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Everyday Health Notes

Shoulder Pain vs Tennis Elbow: How to Tell the Difference

You feel a sharp ache when you grip a handle or lift something, and the pain seems to come from your elbow, but your shoulder blade also feels tender when you press on it. It is hard to tell whether you have two separate problems or whether one is leading to the other.

The Direct Answer

Tennis elbow typically causes pain on the outside of the elbow that worsens when gripping, lifting, or twisting the forearm. Shoulder pain from strain or tendinitis usually centers near the shoulder joint or shoulder blade and may worsen with overhead movement. When both areas hurt at once, the causes may be separate or connected, and a healthcare provider can help determine whether the pain is localized, referred, or part of a broader pattern.

What Tennis Elbow Typically Feels Like

Tennis elbow (lateral epicondylitis) involves the tendons on the outside of the elbow. It commonly results from repetitive gripping, lifting, or twisting motions.

Typical features:

  • Pain on the outer side of the elbow, directly on or near the bony prominence
  • Worsening pain when gripping, lifting, or twisting the forearm (such as turning a doorknob or lifting a grocery bag)
  • Tenderness when pressing on the outside of the elbow
  • Possible mild weakness in grip strength

Tennis elbow usually stays focused on the elbow. It does not typically spread to the shoulder blade, though some people may notice upper arm discomfort along the muscle pathway.

What Shoulder Tendinitis or Strain Typically Feels Like

Shoulder tendinitis or strain affects the rotator cuff tendons, the bursa near the shoulder joint, or the muscles around the shoulder blade.

Typical features:

  • Pain near the shoulder joint, often on the front or side
  • Pain around or beneath the shoulder blade, especially with certain movements
  • Worsening pain when lifting overhead or reaching behind the back
  • Possible burning or aching when pressing directly on the shoulder blade area
  • Tenderness that may feel deeper than surface muscle strain

Shoulder pain does not usually involve the elbow unless there is a separate issue or referred pattern from the neck.

When Both Areas Hurt Together

Some people feel discomfort in both the elbow and the shoulder blade at the same time. This pattern can reflect:

  • Two separate conditions: Tennis elbow plus shoulder blade strain from posture or overuse.
  • A broader pattern: Posture-related strain that affects both the upper arm and the upper back.
  • Referred pain: Neck issues that radiate toward both areas.
  • Systematic involvement: Conditions that affect multiple joints or tendons, such as rheumatoid arthritis or widespread inflammation.

When pain appears in both areas and does not respond to rest or basic care, a healthcare provider can help determine whether the causes are connected or distinct.

What You Can Try First

For mild discomfort in either area:

  1. Rest the involved area: Avoid gripping and twisting if the elbow hurts; avoid overhead lifting if the shoulder hurts.
  2. Apply cold or heat: Use cold soon after strain; heat may help relax tight muscles after a day or two.
  3. Gentle movement: Once pain settles, easy stretches for the forearm or shoulder may help. Stop if movement worsens the pain.
  4. Posture check: Adjust seated and standing positions to reduce strain on both the elbow and the shoulder blade.
  5. Over-the-counter options: NSAIDs can ease pain and inflammation. Follow label directions.

Quick Self-Check: Is Your Pain Tennis Elbow, Shoulder Strain, or Something More?

Answer these quick questions to help clarify what might be involved:

  1. Does the pain focus on the outside of your elbow when you grip or twist?

    • Yes: Tennis elbow may be involved
    • No: Continue to the next question

  2. Does the pain center near your shoulder joint or shoulder blade, especially when lifting overhead?

    • Yes: Shoulder strain or tendinitis may be involved
    • No: Continue to the next question

  3. Do you feel burning or tenderness when pressing directly on the shoulder blade bone?

    • Yes: Shoulder blade inflammation or nerve irritation may be involved; consider medical evaluation
    • No: Continue to the next question

  4. Does the pain appear in both elbows and both shoulder blades at the same time?

    • Yes: A broader pattern may be involved; seek medical advice
    • No: Continue to the next question

  5. Have you tried rest and basic care for more than a week without improvement?

    • Yes: Schedule a medical visit for further evaluation
    • No: Short-term monitoring may still be appropriate

Note: This self-check is informational only. It cannot replace a medical evaluation.

When to Get Medical Advice

Contact a healthcare provider if:

  • Elbow and shoulder pain both persist despite rest and basic care
  • You feel burning or tenderness when pressing on the shoulder blade
  • Pain worsens with lifting, gripping, or overhead movement
  • You have numbness, tingling, or weakness in the arm
  • Discomfort interferes with daily tasks

Seek urgent care if shoulder or elbow pain occurs with chest pressure, shortness of breath, or other possible heart attack symptoms.

FAQ

Q: Can tennis elbow cause shoulder blade pain?

A: Tennis elbow itself affects the elbow tendons. However, some people may have separate shoulder issues, or pain may be referred from the neck. If both areas hurt, a healthcare provider can help determine whether they are connected or distinct.

Q: How do I know if my elbow pain is tennis elbow?

A: Tennis elbow typically causes pain on the outside of the elbow that worsens with gripping, lifting, or twisting the forearm. Tenderness directly on the outer elbow bone is common.

Q: Can shoulder tendinitis feel like burning?

A: Yes. Tendinitis near the shoulder can cause burning or aching that worsens with overhead movement or lifting.

Q: What if both my elbows and both shoulder blades hurt?

A: Pain in multiple areas may suggest a broader pattern such as postural strain, nerve involvement, or a systemic issue. See a healthcare provider for evaluation rather than assuming a single cause.

Q: Should I stop lifting if I have elbow and shoulder pain?

A: If lifting worsens the pain in either area, rest and avoid aggravating activities until you get medical advice. Continuing to strain the areas may prolong discomfort.

Q: When should I see a specialist instead of a GP?

A: If your GP’s initial treatment does not help, or if you have pain in multiple areas with unclear cause, a referral to an orthopedic specialist or rheumatologist may be appropriate.

Common Mistakes

  • Assuming tennis elbow explains shoulder blade pain: Tennis elbow affects the elbow. Shoulder blade tenderness often has a different cause and may need separate evaluation.
  • Ignoring bilateral patterns: Pain in both elbows and both shoulder blades may suggest a broader issue rather than isolated tendinitis.
  • Delaying evaluation when pain spans multiple areas: If basic care does not help and both areas continue to hurt, seek medical advice rather than waiting.

Summary

Tennis elbow causes outer elbow pain that worsens with gripping and twisting. Shoulder tendinitis or strain causes pain near the shoulder joint or blade that worsens with overhead movement. When both areas hurt, the causes may be separate or connected. Seek medical evaluation if pain persists, spreads, or does not respond to basic care.

Disclaimer

This article is for general information only. It cannot replace a diagnosis, treatment plan, or professional advice from a qualified medical provider. If you have persistent or concerning symptoms, seek medical care.

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