Shoulder Pain: Causes, Diagnosis and Treatment

Shoulder pain may be felt at the top of the arm, over the shoulder point, deep in the joint or around the shoulder blade. Reaching overhead, fastening clothing, lifting, lying on the painful side or moving the neck may bring it on. Stiffness, clicking, weakness, tingling or pain travelling below the elbow are useful details. Describe whether the pain began suddenly after an injury or developed while repeating a task.

Seek urgent care after a major injury if the shoulder looks deformed, the arm cannot be moved, or the hand becomes cold, pale, numb or weak. Urgent assessment is also needed for shoulder pain with chest pressure, breathlessness, sweating or faintness. A feverish, hot, swollen shoulder needs prompt medical review. Without these features, arrange an appointment when pain restricts sleep or daily tasks, persists, or keeps returning.

The causes below are in alphabetical order, not a ranking of likelihood. AC Joint Injury presents with pain at the top of the shoulder, often after a fall or direct impact. Biceps Tendinitis presents with front-of-shoulder pain during lifting. Calcific Tendinitis presents with marked tendon irritation and restricted movement. Cervical Radiculopathy presents with neck-related pain, tingling or weakness in the arm. Frozen Shoulder presents with progressive stiffness. Rotator Cuff Tear presents with weakness after injury or tendon wear. Rotator Cuff Tendinitis and Shoulder Impingement present with painful movement. Shoulder Osteoarthritis presents with joint pain and stiffness.

A clinician asks about injury, work or sport, sleep, neck symptoms and which movements provoke pain. They compare active and assisted movement, test strength, feel the joint and check the neck, arm nerves and circulation when needed. An X-ray, ultrasound or other scan may be considered when the examination suggests a bone, tendon or joint problem. The scan is interpreted alongside the examination because similar pain patterns can come from different structures.

Management may combine activity changes, an individually paced exercise programme and short-term pain relief advice. Physiotherapy can restore movement, build rotator-cuff and shoulder-blade control, and guide return to lifting. A Cortisone Injection may be discussed for selected inflammatory or painful conditions after examination. Shockwave Therapy may be considered in some persistent tendon problems. A tear, joint injury, severe stiffness or nerve-related problem needs a plan tailored to its findings; treatment should not be chosen from pain location alone.

Build overhead work, throwing and strength training gradually. Use technique that keeps loads controlled, vary repeated tasks, and include exercises for the upper back, shoulder blade and rotator cuff when appropriate. Take breaks during sustained computer or manual work and keep frequently used objects within a comfortable reach. After an injury, return to heavier activity in stages rather than testing strength with a sudden maximal effort.

Tell the clinician about neck pain, arm tingling, hand numbness, weakness, swelling, bruising, clicking, catching, fever or pain that travels below the elbow. A loss of movement is different from movement that is possible but painful, and that distinction can change the examination.

Arrange assessment if shoulder pain affects dressing, washing, work, sport or sleep, or if it is not improving with sensible activity adjustment. A physiotherapist or orthopaedic clinician can identify whether the shoulder, neck or another structure is involved and set a staged plan. Bring a description of the first trigger, the movements you avoid and any change in strength.