Shoulder pain

Shoulder pain is a common problem that can affect you at any age. Discomfort from shoulder injury normally settles down as your body heals, usually within a few days or weeks.

bones of the shoulder imageThe shoulder is the most mobile joint in your body. It is made up of bones that are held in place by muscles, tendons and ligaments. They are all designed to work together to allow the shoulder to move in many different directions and positions required during daily life, sports and work. When something goes wrong with your shoulder, it hampers your ability to move freely and can cause a great deal of pain and discomfort.

Shoulder pain is rarely a sign of a more serious problem. But sudden severe shoulder pain may be a sign of a heart attack. If you feel shoulder pain that is radiating down your arm or you’re experiencing a tight feeling across the chest and shortness of breath, dial 111 immediately.

What can I do about shoulder pain?

Most shoulder pain will settle over time and often a precise cause for the pain does not need to be understood. Here are a few things you can do to help your shoulder pain.

  • Be patient: your shoulder pain will usually improve gradually over a few weeks, even if there has been an injury or ‘wear and tear’. You may find wearing a support or a sling for a few days helpful.
  • Cooling or warmth: applying an ice bag or frozen peas wrapped in a towel for about 15 to 20 minutes can help ease the pain. For some people with shoulder pain, applying a warm wheat bag for 20-30 minutes several times per day is more effective than applying ice.
  • Stretching and exercise: activity may be painful but not harmful. A small increase in pain while exercising is okay as long as it goes away within 30 minutes and is not worse the next day. If it happens, don’t worry, do fewer repetitions the next time. Planning and pacing are important for recovery. Exercising is important for general health, the healing process, and for your bone and muscle health.
  • Avoid resting for long periods: resting for long periods of time is not helpful and may make your shoulder pain worse over time.
  • Sleep position: if you have pain at night, try using a pillow under the arm of your sore shoulder when lying on the other side. That may put your shoulder in a more comfortable position.
  • Well-being: maintaining a positive attitude and good physical health is important to your recovery and overall well-being.

If you are concerned about your shoulder pain, make an appointment with your health care provider such as a physiotherapist or your doctor (see treatment below).

Possible causes of shoulder pain

Cause Description
Strain An injury to a muscle and/or tendon.
Sprain A stretch and/or tear of a ligament, a band of tissue that joins the end of one bone to another.  
Rotator cuff tendinitis or tear

The rotator cuff is a group of muscles and tendons that surround your shoulder joint, keeping the head of your upper arm bone firmly within the socket of the shoulder. Pain associated with the tendon is often called a ‘tendinopathy’ or ‘tendinitis’. A tear of the tendon may also be present.

Bursitis

Inflammation of the small, fluid-filled sacks, called bursae, that are designed to cushion the tendons and capsule.

Fracture or dislocation A fracture of your collarbone or upper arm bone, or a dislocation of the shoulder joint, can cause shoulder pain. This is usually caused by a fall or accident.  
Frozen shoulder Frozen shoulder occurs when the soft tissue that surrounds your shoulder joint, known as the capsule, becomes inflamed and thickened. It's not fully understood why this happens. 
Osteoarthritis Osteoarthritis is the most common form of arthritis affecting people as they get older. It is often called 'wear and tear' of the cartilage that covers the ends of your bones. Read more about osteoarthritis.

How is shoulder pain assessed?

If you are concerned about shoulder pain, see a physiotherapist or your GP. They will ask you questions about your shoulder, when the pain started and how it affects your daily life. They will also perform a physical examination and discuss treatment options with you.

Further testing is not normally needed, but if your pain persists, your physiotherapist or GP may suggest blood tests, an x-ray or an ultrasound scan. 

What treatment is there for shoulder pain? 

Physiotherapy

Physiotherapy is one of the most common treatments for shoulder pain. Physiotherapists will:

  • Assess your shoulder pain and movement limitations, and discuss the best way to address these.
  • Explore ways to modify your daily tasks, work and sports/recreational activities so that you can continue with them.
  • Teach you exercises that can help to reduce pain and strengthen your shoulder.
  • Provide advice for general exercise for general health.

Read more about non-medicine treatments for pain.

Medication

Pain-relieving medications such as paracetamol and anti-inflammatories can help to reduce your pain and swelling. These are best used for a short time only and are not usually a long-term solution. If your pain persists, your doctor may recommend a corticosteroid injection into the joint. Read more about pain relief medication.

Surgery

In rare cases, surgery may be an option if other treatments have not worked. Surgery may be used to treat rotator cuff tears if the tear is large and if other treatment options have not worked after 3 to 6 months. Joint replacement surgery may be an option for osteoarthritis of the shoulder if there is persistent shoulder pain that interferes considerably with daily life.

Learn more

Helpsheet: shoulder pain British Elbow & Shoulder Society
Shoulder pain NHS Choices, UK, 2014
Rotator cuff tear Ortho.Info American Academy of Orthopedic Surgeons

Reviewed by

Gisela Sole is Associate Professor at the School of Physiotherapy, University of Otago, Dunedin. She is a physiotherapist, currently focusing on education and research which explores optimal management for individuals with musculoskeletal pain and injury, with special interest in persistent shoulder pain and knee injuries.
Credits: Health Navigator Editorial Team. Reviewed By: Associate Professor Gisela Sole, School of Physiotherapy, University of Otago Last reviewed: 26 Nov 2018