Shoulder pain
Shoulder pain is a common problem and may result from a variety of causes. In most cases shoulder pain is short-lived and can be managed without recourse to a health care professional. Self-care may include keeping moving, relative rest, tailored exercise, adjusting posture and using over the counter painkillers. If pain continues for more than a few weeks or is too severe to manage, then a physiotherapist, GP or pharmacist may be able to offer some extra help.
One in three GP appointments for musculoskeletal complaints is for shoulder pain. It is estimated around two in three of the population will experience shoulder pain at some point in their lifetime.
Causes of shoulder pain
The shoulder is a ball & socket joint like the hip. However, unlike the hip joint, the socket in the shoulder joint (glenoid) is very shallow and relies on a number of muscles and tendons to hold the ball (humeral head) within the socket and maintain its strength (collectively known as the rotator cuff).
Causes of shoulder pain could include:
Injury
Sprain/strain injuries to the muscles and tendons around the shoulder associated with overuse, injury or minor falls are very common. Minor tears of these muscles and tendons will usually repair themselves over a 6-8 week period without any special intervention. More severe injuries can lead to complete rupture of a muscle or ligament or even to dislocation of the humeral head or damage to the bones of the upper arm (humerus), collar bone (clavicle) or shoulder blade (scapula). These injuries are associated with severe pain +/- deformity of the shoulder/upper arm and require early medical assessment.
Infection
Infections of the shoulder are commonly, but not always, associated with a local penetrating injury. Signs of inflammation include swelling, redness and heat.If there is an infection present in your shoulder you may feel generally unwell with a raised temperature.
Infection in a large joint like the shoulder can lead to long-term joint damage as well as more serious generalised illness. If you suspect an infection in your shoulder, then you should seek immediate medical assessment via your GP or A&E
Poor posture
The way you stand or sit for long periods of time, including at work or when using a computer can cause the muscles between your neck and shoulder to become tense.
Referred pain
This is where a problem in a different part of your body causes a pain somewhere else. For example, your upper arm and shoulder blade can feel painful as a result of neck problems.
Neck problems can also cause tingling feelings in your arm or hand.
Shoulder impingement (painful arc or rotator cuff syndrome)
This is a common cause of shoulder pain and in most cases will get better over a few weeks to months; for a small number of people the problem may persist.
The rotator cuff is a group of muscles and tendons that keep the upper arm bone held in the shoulder blade socket. Pain from a problem with the rotator cuff is often called shoulder impingement. The condition causes swelling, pain or damage to the tendons of the rotator cuff. This can make it painful and difficult to move your arm properly. You may find it painful and difficult to lift your arm away from your body, particularly if you’re trying to lift your arm above your head. Your arm may feel weak, or you may have a dull lingering pain in your upper arm. The term impingement refers to the rotator cuff tendon becoming pinched or trapped by arthritic bone, but we now know that this is not the underlying problem as was once thought. Instead, it’s caused by overuse or age-related problems with the tendons themselves – but the name is still used. This condition can also be called painful arc syndrome.
Rest and physiotherapy are the main courses of treatment for a shoulder impingement. Your doctor may recommend an injection of steroids and a local anaesthetic, to help with the pain.
Frozen shoulder (adhesive capsulitis)
A frozen shoulder is when the capsule around the joint has become too tight, stopping you moving your shoulder. We don’t always know why this happens, though sometimes it follows an injury, a heart attack or stroke, and it’s more common in people with diabetes who can’t produce insulin properly.
The condition will usually resolve itself in time, but it may take as long as two to three years. The pain can be severe, and you may feel sudden muscle pains, called muscle spasms, especially at night. You may need painkillers to help.
Physiotherapy or a steroid injection may also help.
Most people with frozen shoulder make a full recovery. But, if your problem continues even after trying other treatment options, you may need to consider surgery. Your doctor or physiotherapist will talk to you about which operation will help your condition most. To stop the problem returning you’ll need to follow a programme of exercises afterwards. It’s important to do your exercises regularly to get your shoulder back to full use and keep it working properly.
Long-term health conditions
If your shoulder pain persists this may be because of a long-term health condition such as arthritis. The most common form of arthritis is osteoarthritis which is characterised by persistent pain and stiffness.
