Yes, tumors can develop in the shoulder, both in the bones and in the surrounding soft tissue. The good news is that most shoulder tumors are benign. In one study of over 200 shoulder tumors, about 52% turned out to be noncancerous. Still, malignant tumors do occur in this area, either as cancers that start in the shoulder or as cancers that spread there from somewhere else in the body. Understanding the types, warning signs, and how they differ from common shoulder injuries can help you know what to watch for.
Most Shoulder Tumors Are Benign
The majority of growths found in the shoulder are not cancer. Among benign bone tumors, the most common are fluid-filled cysts (about 37% of cases), followed by enchondromas, which are small cartilage growths inside the bone (about 20%), and osteochondromas, which are bony projections near joints (about 15%). These often cause no symptoms at all and are sometimes discovered by accident on an X-ray taken for an unrelated reason.
Soft tissue tumors in the shoulder are also mostly harmless. Lipomas, which are slow-growing lumps of fat under the skin, account for roughly 42% of benign soft tissue growths in the shoulder area. Other noncancerous soft tissue masses include elastofibromas (firm growths near the shoulder blade), synovial chondromatosis (loose cartilage fragments inside a joint), and schwannomas (growths on nerve coverings). Many of these feel like a painless lump and grow slowly over months or years.
Cancerous Tumors in the Shoulder
Malignant tumors can originate in the shoulder’s bones or soft tissues. Among primary bone cancers in adults, chondrosarcoma is the most common type (about 40% of adult bone cancers), typically diagnosed between ages 30 and 60. Osteosarcoma is the second most common in adults (about 28%) but the most frequent in children and teenagers, where it accounts for 56% of bone cancers. Osteosarcoma tends to develop near the growth plates of long bones, making the upper arm bone (the humerus) a recognized site.
Ewing sarcoma, the second most common bone cancer in children, usually affects those between 10 and 20 years old and is more common in boys. It most often appears in the thighbone, upper arm, pelvis, or shinbone, and in rare cases can develop in the shoulder blade. Symptoms typically include a progressively enlarging swelling, pain that worsens at night, low-grade fever, and fatigue.
Soft tissue sarcomas can also form in the shoulder region. These cancers start in muscle, fat, fibrous tissue, or blood vessels. They often appear as a painless lump under the skin that gradually increases in size. Because they can grow for a while without causing discomfort, they sometimes aren’t noticed until they’re large enough to press on nearby nerves, at which point pain or limited movement develops.
Cancer That Spreads to the Shoulder
Not all malignant shoulder tumors start there. Cancer from other parts of the body frequently spreads to bone, and the upper arm and shoulder blade are possible destinations. Prostate cancer has the highest rate of spreading to bone, with a 5-year incidence of 52%. Breast cancer follows at 41%, head and neck cancer at 36%, and lung cancer at 33%. Even melanoma and cancers of the liver, pancreas, and esophagus spread to bone in 20% to 30% of cases.
Metastatic tumors in the shoulder can be tricky because they mimic common orthopedic problems. In one documented case, a woman with breast cancer presented with shoulder pain and limited movement that initially looked like a rotator cuff tear. Physical exam signs pointed toward a torn tendon, but ultrasound showed no tear. Further imaging with MRI and a bone scan revealed the pain was actually caused by cancer that had spread to her shoulder bones.
How Tumor Pain Differs From Common Injuries
Shoulder pain is extremely common, and in the vast majority of cases it comes from rotator cuff problems, bursitis, or arthritis. But certain features of shoulder pain should raise concern about something more serious.
- Night pain that disrupts sleep: While rotator cuff injuries can hurt at night, tumor-related pain tends to be persistent and worsening, often described as a deep ache that doesn’t respond to position changes.
- Pain that doesn’t improve with rest: Musculoskeletal injuries generally improve with activity modification. Tumor pain tends to be constant or progressive regardless of rest.
- A growing lump: A visible or palpable mass in the shoulder area that steadily increases in size, whether painful or not, warrants investigation.
- Unexplained symptoms: Low-grade fever, fatigue, unintentional weight loss, or weakness combined with shoulder pain can signal something beyond a simple injury.
- No improvement after treatment: If physical therapy, anti-inflammatory medications, or rest haven’t helped after several weeks, imaging can help rule out a mass.
How Shoulder Tumors Are Diagnosed
The diagnostic process usually starts with a plain X-ray, which can reveal bone abnormalities like unusual growths, areas of bone destruction, or suspicious cysts. If the X-ray raises any concern, or if a soft tissue mass is suspected, MRI is the next step. MRI provides detailed images of both bone and the surrounding muscles, tendons, and other soft tissues, making it the best tool for evaluating a possible tumor’s size, location, and relationship to nearby structures.
When imaging suggests a tumor, a biopsy confirms the diagnosis. There are several approaches. Fine-needle aspiration uses a thin needle to extract cells, but it has the lowest accuracy. Core needle biopsy, which removes a small cylinder of tissue, is more reliable at about 83% diagnostic accuracy. Open (incisional) biopsy, where a surgeon removes a tissue sample through a small incision, offers the highest accuracy at around 94% but is more invasive. For small, superficial lumps that imaging suggests are benign, the entire mass may be removed at once for examination.
Treatment and Recovery
Treatment depends entirely on whether the tumor is benign or malignant. Many benign tumors require nothing more than monitoring with periodic imaging. If a benign growth causes pain or limits movement, surgical removal is straightforward and recovery is typically quick.
For malignant tumors, treatment has improved dramatically. Before the 1970s, cancerous tumors of the shoulder often required amputation of the entire arm. Today, 80% to 90% of malignant shoulder tumors can be treated with limb-salvage surgery, where the tumor is removed while preserving the arm. Reconstruction after surgery varies depending on what was removed. Options include custom prosthetic replacements for the upper arm bone or shoulder blade, bone grafts taken from the patient’s own body (often the fibula), donor bone grafts, or specialized techniques that suspend the remaining arm bones from the collarbone or ribs.
Functional outcomes after limb-salvage surgery are generally favorable, though some loss of shoulder range of motion is common. Patients who receive prosthetic reconstruction of the shoulder blade tend to have better functional scores (around 79%) compared to those who have simpler suspension procedures (around 59%). For the upper arm bone, techniques using the patient’s own bone (like fibula grafts or treated tumor bone that’s reimplanted) tend to produce the best functional results, with scores around 80% to 84% of normal function.
Survival for Malignant Shoulder Tumors
For osteosarcoma of the upper arm, the 5-year survival rate is approximately 65%. This is somewhat lower than osteosarcoma in other common locations like the thighbone or shinbone, partly because shoulder tumors have higher rates of local recurrence and a greater tendency to spread to the lungs. Chondrosarcoma generally has better outcomes because it tends to grow more slowly, though survival depends heavily on the tumor’s grade. Outcomes for metastatic tumors in the shoulder depend primarily on the type and stage of the original cancer rather than the shoulder tumor itself.
Early detection makes a significant difference for all types. A persistent, unexplained lump or shoulder pain that doesn’t follow the usual pattern of a sports injury or overuse problem is worth getting imaged, particularly if it’s been present for more than a few weeks and isn’t improving.