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Key points about 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.
The 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.
When something goes wrong with your shoulder, it hampers your ability to move freely and can cause 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.
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).
An injury to a muscle and/or tendon.
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.
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 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 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.
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.
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.
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.
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.
The following videos from the British Elbow & Shoulder Society (BESS) describe some simple shoulder exercises. Check with your healthcare provider or physiotherapists if these are suitable for you.
Shoulder injuries or aches and pains are common and learning to do an effective shoulder examination is essential. For those of us who have been practising for years, it can still be worth reviewing our techniques and upskilling ourselves!
The standard order is: LOOK, FEEL, MOVE, SPECIAL TESTS.
This video provides another perspective on the shoulder examination and has been produced by students at Oxford University Medical School in conjunction with the faculty. It is part of a series of videos covering Orthopaedic examinations and is linked to Oxford Medical Education(external link)