Shoulder Pain: Common Causes and What to Do Next

Shoulder pain does not always mean serious damage—and knowing when to keep moving, seek assessment or investigate further can make all the difference

Shoulder pain is common.

It can make simple things surprisingly difficult — reaching into a cupboard, putting on a shirt, sleeping on one side, lifting a bag or reaching behind your back.

Patients often want to know:

What exactly is injured? Do I need a scan? Should I rest it? And is a steroid injection the answer?

Sometimes there is a clear injury.

But often shoulder pain develops gradually, and the first priority is not finding the perfect label. It is working out:

Is there anything serious here, what movement is being limited, and what is most likely to help you regain function?

Why is the shoulder so easy to irritate?

The shoulder is built for movement.

It allows more movement than most joints, but that mobility depends on several structures working together:

• the shoulder joint itself
• the rotator cuff tendons
• the bursa
• muscles around the shoulder blade
• the collarbone and acromioclavicular joint
• the biceps tendon
• nerves from the neck and arm

Because so many structures contribute to shoulder movement, pain does not always come from one clearly identifiable problem.

That is why shoulder pain is often diagnosed from the pattern of symptoms and examination, rather than from a scan alone.

What are the common causes?

Several problems account for most shoulder pain seen in general practice.

These include:

• rotator cuff related shoulder pain
• bursitis
• frozen shoulder
• osteoarthritis
• acromioclavicular joint pain
• biceps tendon pain
• referred pain from the neck
• traumatic injury

These problems do not all behave the same way.

A painful shoulder after a fall is very different from a shoulder that has slowly become stiff over six months.

What is rotator cuff related shoulder pain?

The rotator cuff is a group of muscles and tendons that help control shoulder movement.

Rotator cuff related shoulder pain is one of the most common causes of shoulder symptoms in adults.

Typical features include:

• pain when lifting the arm
• pain reaching overhead
• discomfort reaching behind your back
• pain lying on the affected side
• weakness because movement hurts
• a painful arc when lifting the arm

This does not necessarily mean the tendon is torn.

Tendons can become painful or irritated without being structurally destroyed.

And, just like in the back and knee, imaging changes do not always match symptoms.

What about bursitis or “impingement”?

A bursa is a small fluid-filled structure that helps tissues glide smoothly.

The subacromial bursa can become irritated and painful, often alongside rotator cuff related pain.

Patients are sometimes told they have “impingement”, suggesting a tendon is simply being pinched by bone.

The reality is usually more complicated.

Many people have structural features that look narrow or abnormal on scans and never develop pain.

The practical treatment often focuses less on the label and more on:

• reducing aggravating load temporarily
• restoring movement
• rebuilding strength
• improving confidence
• using short-term symptom relief when needed

The shoulder is not necessarily being damaged every time overhead movement hurts.

What is frozen shoulder?

Frozen shoulder, or adhesive capsulitis, behaves differently.

The main feature is not just pain.

It is a progressive loss of shoulder movement, affecting both:

• movement you perform yourself, and
• movement someone else can produce when examining the joint

Patients may notice they cannot:

• reach overhead
• put on a bra
• tuck in a shirt
• reach into a back pocket
• rotate the arm normally

Frozen shoulder can be very painful, especially at night.

It is more common in people with diabetes and can sometimes follow injury or surgery.

It usually improves, but recovery can be slow — often many months and sometimes 1–3 years.

If the shoulder is becoming progressively stiff in several directions, it deserves assessment rather than repeatedly being treated as simple “bursitis”.

What about arthritis?

The main shoulder joint can develop osteoarthritis, although this is less common than knee or hip osteoarthritis.

It may cause:

• deep aching pain
• stiffness
• reduced movement
• grinding or creaking
• difficulty with lifting and overhead activity

Treatment usually starts with activity modification, exercise, strengthening and sensible pain management.

Surgery is considered when symptoms are severe and function remains poor despite good non-surgical treatment.

Could the pain be coming from my neck?

Yes.

Nerves supplying the shoulder and arm come from the neck.

Neck problems can cause pain around the shoulder blade or upper arm.

Clues include:

• neck pain
• pain travelling below the elbow
• tingling or numbness
• electric or burning pain
• weakness
• symptoms changing with neck movement

Sometimes a person has both a shoulder problem and a neck problem.

This is why examining the neck can be important even when the main complaint is shoulder pain.

Do I need an X-ray, ultrasound or MRI?

Not always.

For many common shoulder problems, a good history and examination provide enough information to start treatment.

Imaging is most useful when:

• there has been significant trauma
• fracture is possible
• a major tendon tear is suspected
• there is marked weakness
• symptoms are not improving as expected
• arthritis is suspected
• surgery is being considered
• the diagnosis remains uncertain

The test should answer a question.

“What are we looking for, and would finding it change the plan?”

Routine scans can identify age-related tendon changes that may have little to do with your pain.

Why do scans often show tendon tears?

Because tendon abnormalities become more common with age.

Partial tears, degeneration and even some full-thickness rotator cuff tears can exist without causing symptoms.

That does not mean a tear should be ignored.

But it does mean:

a scan result needs to match the history, examination and level of function.

A report that sounds dramatic does not automatically mean the shoulder requires surgery.

Should I rest my shoulder?

Usually not completely.

If a particular movement has triggered a flare, temporarily reducing that activity may help.

But prolonged avoidance can lead to:

• more stiffness
• reduced strength
• loss of confidence
• poorer function

The aim is usually to modify load rather than stop all movement.

That may mean:

• reducing repeated overhead lifting for a while
• changing gym exercises
• using a lighter load
• shortening the range temporarily
• gradually building activity again

The shoulder generally responds better to progressive use than complete protection.

Should I exercise through shoulder pain?

