Ankylosing Spondylitis Shoulder Pain: Signs, Causes and Treatment

Ankylosing Spondylitis Shoulder Pain: Signs, Causes and Treatment

Ankylosing spondylitis is a chronic inflammatory condition that primarily affects the spine and can lead to discomfort and pain in various parts of the body. One of the common areas where individuals with ankylosing spondylitis experience pain is in the shoulders. In this article, we will explore the causes, symptoms, and management of ankylosing spondylitis shoulder pain.

Understanding Ankylosing Spondylitis Shoulder Pain

Ankylosing spondylitis is a type of arthritis that mainly targets the spine and sacroiliac joints. However, it can also involve other joints, including the shoulders. The pain experienced in the shoulders is often due to inflammation and stiffness caused by the disease.

Shoulder pain in AS can be quite debilitating and can have a significant impact on a person’s quality of life.

Symptoms and Diagnosis

Ankylosing spondylitis (AS) is a chronic autoimmune disease that primarily affects the spine and sacroiliac joints, but it can also involve other parts of the body. Here are the common symptoms and the diagnostic process for ankylosing spondylitis:

Common Symptoms

  • Back Pain: Chronic and persistent pain in the lower back is one of the hallmark symptoms of AS. The pain often starts gradually and worsens over time. It tends to be more severe in the morning or after periods of inactivity and may improve with exercise.
  • Stiffness: AS can cause stiffness, especially in the morning or after periods of rest. This stiffness can last for more than 30 minutes and gradually improves with movement.
  • Pain and Inflammation: AS is an inflammatory condition, so it often leads to inflammation in various joints and ligaments. In addition to the lower back, it can affect the hips, shoulders, chest, and neck. Inflammation can cause pain, swelling, and tenderness in these areas.
  • Reduced Range of Motion: As AS progresses, it can lead to a reduced range of motion in the spine and affected joints. This can limit a person’s ability to perform everyday activities.
  • Fatigue: Chronic pain and inflammation can lead to fatigue and a feeling of general malaise.
  • Eye Inflammation: Some people with AS may experience eye inflammation (uveitis or iritis), which can cause eye pain, redness, and sensitivity to light.
  • Chest Pain: In rare cases, AS can cause inflammation in the chest wall, leading to chest pain that worsens with deep breaths.
  • Weight Loss and Loss of Appetite: Persistent inflammation and pain can lead to weight loss and a loss of appetite.

Diagnostic Procedures

Diagnosing ankylosing spondylitis can be challenging, as it often requires a combination of clinical evaluation, medical history, imaging studies, and blood tests. Here’s how the diagnostic process typically unfolds:

  • Medical History and Physical Examination: Your healthcare provider will ask about your symptoms, medical history, and family history of autoimmune diseases. They will also perform a physical examination to assess your mobility, tenderness, and range of motion.
  • Blood Tests: While there is no specific blood test that definitively diagnoses AS, certain markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), may be elevated in AS patients. A genetic marker called HLA-B27 is also strongly associated with AS, though not everyone with AS is HLA-B27 positive.
  • Imaging Studies: X-rays and MRI scans are commonly used to assess the extent of inflammation and damage in the spine and joints. X-rays may show changes in the sacroiliac joints or evidence of fusion of vertebrae, while MRI can reveal early signs of inflammation.
  • Clinical Criteria: AS is often diagnosed based on a combination of clinical criteria. The most widely used criteria are the modified New York criteria, which require the presence of specific symptoms and evidence of sacroiliitis (inflammation of the sacroiliac joints) on imaging.

The Connection Between Ankylosing Spondylitis and Shoulder Pain

Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease that primarily affects the spine and sacroiliac joints, but it can also involve other parts of the body, including the shoulders. The connection between ankylosing spondylitis and shoulder pain lies in the inflammatory process and structural changes that occur in the joints and soft tissues of the shoulders in individuals with AS. Here’s a closer look at this connection:

  • Inflammatory Process: In AS, the immune system mistakenly targets the body’s own tissues, leading to chronic inflammation. This inflammation can affect various joints and ligaments throughout the body. In the shoulders, inflammation can target the synovial joints, tendons, and ligaments, leading to pain and other symptoms.
  • Sacroiliac Joint Involvement: AS often begins with inflammation in the sacroiliac joints, which are located at the base of the spine and connect the spine to the pelvis. As the disease progresses, inflammation can spread to other parts of the spine and nearby joints, including the shoulders.
  • Enthesitis: Enthesitis is the inflammation of the entheses, which are the sites where tendons and ligaments attach to bone. In AS, enthesitis is a common feature and can occur in various locations, including the shoulders. Enthesitis in the shoulder region can lead to pain and discomfort.
  • Muscle Tension: Inflammation and pain in the shoulder area can cause muscle tension and spasms, further contributing to shoulder pain and limited mobility.
  • Structural Changes: Over time, chronic inflammation in AS can lead to structural changes in the affected joints. In the shoulders, this can result in joint damage, loss of mobility, and even joint fusion. These changes can lead to persistent shoulder pain and reduced function.
  • Postural Changes: AS can also affect posture, with individuals often adopting a stooped or forward-leaning posture due to spinal involvement. An altered posture can place additional stress on the shoulders and contribute to pain.
  • Radiating Pain: Shoulder pain in AS may not be isolated to the shoulder region alone. It can radiate down the arms or neck, making it sometimes difficult to pinpoint the exact source of discomfort.

Managing Ankylosing Spondylitis Shoulder Pain

Managing shoulder pain associated with ankylosing spondylitis (AS) can be challenging, but with the right approach, you can alleviate discomfort and improve your shoulder function. Here are some strategies and treatments for managing AS-related shoulder pain:


  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs like ibuprofen or naproxen can help reduce inflammation and relieve pain. These medications are often used as a first-line treatment for AS-related shoulder pain.
  • Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs like sulfasalazine or methotrexate may be prescribed if NSAIDs alone are not sufficient in controlling inflammation.
  • Biologic Drugs: In cases of more severe or uncontrolled AS, biologic drugs like tumor necrosis factor (TNF) inhibitors (e.g., adalimumab, etanercept) may be recommended. These drugs specifically target the inflammatory process in AS.

Physical Therapy

A physical therapist can develop an exercise program tailored to your needs. These exercises focus on improving posture, and range of motion, and strengthening the muscles around the shoulders and spine. Stretching and range of motion exercises are particularly important for shoulder mobility.

Lifestyle Changes

Lifestyle changes can play a significant role in managing ankylosing spondylitis (AS) shoulder pain and improving your overall quality of life. These changes aim to reduce inflammation, improve mobility, maintain a healthy weight, and minimize the impact of AS on your daily activities. Here are some lifestyle modifications that can help:

  1. Regular Exercise:
    • Engage in regular, low-impact exercises that promote flexibility, strength, and cardiovascular health. Swimming, water aerobics, and walking are excellent options. These activities are gentle on the joints while promoting mobility and overall fitness.
    • Consult with a physical therapist or a knowledgeable fitness trainer who can create an exercise program tailored to your specific needs and limitations.
  2. Posture Improvement:
    • Focus on maintaining good posture throughout the day. Proper posture can help reduce the strain on your shoulders and spine.
    • Invest in ergonomic furniture and accessories for work and home to support good posture.
  3. Stress Management:
    • Stress can exacerbate AS symptoms, including pain. Practice stress management techniques such as meditation, deep breathing exercises, and mindfulness to help reduce stress and its impact on your condition.

Preventing Shoulder Pain Flare-Ups

Understanding and recognizing triggers that exacerbate shoulder pain is essential. Some of the ways to prevent these are:

  • Proper Sleep and Rest: Ensure you get adequate, quality sleep. A supportive mattress and proper sleep positioning can help reduce pain and stiffness in the mornings.
  • Avoid Overexertion: Listen to your body and avoid pushing yourself too hard. Overexertion can lead to increased pain and inflammation.
  • Diet and Nutrition: Maintain a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and lean proteins. Omega-3 fatty acids, found in fish like salmon and flaxseeds, may also have anti-inflammatory benefits.
  • Hydration: Stay well-hydrated by drinking plenty of water. Proper hydration supports joint health and helps your body function optimally.
  • Quit Smoking: If you smoke, consider quitting. Smoking can worsen the symptoms of AS and increase inflammation.
  • Avoid Triggering Activities: Identify activities or positions that aggravate your shoulder pain and try to avoid or modify them. This could include specific exercises, lifting heavy objects, or sitting for prolonged periods without breaks.
  • Regular Follow-up: Maintain regular check-ups with your rheumatologist to monitor your condition and make adjustments to your treatment plan as needed.


Ankylosing spondylitis shoulder pain can be challenging to manage, but with a combination of medications, exercises, and lifestyle changes, individuals can find relief and maintain a good quality of life.

If you’re experiencing Shoulder pain, physical therapy for shoulder pain at PhysioMantra can help: Book an online physical therapy session.