Shoulder pain

Often shoulder pain goes away in a few weeks, but it’s important to see a doctor if:

• It’s sudden and severe
• It’s affecting your ability to do everyday things
• It hasn’t gone away after a few weeks

It may be the sign of an injury or medical condition that can be treated.

Your shoulder is a ball-and-socket joint made of three main bones: 

• Collarbone (clavicle)
• Shoulder blade (scapula) — the top part is called the acromion
• Upper arm bone (humerus)

It is held together by a capsule made of cartilage that helps the bones move smoothly. Your shoulder contains two main joints:

• The acromioclavicular joint — this is where the acromion and the clavicle meet
• The glenohumeral joint — this is where the head of the humerus meets the outer edge of the scapula

Your shoulder is one of the most mobile joints in your body. It moves forward and backwards, up and down, and in a circular motion. This range of movement is possible due to the rotator cuff — a band of four tendons that connect muscles to the bones in your shoulder. There are also fluid-filled sacs (bursae) between your rotator cuff and acromion to allow you rotator cuff to move smoothly. 

When you lift your arm up to shoulder height, the space between your rotator cuff and the acromion narrows. If there is any inflammation or damage to tissues in this area (eg the acromion, bursae or rotator cuff) you may have shoulder pain and difficulty moving your arm freely eg lifting it over your head. This can be caused by your rotator cuff catching on the acromion — this is called shoulder impingement and can be painful. 

You may also have a painful shoulder due to: 

• Age — shoulder pain is more common after age 60 because of wear and tear causing tissues in the shoulder to deteriorate
• Certain diseases — this includes diseases affecting your heart, gall bladder and liver, as well as conditions affecting the spine in your neck 
• Injury or overuse eg due to manual labour, playing sports or repetitive movements

When to seek medical advice for shoulder pain

Often shoulder pain goes away in a few weeks but it’s important to see a doctor if:

• It hasn’t gone away after a few weeks
• It’s affecting your ability to do everyday things
• It’s preventing you from properly moving your arm or shoulder 
• It’s sudden and severe

It may be the sign of an injury or medical condition that can be treated.

It’s important to seek immediate medical advice if:

• You can’t move your arm
• You have a fever or feel unwell
• You have pins and needles or numbness in your arm
• You have sudden and severe pain or severe pain in both shoulders
• Your arm feels hot or cold to the touch
• Your arm or shoulder is swollen or has changed shape

You should also seek urgent medical care if your shoulder pain started after an accident or injury. These could be signs of a serious condition eg a broken or dislocated bone or a torn ligament or tendon.

There are different types of shoulder pain depending on the cause:

Chronic (long-term) pain

This is often a symptom of wear and tear of the joint caused by osteoarthritis, where the cartilage at the ends of the bones wears away, so the bones rub together painfully. Rheumatoid arthritis, frozen shoulder or a trapped nerve can also cause long-term shoulder and joint pain.

Pain that gets worse with movement

This is often caused by a rotator cuff injury, which affects the band of muscles and tendons surrounding your shoulder joint. Injury or wear and tear to the rotator cuff can cause: 

• Bursitis
• Rotator cuff tendonitis — this is the most common cause of shoulder pain and is caused by swollen tendons
• Shoulder impingement

You're more likely to have this kind of shoulder pain if you play a lot of sport or work in a job that involves repetitive movement and reaching of your arms.

Sudden or severe onset of pain

This usually follows an injury such as a:

• Dislocated shoulder
• Fracture of your arm, collarbone or shoulder
• Ruptured tendon

It can also be a sign of septic arthritis — an infection of the shoulder joint.

Pain on top of the shoulder

This is caused by problems with your acromioclavicular joint eg dislocation or stretched or torn ligaments.

Referred pain 

Shoulder pain may also be referred, which means it comes from another area of your body but you feel it in your shoulder. This could include back pain, such as upper back pain, whiplash injury, or chest or heart conditions. It can also be caused by injury elsewhere in your body, usually your neck or biceps.

What can cause shoulder pain without injury?

Shoulder pain can also be caused by overuse, which causes inflammation and swelling of the bursae or tendons. Other causes include bone growths (spurs) along the edges of the bones in your shoulder joint and heart attack.

What is shoulder pain a sign of?

Shoulder pain can be a sign of damage to the tissues of your shoulder joint due to injury or overuse. However, it can also be a sign of: 

• Heart disease
• Gallbladder disease
• Liver disease 
• Nerve pain — this may also cause numbness, pins and needles, and tingling in your shoulder; you may find that the pain spreads to other areas or doesn't always affect your shoulder but moves to affect other areas

Your doctor will discuss your shoulder pain with you and ask about your medical history. They may also ask you questions about: 

• How your pain is affecting your life eg:
• Does it disturb your sleep?
• Has it restricted the activities you normally do?
• The location of your pain eg: 
• Can you pinpoint exactly where your pain is?
• Do you have pain in one or both shoulders?
• Does it spread or move to other areas of your body?
• What changes your pain eg: 
• Does it hurt when you rest? 
• Does it worsen when you carry out certain movements?
• What makes it better or worse?
• What your pain and shoulder feel like eg: 
• Has your shoulder felt hot, red or swollen?
• Is your pain sharp or dull?
• When your pain began eg: 
• Did it start suddenly? 
• What were you doing when it started (if it began suddenly)? 

They will carry out a physical examination to check for swelling and tenderness. This may also include assessing your range of movement.

Other investigations may include:

• An ultrasound scan or MRI scan to examine the soft tissues around your joint
• An X-ray
• Blood tests to see whether you have an underlying medical condition, such as rheumatoid arthritis

In some cases, your doctor may refer you to a shoulder specialist — an orthopaedic consultant or a rheumatologist (who specialises in diagnosing and treating musculoskeletal problems and arthritis).

How do you relieve shoulder pain?

There are a number of treatments to relieve shoulder pain including:

• Avoiding activities that cause the pain
• Compression with an elastic bandage — this can reduce swelling
• Maintaining good posture — this includes: 
• Sitting with a cushion behind your lower back 
• Standing up straight with your shoulders down and slightly back
• Resting your arm when needed eg when sitting, place your arm on a cushion in your lap and when standing, use a shoulder immobiliser or sling
• Staying active and doing regular shoulder exercises for six to eight weeks — the Chartered Society of Physiotherapy provides information on exercises for shoulder pain
• Taking over-the-counter painkillers (eg ibuprofen, paracetamol or topical creams) if advised by your doctor

You can also try using heat packs (eg a hot water bottle wrapped in a tea towel) or ice packs (a frozen bag of vegetables wrapped in a tea towel). Apply your heat or ice pack for up to 20 minutes three times a day.

You will need to regularly use these treatments for at least two weeks before your pain starts to improve. It may take six months or more for a complete recovery. 

Avoid making pain worse

Make sure you do not: 

• Do things that worsen your pain
• Slouch when sitting ie roll your shoulders forward and bring your neck forward
• Stop using your shoulder completely 
• Use heavy gym equipment or put together your own strenuous exercises

Shoulder pain treatments from a doctor

If your pain doesn’t improve your doctor may arrange for you to have:

• A steroid injection into your shoulder to reduce pain and swelling
• Physiotherapy — the number of sessions will depend on the cause of your pain
• Stronger non-steroidal anti-inflammatory drugs (NSAIDs)

In some cases, you may need to have surgery to repair a rotator cuff injury, release a frozen shoulder, or you may need shoulder joint replacement surgery.