Everyone’s joints go through a normal cycle of wear and repair during their lifetime. As your joints repair themselves, their shape and structure can change. When this happens in one or more of your joints, it’s known as osteoarthritis.
The exact cause of osteoarthritis is often not known, as there can be quite a few reasons why a person develops the condition. These include the genes inherited from your parents. Osteoarthritis is common and can affect people of any age, but it usually starts in people over the age of 45. Research has shown that injuries and jobs that put repeated strain on your elbows and shoulders can increase your risk of getting osteoarthritis in these joints.
- You can download a pdf booklet about Osteoarthritis of the elbow & shoulder here.
- Other forms of arthritis include rheumatoid arthritis and gout but symptoms from these conditions in the shoulder joint are less common.
- You can read more about the common causes of shoulder pain on the NHS website.
Selfcare and more information
Managing shoulder pain
Keep moving, exercise and rest
It can be tempting to avoid activity or moving your joint when you are in pain.
However, this could lead to your shoulder joint becoming stiff and making the pain worse.
Try to:
- Continue with your daily routines as far as you can
- Use icepacks on your shoulder a few times in the day to relieve pain from a minor injury or inflammation. Wrap the ice pack in a towel (frozen veg or ice cubes in a bag would also work) and apply to your shoulder for around 20 minutes at a time
- Apply heat packs for other forms of shoulder pain where your muscles are sore or tense
- Continue moving but try to avoid activities or movement that significantly increase your pain.
- Follow some simple daily shoulder exercises. These can help reduce your pain, increase movement and strengthen muscles.
Posture
Try to:
- take more notice of how you sit at work – bad seating positions can irritate existing shoulder problems, making the pain worse. Sometimes you can get advice about your workstation from an occupational health adviser.
- keep moving. Take frequent breaks and avoid sitting in one position continuously for long periods.
Click here to read more about improving your posture
Medication
A pharmacist can usually provide advice on whether medication could help your condition and, if so, what would be the best thing to try.
Some medications can help with short term pain, including paracetamol and low dose non-steroidal anti-inflammatory drugs. If you need pain relief for more than two weeks, ask for guidance from your pharmacist or GP.
Complementary treatments
Some people find that treatments such as aromatherapy or massage are helpful in relieving pain and discomfort in their shoulder.
There is currently a lack of evidence to suggest complementary therapies help everyone, and for this reason they aren’t generally recommended by NICE.
You can read more about complementary and alternative medicine here.
Professional help
If your pain is severe or does not improve with self-help measures, then you should seek advice from your GP. In some parts of Devon, you can refer yourself directly for NHS physiotherapy without needing to see your GP first.
Surgery for shoulder impingement
Local commissioning policies are in place for this condition
Please be aware that there are local commissioning policies in place for this condition. This means that certain treatments may not be available to you on the NHS. This is because these treatments have been assessed by experts as less effective, with more side effects or only work well in certain scenarios. Overall, it is better to use other treatments at least initially.
Most cases of shoulder impingement will get better over time and can be managed at home with help from the pharmacist, physiotherapist or GP. Using exercise programmes and attending physiotherapy are safe and effective ways to treat your shoulder impingement. This usually means that surgical treatment does not need to be considered.
In Devon, surgery for subacromial shoulder impingement will only be considered for patients who have persistent or worsening symptoms. All surgery comes with a risk. Although the risk is low with arthroscopic decompression, they can include infection, frozen shoulder, ongoing pain, potential damage to blood vessels or nerves and those associated with having a general anaesthetic including death. In addition, it takes time to recover after surgery. It is necessary to attend physiotherapy following surgery and continue with a programme of recommended exercises in between your physiotherapy appointments.
Click here to view the full Clinical Commissioning Policy for Devon which explains when surgery may be considered.
Useful information about shoulder pain
You can find further information about shoulder pain using the resources listed below.
- Arthritis UK- Shoulder pain
- Torbay and South Devon NHS Foundation Trust – Torbay shoulder exercise programme
- Shoulder pain – NHS UK
Waiting for a specialist opinion
If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found below.
How long will I wait?
If a hospital assessment and/or treatment is clinically recommended you will be referred for to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.