Shoulder Pain: Common Causes and Treatment

Rotator cuff problems

The rotator cuff is a group of four muscles and tendons that keep the ball of the shoulder centred in its socket. Problems range from irritation (tendinopathy) and impingement to partial or full tears. Pain is often felt on the outer upper arm, worse when lifting the arm or lying on that side. Tears may follow a fall or develop with age. Read more about rotator cuff tears.

Frozen shoulder

Frozen shoulder (adhesive capsulitis) causes the shoulder capsule to become inflamed and tight. It typically passes through painful, stiff and recovering phases over many months. It is more common in middle age and in people with diabetes or thyroid problems. A key feature is loss of movement in all directions, including when someone else tries to move the arm. See frozen shoulder for treatment options.

Instability and dislocation

Shoulder instability means the ball slips partly or fully out of the socket. It often starts with an injury and is more common in younger, active people. After a first dislocation, some people continue to feel the shoulder slipping or have repeated dislocations. Tears of the labrum, the rim of cartilage around the socket, may be involved.

Arthritis and other causes

Arthritis of the main shoulder joint or the small joint at the top of the shoulder (acromioclavicular joint) causes aching, stiffness and grinding, often in older adults. Other causes include calcific tendinitis, biceps tendon problems and fractures after falls.

Referred pain from the neck is common. Neck problems can cause pain over the shoulder blade and down the arm, sometimes with tingling or numbness in the hand. Examining the neck is part of every shoulder assessment.

How is shoulder pain evaluated?

Evaluation begins with where the pain is, what triggers it and whether there was an injury. The surgeon examines movement, strength, stability and the neck. X-rays show arthritis, calcium deposits and fractures. Ultrasound or MRI may be used to look at the rotator cuff, labrum and other soft tissues when the result would change treatment.

How is shoulder pain treated?

• Activity changes: avoiding aggravating movements for a time, without stopping all use.
• Physiotherapy: the main treatment for many shoulder problems, focusing on movement, strength and posture.
• Pain relief guided by your doctor.
• Injections in selected cases, for short-term relief to help rehabilitation.
• Surgery, often by arthroscopy, for problems such as repairable rotator cuff tears, recurrent dislocation or frozen shoulder that does not respond to other treatment. Shoulder replacement may be considered for advanced arthritis.

Simple measures that may help at home

For mild shoulder pain without a significant injury, some simple steps may help while you arrange an assessment if needed:

• Keep the shoulder moving gently within comfort; avoid holding it still for long periods.
• Reduce activities that clearly aggravate it, such as repeated overhead lifting, for a short time.
• Use ice or warmth, whichever feels more comfortable.
• Check your posture at work, especially when using a computer or phone for long periods.
• Sleep with a pillow supporting the arm if lying down is painful.

Avoid forcing painful stretches or heavy gym exercises until the cause is known. If pain is not settling after a few weeks, or if you have weakness, numbness or night pain, it is sensible to have the shoulder assessed.

Recovery and long-term shoulder health

Recovery depends on the cause. Tendon problems often improve over weeks to months with a progressive exercise programme. Frozen shoulder may take many months to resolve, though treatment can ease pain and help movement along the way. After surgery, such as rotator cuff repair or stabilisation, the arm is usually protected in a sling for a period, followed by staged physiotherapy over several months. These are typical ranges that vary.

Keeping the shoulder blade and rotator cuff muscles strong, warming up before sport, using good lifting technique and taking breaks from repeated overhead work may help reduce the chance of problems returning. If you play overhead sports, a coach or physiotherapist can review your technique.

When should you seek prompt or urgent care?

Call emergency services or go to the nearest emergency department immediately if sudden left shoulder or arm pain comes with chest discomfort, breathlessness, sweating, nausea or light-headedness. These can be signs of a heart attack.

Also seek urgent care for a visibly deformed shoulder after an injury, inability to move the arm after a fall, or a hot, swollen, painful shoulder with fever. See a specialist promptly for weakness after an injury, since some rotator cuff tears are best treated early, and for pain that does not improve after a few weeks.

Discuss your situation with Dr. Karnav Panchal for assessment of shoulder injuries and pain.

Common questions