Shoulder pain is very common. Some causes of shoulder pain resolve within a few weeks without any treatment apart from simple medicines for pain relief. However, some causes of shoulder pain can last for a long time and your doctor will need to arrange further tests and treatment. You should see your doctor if the pain is severe, if it follows an injury or if it doesn't get better after a few weeks.
The shoulder joint
There are three bones in the shoulder region - the collarbone (clavicle), the shoulder blade (scapula) and the upper arm bone (humerus). The scapula is a triangular-shaped bone that has two important parts to it: the acromion and the glenoid. The three bones in the shoulder region form part of two main joints:
- The acromioclavicular joint between the acromion of the scapula and the clavicle.
- The glenohumeral joint between the glenoid of the scapula and the humerus.
There are also a number of muscles, ligaments and tendons around the shoulder. Ligaments are fibres that link bones together at a joint. Tendons are fibres that attach muscle to bone.
How common is shoulder pain?
Shoulder pain is very common and can affect all ages. Some causes of shoulder pain such as osteoarthritis, frozen shoulder and rotator cuff disorders, mainly affect middle-aged and older people. Shoulder pain caused by sports injuries is more common in younger age groups.
What are the causes of shoulder pain?
See also separate leaflet called Joint Pain. Shoulder pain is a common problem with a number of different causes which include:
- Frozen shoulder. This is sometimes called adhesive capsulitis of the shoulder. It is a condition where a shoulder becomes painful and stiff. Without treatment, symptoms usually go but this may take up to 2-3 years.
- Rotator cuff disorders. The rotator cuff is a group of muscles and tendons that surround the shoulder joint and help to keep it stable. Rotator cuff disorders are one of the most common causes of shoulder pain. Most people can be successfully treated and have complete recovery.
- Osteoarthritis in the shoulder joint.
- Septic arthritis. This is an infection in the joint. Symptoms include pain and tenderness over a joint, pain on moving the joint, and feeling unwell. Septic arthritis is uncommon but needs urgent hospital treatment.
- Arthritis affecting a number of other different joints as well as the shoulder - eg, rheumatoid arthritis.
- Injury (trauma):
- A broken bone (fracture), such as a fracture of the upper arm bone (humerus) or a broken collarbone (clavicle).
- A soft tissue injury such as an injury to a ligament, tendon or muscle around your shoulder joint. This may be caused in many different ways, such as a sports injury, a road traffic accident or a shoulder strain following heavy lifting or carrying.
- Shoulder dislocation. See separate leaflet called Common Dislocations.
- Shoulder instability. The shoulder is unstable because the joint does not keep the bones close together. The humerus often 'pops out' of position.
- Acromioclavicular joint disorders - some conditions (such as a shoulder injury or osteoarthritis) may affect the acromioclavicular joint, which is the joint at the top of the shoulder (see the diagram above).
- Referred pain. In some cases, pain is caused by a problem in another area, especially the neck, but the pain is felt in the shoulder. See separate leaflets called Nonspecific Neck Pain and Whiplash Neck Sprain.
Sports that may cause shoulder injuries include sports with repeated throwing or bowling, or contact sports such as rugby. Shoulder instability and acromioclavicular joint disorders often affect people who play regular sport.
Are there are tests (investigations) for shoulder pain?
Your doctor may advise investigations, which will depend on an initial examination to determine the most likely cause of your shoulder pain. Investigations may include:
- Blood tests to see whether you may have an underlying arthritis such as rheumatoid arthritis. X-rays may be needed to see whether you have a bone or joint problems.
- An ultrasound scan may be needed to assess whether there is a problem with the soft tissues of your shoulder.
- Referral, which may be needed for further investigations, such as an MRI scan. Specialist doctors you may be referred to include:
- A doctor specialising in bones and joints (an orthopaedic specialist).
- A doctor specialising in diagnosis and treatment of arthritis and musculoskeletal conditions (a rheumatology specialist).
What are the treatments for shoulder pain?
Initial treatment includes taking simple medicines for pain relief, such as ibuprofen or paracetamol. Ice packs can also be used to reduce pain. You should avoid activities that may cause more pain in your shoulder, such as heavy lifting and carrying.
You should see a doctor if your shoulder pain is very bad, does not resolve within a few weeks or was caused by an injury. Depending on the cause of your shoulder pain, further treatments may be needed. These treatments may include physiotherapy or a steroid injection into your shoulder.
You may also need to be referred to a bone and joint specialist (orthopaedic specialist or rheumatology specialist) to see if any further treatment is required, such as a surgical operation to treat the cause of your shoulder pain. However, surgery is not needed for most causes of shoulder pain.
Clinical Editor's note
February 2018 - Dr Hayley Willacy recently read a paper in The Lancet journal looking at surgical treatment for shoulder pain - see further reading below. Key hole (arthroscopic) decompression is a common surgery for shoulder tip (subacromial) pain, but its effectiveness is uncertain. Decompressing means removing bone spurs and soft tissue through a thin telescope introduced through a key hole cut. The findings of their study show there is little value in this operation for pain, and this should be discussed with patients during the shared treatment decision-making process.
What is the outcome (prognosis)?
The outcome will depend on the underlying cause. Shoulder pain may only last for up to a few weeks, last a few years or may be a lifelong problem. However, if the cause of your shoulder pain is diagnosed and treated early then this can help to resolve or greatly reduce the pain in your shoulder.
Further reading and references
Shoulder pain; NICE CKS, April 2015 (UK access only)
Burbank KM, Stevenson JH, Czarnecki GR, et al; Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician. 2008 Feb 1577(4):453-60.
Burbank KM, Stevenson JH, Czarnecki GR, et al; Chronic shoulder pain: part II. Treatment. Am Fam Physician. 2008 Feb 1577(4):493-7.
Shoulder Disorders; Wheeless' Textbook of Orthopaedics
Beard DJ, Rees JL, Cook JA, et al; Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018 Jan 27391(10118):329-338. doi: 10.1016/S0140-6736(17)32457-1. Epub 2017 Nov 20.
First two weeks after surgery the pain was intense and I could not sleep unless I was in a recliner. Have been wearing the immobilized but have a tendency to remove it when I know that there is no...KJean
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