Overview
Shoulder pain is extremely common and can arise from a wide range of causes. The shoulder is the most mobile joint in the body, which makes it vulnerable to injury and instability. Pain can originate from the joint itself, the surrounding muscles, tendons, and bursa, or may even be referred from the neck or chest.
Common Causes
- Rotator cuff injuries — tears or tendonitis of the shoulder tendons
- Frozen shoulder (adhesive capsulitis) — stiffness and pain that develops gradually
- Impingement syndrome — tendons caught between shoulder bones
- Bursitis — inflammation of the shoulder bursa
- Acromioclavicular (AC) joint arthritis or injury
- Shoulder dislocation or instability
- Biceps tendonitis
- Osteoarthritis or rheumatoid arthritis
- Referred pain from the neck (cervical radiculopathy)
Treatment
- Rest and activity modification
- Ice or heat therapy
- NSAIDs
- Physiotherapy — exercises to restore strength and range of motion
- Corticosteroid injections
- Surgery — for severe rotator cuff tears, instability, or advanced arthritis
Frozen Shoulder
Frozen shoulder typically develops in three stages: the freezing stage (increasing pain and stiffness), the frozen stage (reduced movement but less pain), and the thawing stage (gradual return of movement). It usually resolves on its own but can take 1–3 years. Physiotherapy and corticosteroid injections can speed recovery.
Working out what is going on
The shoulder is the most mobile joint in the body, which makes it prone to problems. Where and when it hurts gives useful clues, although a proper assessment is the best way to know.
- Pain on the outer upper arm when lifting your arm out to the side or overhead, often worse at night and lying on that side: commonly a rotator cuff problem, sometimes called subacromial pain.
- Gradually increasing pain followed by marked stiffness, so you cannot reach behind your back or turn your arm outwards: often frozen shoulder, which is more common between 40 and 60 and in people with diabetes.
- Deep ache and stiffness with grinding, usually over 60: may be shoulder osteoarthritis.
- Pain on top of the shoulder where the collarbone meets the shoulder blade: may be the acromioclavicular (AC) joint.
- Sudden severe pain and weakness after a fall or heavy lift: may be a tendon tear or dislocation, which needs prompt assessment.
- Pain and stiffness in both shoulders and hips, worse in the morning, in someone over 50: may be polymyalgia rheumatica, which needs a GP review.
Pain that is not coming from the shoulder
Some pain felt in the shoulder comes from elsewhere. Neck problems can cause pain spreading over the shoulder and down the arm, often with tingling. Rarely, shoulder pain can be a sign of a heart, lung or abdominal problem. Call 999 if shoulder or arm pain comes with chest pain, breathlessness, sweating or feeling sick.
Self-help that works for most people
Most shoulder pain improves over weeks to months. These steps help many people while it settles.
- Keep the shoulder moving gently within comfort. Complete rest tends to make stiffness worse.
- Modify, rather than stop, activities that provoke pain, such as repeated overhead reaching.
- Try a heat pack or an ice pack wrapped in a towel for short periods, whichever eases it more.
- Simple painkillers or anti-inflammatory gel may help you keep moving; check with a pharmacist.
- At night, try lying on the other side with a pillow hugged in front of you to support the painful arm.
- Start gentle exercises, such as pendulum swings, and progress to strengthening the muscles around the shoulder blade and rotator cuff as pain allows.
Physiotherapy and exercise
Most shoulder problems, including rotator cuff pain and osteoarthritis, improve with a structured exercise programme over several weeks to months. A physiotherapist can assess your shoulder, check your neck and posture, and tailor exercises. In many areas you can refer yourself to NHS physiotherapy or see a first contact practitioner at your GP surgery. Strengthening is usually the key part of recovery, and some discomfort during exercise is normal as long as it settles afterwards.
Injections and other treatments
A steroid injection can reduce pain for some weeks, which can make it easier to do your exercises. It is most helpful in frozen shoulder and some rotator cuff problems. Injections are usually combined with exercise rather than used alone. For frozen shoulder, which can take a long time to resolve, other options include a procedure to stretch the joint capsule with fluid (hydrodilatation) or surgery. Surgery may also be considered for large tendon tears or severe osteoarthritis, including shoulder replacement. See our guide to arthritis surgery options.
When to see a GP or get urgent help
See your GP or a physiotherapist if pain has not improved after a couple of weeks of self-help, stops you sleeping, or you cannot lift your arm. Go to A&E after an injury if your shoulder looks deformed, you cannot move your arm, or you have numbness in the arm. Get same-day advice if the shoulder is hot and swollen and you feel feverish or unwell, or if you have new pain and stiffness in both shoulders with a headache or jaw pain when chewing.
About this page
Written by Louis Maxwell, First Contact Practitioner (HCPC PH128483), and pending clinical review. This is general information, not a diagnosis. Always follow the advice of your own GP, physiotherapist or rheumatology team. For emergencies call 999; for urgent advice use NHS 111.