotator cuff includes the infraspinatus and teres minor, two of the four small muscles and tendons that wrap around the head of the upper arm bone (humerus). These structures sit along the back of the shoulder blade and attach to the upper humerus, helping rotate the arm outward and keep the ball centered in the socket.
  • The posterior shoulder capsule is the back portion of the soft tissue envelope that surrounds the shoulder joint. The posterior labrum is the back part of the thick cartilage rim that lines the socket. Together, these structures help stabilize the shoulder when force pushes the ball of the joint backward.
  • The scapula, or shoulder blade, forms the bony foundation for the back of the shoulder. Muscles such as the trapezius and rhomboids attach to the scapula and help control its position during movement.

Posterior shoulder pain can originate in any of the structures listed above. An evaluation by Dr. Kruse, Dallas shoulder surgeon, and our clinical team can help pinpoint the underlying cause of your symptoms and identify the right next steps for treatment.

Common Causes Of Back Shoulder Pain

Common causes of posterior shoulder pain include:

Posterior Labral Tear

A posterior labral tear affects the cartilage rim at the back of the shoulder socket. Because the labrum helps stabilize the shoulder, injury may cause deep posterior shoulder pain, clicking, catching, weakness, or a feeling that the joint isn’t moving smoothly. This type of tear often occurs as the result of pushing, tackling, bench pressing, throwing, or catching a fall.

Infraspinatus/Teres Minor Strain

The infraspinatus and teres minor are posterior rotator cuff muscles that help rotate the arm outward and stabilize the shoulder. Strain or irritation may develop after sports, lifting, throwing, repetitive use, or sudden overload. Patients may notice pain in the back or outside of the shoulder and weakness with external rotation, such as opening a car door or rotating the arm back to throw a ball.

Cervical Radiculopathy (Referred Pain From Neck)

Cervical radiculopathy occurs when a nerve root in the neck becomes inflamed or compressed (pinched). Although the problem begins in the cervical spine, pain can travel into the shoulder blade, shoulder, arm, hand, or fingers. It may feel burning or electric and may be accompanied by numbness, tingling, pins-and-needles sensations, or weakness.

Scapular Dyskinesis

Scapular dyskinesis is a condition characterized by the shoulder blade not moving or positioning normally during arm motion. When the shoulder blade doesn’t glide properly, nearby muscles and tendons may become overloaded, causing pain around the back of the shoulder, upper back, or shoulder blade.

Muscle Trigger Points

Trigger points are tight, sensitive areas in muscle that can refer pain to nearby regions, including the back of the shoulder, neck, and shoulder blade. They may develop from poor posture, overuse, stress, repetitive work, or compensation after an injury.

Arthritis (Glenohumeral Or AC Joint)

Glenohumeral arthritis affects the main ball-and-socket joint of the shoulder and can sometimes refer the pain toward the back of the shoulder. Symptoms may include deep shoulder pain, stiffness, grinding, reduced motion, and difficulty reaching behind the back or overhead. Acromioclavicular (AC) joint pain is usually felt more at the top of the shoulder rather than the back.

Diagnostic Approach

Diagnosing pain in the back of the shoulder typically starts with a detailed symptom history. Dr. Kruse and our clinical team will ask where the pain is located, when it started, which movements make it worse, and whether symptoms travel into the shoulder blade, arm, hand, or fingers.

Next, an in-depth physical examination may include:

  • Strength testing
  • Range-of-motion assessment
  • Shoulder-specific provocative tests
  • Scapular motion evaluation
  • A neck evaluation when nerve-related symptoms are present
  • Nerve screening, including EMG testing, may be considered when numbness, tingling, weakness, or radiating pain suggests nerve involvement

Imaging is often  used to rule out diagnoses, confirm a diagnosis, and evaluate the structures most likely to be involved. X-rays can assess arthritis or structural changes in the shoulder joint. Ultrasound may be used to evaluate the rotator cuff, biceps tendon, and inflamed bursa. MRI can help assess the labrum, rotator cuff, capsule, and other soft tissues. If shoulder testing is negative and symptoms suggest nerve involvement, cervical spine MRI may be recommended to determine whether the pain is coming from the neck.

Treatment For Posterior Shoulder Pain

Treatment for posterior shoulder pain depends on the underlying diagnosis:

  • For soft-tissue irritation, muscle trigger points, scapular dyskinesis, or muscle overload, initial care may include rest from aggravating activity, posture work, stretching, and physical therapy focused on strengthening, shoulder blade control, functional training, and a gradual return to activity.
  • If symptoms are related to rotator cuff strain, tendon irritation, inflammation, or bursitis, treatment may include activity modification, short-term anti-inflammatory medication, targeted physical therapy, and in some cases, a corticosteroid injection to reduce inflammation.
  • If pain is related to a posterior labral tear, treatment depends on the severity of symptoms, activity goals, and whether instability, catching, or persistent pain is present. Some patients improve with physical therapy, while others may benefit from arthroscopic labral repair.
  • If symptoms are caused by glenohumeral arthritis, treatment may include anti-inflammatory medication, physical therapy, injections, and activity modification. When arthritis is severe and daily function is significantly limited, shoulder replacement may be considered.
  • If symptoms suggest cervical radiculopathy, or another nerve-related condition, additional nerve testing, cervical spine imaging, image-guided procedures, or referral to an appropriate specialist may be recommended.
  • For tendon or soft-tissue conditions, biologic options such as PRP may be discussed when appropriate.
  • When symptoms are related to a structural shoulder problem, such as a significant rotator cuff tendon tear, persistent impingement, or a posterior labral tear, an operation may be recommended. Depending on the diagnosis, this may include arthroscopic labral repair, rotator cuff repair, decompression procedures, or shoulder replacement. Learn all about shoulder surgery here.

As a high-volume rotator cuff surgeon, Dr. Kruse emphasizes accurate diagnosis, individualized planning, and non-surgical care when appropriate before considering a procedure. The right treatment plan depends on the structure causing the pain, the severity of symptoms, and each patient’s goals for comfort, mobility, and function.

Dealing With Back Shoulder Discomfort?

If pain in the back of your shoulder is limiting your sleep, work, exercise, or everyday movement, Dr. Kevin Kruse and our experienced clinical team can help identify the source of your symptoms and recommend the next step toward relief.

Schedule an appointment today to relieve shoulder pain and get started.