Some discomfort during rehabilitation can be acceptable.

The useful questions are:

• Is the pain tolerable?
• Does it settle reasonably quickly afterwards?
• Is movement improving?
• Is strength improving?
• Is the shoulder becoming more functional?

If exercise causes severe pain, major loss of function or symptoms that remain substantially worse for days, the program needs adjusting.

The goal is progressive loading, not endlessly provoking the shoulder.

What exercises help?

The exact program depends on the diagnosis and your current function.

Common rehabilitation areas include:

• rotator cuff strengthening
• shoulder blade control
• range-of-motion exercises
• gradual overhead loading
• pushing and pulling movements
• general upper-body strength

You do not necessarily need complicated exercises.

A few well-chosen exercises performed consistently are often more useful than a long list that never gets done.

A physiotherapist or exercise physiologist can help if the shoulder is significantly limiting you or you are unsure how to progress safely.

What about posture?

Posture can influence symptoms, especially when someone spends long periods at a desk.

But shoulder pain is rarely explained by one “bad posture”.

There is no perfect shoulder position that needs to be held all day.

It is usually more useful to change position regularly, move the shoulders and neck, take breaks from prolonged desk work and build strength and capacity.

Do painkillers help?

Sometimes.

The aim is usually to make movement, sleep and rehabilitation easier rather than remove every sensation of pain.

Options may include:

• short-term anti-inflammatory medicines
• topical anti-inflammatory gels
• paracetamol in selected people

NSAIDs are not suitable for everyone, especially people with certain kidney, stomach, cardiovascular or medication-related risks.

Medication should support recovery rather than replace movement and rehabilitation.

What about a steroid injection?

A corticosteroid injection can provide short-term pain relief for selected shoulder problems.

It can be useful when pain is:

• severe
• disturbing sleep
• preventing rehabilitation
• substantially limiting movement

But an injection is not automatically required for every painful shoulder.

And it does not “repair” a tendon.

I tend to think of an injection as a possible window of opportunity:

reduce pain enough to restore movement, sleep and rehabilitation.

Where the injection is given depends on what is being treated. Possible targets include the subacromial space, the shoulder joint itself or the acromioclavicular joint.

Some injections are performed using anatomical landmarks and others with ultrasound guidance, depending on the target and clinical situation.

Repeated corticosteroid injections are generally not the preferred long-term strategy because the benefit is temporary and repeated exposure can carry risks.

The important issue is whether the injection is appropriate, accurately targeted and part of a broader treatment plan.

What about PRP?

Platelet-rich plasma, or PRP, is marketed for several tendon and joint conditions.

For common shoulder problems, evidence is mixed and depends on the diagnosis.

Some people may choose to consider it after discussing:

• the evidence
• cost
• alternatives
• likely benefit
• uncertainty

It should not replace rehabilitation, progressive strengthening and other treatments with stronger established evidence.

Do I need physiotherapy?

Not everyone needs prolonged treatment.

Physiotherapy can be particularly useful when:

• movement is restricted
• strength has fallen
• you do not know how to exercise safely
• symptoms are recurring
• sport or work demands need to be restored
• fear of movement is limiting activity

The goal should be to give you a plan you can increasingly manage yourself.

The shoulder should become more capable, not more dependent on treatment.

When does surgery matter?

Most common shoulder problems are treated without surgery.

Surgery becomes more relevant when there is:

• a significant acute traumatic rotator cuff tear
• major persistent weakness
• substantial functional loss
• failure of appropriate rehabilitation
• severe arthritis with persistent pain and poor function

A sudden traumatic tear with major weakness is different from a gradual degenerative tear found on a scan in an older adult.

Shoulder replacement can also be very effective for selected people with advanced arthritis.

But surgery should match the symptoms, examination, function and imaging together.

An abnormal scan by itself is not enough.

When should I see my GP?

Arrange a review if:

• pain is severe or persistent
• the shoulder is becoming progressively stiffer
• weakness is developing
• you cannot raise the arm normally
• sleep is repeatedly disturbed
• pain is affecting work or daily activities
• symptoms follow a significant injury
• pain travels down the arm with numbness or tingling
• symptoms are not improving despite sensible self-management

Your GP can help determine whether the pattern looks like rotator cuff pain, frozen shoulder, arthritis, neck-related pain or another problem.

When should shoulder pain be assessed urgently?

Seek prompt or urgent medical assessment if shoulder pain is associated with:

• major trauma or visible deformity
• sudden inability to move the arm after injury
• a hot, red, very swollen joint
• fever or feeling significantly unwell
• rapidly worsening weakness or numbness
• a cold, pale or poorly perfused arm
• chest pain, shortness of breath, sweating or nausea

Not all pain around the shoulder actually comes from the shoulder.

Pain associated with chest symptoms can sometimes represent a heart problem and should not simply be assumed to be musculoskeletal.

Start with one action

If you have a painful shoulder without a major injury or red flag, start by asking:

“What movement can I still do comfortably?”

Keep that movement going.

Then gradually rebuild the movements and strength that have become difficult.

If the shoulder is becoming progressively stiff, markedly weak or simply not improving, get it assessed rather than repeatedly avoiding movement.

The Bottom Line

Shoulder pain is common, and a scan is not always the first or most useful step.

For many common shoulder problems:

• keep the shoulder moving
• modify aggravating activities rather than stopping everything
• gradually rebuild strength
• use medication sensibly when needed
• use injections selectively rather than as a cure

A dramatic ultrasound or MRI report does not automatically mean surgery.

And a painful shoulder does not necessarily mean something is being damaged every time it moves.

The useful question is not simply “What does my scan show?” It is “What is limiting this shoulder, and what will help me restore movement, strength and function?”

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• Joint Injections: What to Expect