Shoulder Pain: Symptoms, Causes & Which Doctor to See

What causes shoulder pain?

The shoulder is the most mobile joint in the body, relying on the rotator cuff, a group of four muscles and tendons, to keep the ball centred in a shallow socket. That mobility makes it prone to overuse and injury. Rotator cuff tendinopathy, sometimes called impingement or subacromial pain, is the most common cause, often after repetitive overhead activity or a sudden increase in load.

Frozen shoulder (adhesive capsulitis) causes a painful, stiff shoulder that slowly loses movement and is more common between 40 and 60 years and in people with diabetes or thyroid disease. Other causes include rotator cuff tears, calcific tendinitis, arthritis, dislocation and instability, and fractures after falls. Pain can also be referred from the neck or, importantly, from the heart, gallbladder or lungs.

• Rotator cuff tendinopathy or impingement
• Rotator cuff tears after injury or with age
• Frozen shoulder, especially with diabetes
• Calcific tendinitis
• Arthritis of the shoulder or collarbone joint
• Dislocation or instability
• Pain referred from the neck

What are the symptoms of shoulder problems?

Rotator cuff pain is usually felt over the outer upper arm and is worse when lifting the arm out to the side or overhead, reaching behind, or lying on that shoulder at night. Weakness when lifting suggests a tear.

Frozen shoulder causes deep aching and steadily increasing stiffness, so that reaching a back pocket, fastening a bra, combing hair or putting on a shirt becomes difficult, even when someone else tries to move the arm. Clicking, catching or a feeling of the shoulder slipping suggests instability or a labral problem. Neck-related pain often comes with neck stiffness and tingling down the arm.

Pain on top of the shoulder, where the collarbone meets the shoulder blade, points to the acromioclavicular joint, commonly injured in falls from two-wheelers or during contact sport. Pain that is constant, present at rest and unaffected by movement is less typical of a shoulder joint problem and needs a broader look for causes elsewhere.

• Pain on lifting the arm overhead or to the side
• Night pain, especially lying on the affected side
• Stiffness and loss of movement
• Weakness when lifting
• Clicking, catching or slipping
• Pain or tingling travelling down the arm

When is shoulder pain an emergency?

Left shoulder or arm pain together with chest discomfort can be a heart attack, and needs emergency care immediately. If any of the following apply, go to the nearest emergency department or call 112 or 108.

Right shoulder-tip pain with upper abdominal pain can come from the gallbladder, and shoulder-tip pain with abdominal pain in a woman who could be pregnant can signal an ectopic pregnancy; both need urgent assessment.

• Shoulder or arm pain with chest pain, sweating, breathlessness or nausea
• A visibly deformed shoulder after a fall or injury
• Unable to move the arm at all after injury
• A hot, red, swollen shoulder with fever
• Arm that is cold, pale, numb or very weak
• Shoulder-tip pain with abdominal pain and possible pregnancy

Which doctor should I see for shoulder pain?

An orthopaedic surgeon, ideally with an interest in the shoulder, diagnoses and treats shoulder conditions, working with physiotherapists. At Lotus, the orthopaedics team examines the shoulder and neck, decides which imaging is useful, and plans exercise-based, injection or surgical treatment.

Book an appointment if pain has not improved after two to three weeks of self-care, if you cannot lift your arm properly, if pain wakes you at night, if your shoulder is getting stiffer, or if you have had a dislocation. A sudden loss of strength after a fall or lifting injury should be seen within days, because some tendon tears do better with early repair.

• Pain not improving after two to three weeks
• Night pain disturbing sleep
• Progressive stiffness
• Weakness lifting the arm
• Previous dislocation or feeling of instability
• Diabetes with a painful, stiff shoulder

What happens at an orthopaedic shoulder consultation?

The doctor asks about how pain started, your work, sport and hobbies, sleep, diabetes, thyroid disease, previous injuries and treatments. They examine both shoulders and the neck, watch movement, compare active and assisted range, and test the strength of each rotator cuff muscle.

The pattern of findings often points to the diagnosis before any scan. You will be told what is likely causing the pain, what the treatment plan is, and how long recovery usually takes.

If an injection is suggested, ask about the expected benefit, how many injections are reasonable and, if you have diabetes, how to monitor your blood sugar afterwards, since steroids can raise it for a few days.

• Wear a vest or loose top so both shoulders can be seen
• Note which movements are painful or restricted
• Bring X-ray, ultrasound or MRI reports
• Mention diabetes, thyroid disease and heart symptoms
• Ask how long recovery usually takes

Which scans are needed for shoulder pain?

An X-ray shows arthritis, calcium deposits in tendons, fractures and dislocations. Ultrasound is useful for rotator cuff tears, bursitis and calcific tendinitis, and can guide injections.

MRI shows tendons, cartilage and the labrum in more detail and is used when surgery is being considered or after dislocation. Blood sugar and thyroid tests are often checked in frozen shoulder.

• X-ray
• Ultrasound of the shoulder
• MRI or MR arthrogram in selected cases
• HbA1c and thyroid tests for frozen shoulder
• Neck imaging if pain is coming from the spine

How is shoulder pain treated?

Most rotator cuff pain improves with a graded exercise programme that gradually loads the tendons, supported by pain relief and adjusting aggravating activities for a while. Complete rest causes stiffness and weakness. A steroid injection can reduce pain for some weeks and make exercise easier but does not repair tissue.

Frozen shoulder usually improves over months to a few years. Pain relief, gentle stretching, physiotherapy, steroid injection into the joint and hydrodilatation can help; manipulation under anaesthesia or keyhole release is considered when stiffness persists. Rotator cuff tears may be repaired arthroscopically, particularly after injury in active people. Recurrent dislocation may need stabilisation, and severe arthritis may need joint replacement.

Calcific tendinitis can cause sudden, severe pain and may be treated with ultrasound-guided needling or shock wave therapy when it does not settle. Many people over 60 have rotator cuff tears without pain, so a tear on a scan does not automatically need surgery; treatment depends on symptoms, function and how the tear occurred.

• Activity modification and pain relief
• Physiotherapy and home exercise programme
• Steroid injection in selected cases
• Hydrodilatation for frozen shoulder
• Arthroscopic rotator cuff repair
• Stabilisation surgery for recurrent dislocation
• Shoulder replacement for severe arthritis

How can I prevent shoulder pain?

Set up your workstation so you are not reaching forward or holding your arms raised for long periods, and take regular breaks to roll and stretch the shoulders. Strengthen the rotator cuff and shoulder blade muscles with light resistance bands two or three times a week.

Warm up before badminton, cricket, swimming or gym sessions, increase training load gradually, and avoid sudden heavy overhead lifts. Keep diabetes well controlled, and move the shoulder gently after any minor injury rather than keeping it still for long.

• Ergonomic desk set-up
• Regular shoulder and upper back exercises
• Warm up before sport
• Increase training loads gradually
• Good diabetes control
• Gentle early movement after minor injury

When should I follow up for shoulder pain?

Exercise programmes are usually reviewed after six to twelve weeks. Expect gradual improvement; some shoulder problems take several months to settle. Frozen shoulder needs regular review of movement over its course.

Return sooner if weakness develops, pain becomes much worse, the shoulder becomes stiffer despite exercises, or you have a new injury.

• Review after six to twelve weeks of exercise
• Earlier review for new weakness or worsening pain
• Regular follow-up for frozen shoulder
• Rehabilitation follow-up after any surgery
• Continue exercises for some weeks after pain settles