Shoulder Pain: Causes, Symptoms, and Effective Treatment Strategies

Shoulder pain often shows up in ordinary moments: reaching for the top shelf, putting on a jacket, rolling onto that side in bed. The shoulder moves more than any other joint, and that range comes at the cost of stability, which makes it vulnerable to several different problems. Identifying which one is involved decides the treatment, and most shoulder pain is treated without surgery.

The rotator cuff and shoulder pain guide covers assessment and treatment in detail. The guides to frozen shoulder and calcific tendinopathy cover two other common causes.

What causes shoulder pain?

The rotator cuff, a group of four muscles and their tendons that hold the ball of the shoulder in its socket, is the commonest source. It can become painful from overload or be torn in a fall. Changes in the cuff are also common with age in people without pain, so a scan finding doesn’t always explain the symptoms, as the article on rotator cuff scan results explains.

Frozen shoulder causes pain and progressive stiffness as the joint capsule thickens and tightens. Osteoarthritis and rheumatoid arthritis can affect the shoulder joint too. Pain referred from the neck can also be felt in the shoulder.

What are the symptoms?

Rotator cuff pain is usually felt on the outside of the upper arm, and is worse when lifting the arm out to the side or reaching behind the back. Frozen shoulder causes a gradual loss of movement in every direction, even when someone else moves the arm. Arthritis causes stiffness and aching, particularly in the morning or after rest.

How is it treated?

Most shoulder pain improves with a programme that gradually strengthens the shoulder and the muscles around the shoulder blade, together with changes to the activities that aggravate it. Complete rest tends to make the shoulder stiffer. Pain relief can help for a time, and a GP or pharmacist can advise what suits a person’s health.

A cortisone injection under ultrasound guidance can ease pain for a while, particularly when it is disrupting sleep or stopping rehabilitation. Surgery has a role for some tears after injury, for frozen shoulder that stays stuck despite good treatment, and for severe arthritis.

Where do prolotherapy and PRP fit?

For shoulder pain that persists despite good rehabilitation, prolotherapy (an injection of a concentrated sugar solution) and PRP (concentrated platelets from a person’s own blood) are sometimes considered. How prolotherapy works is not fully understood, and the evidence for both varies with the condition. Neither is a guaranteed cure, and either is discussed only once the diagnosis is clear.

Can shoulder pain be prevented?

Keeping the shoulder and upper back muscles strong, building up gradually when taking on more overhead work or a new sport, and using good technique all reduce strain on the shoulder.

When should shoulder pain be checked?

Shoulder pain after a fall with sudden weakness, a deformed shoulder, a hot swollen joint, fever, or pain with chest discomfort or breathlessness needs prompt or urgent assessment. Pain that lasts more than a few weeks, wakes someone at night or steadily stiffens the shoulder is worth reviewing.