Shoulder Pain: Common Causes and Management
The shoulder trades stability for range of movement, which is why it is vulnerable. Most pain arises from the tendons and surrounding structures rather than from the joint surfaces.
Rotator cuff related pain
The most common presentation. Pain on the outer upper arm, worse when lifting the arm to the side or above shoulder height, and frequently worse at night when lying on that side.
It relates to the tendons that stabilise and move the shoulder, and the terminology has shifted away from impingement toward describing it by symptom pattern.
Evidence supports progressive loading exercise as the primary treatment, generally outperforming rest.
Recovery is measured in months, and the most common reason treatment fails is stopping too early.
Frozen shoulder
Adhesive capsulitis produces progressive loss of movement in all directions, including when someone else moves the arm passively.
That distinction matters: rotator cuff problems limit active movement more than passive, whereas frozen shoulder restricts both.
It typically progresses through painful, stiff and recovering phases over many months to years. It is more common in people with diabetes.
Management focuses on pain control and maintaining what movement exists. It generally resolves, slowly.
Other causes
Acromioclavicular joint problems produce pain localised to the top of the shoulder, worse reaching across the body.
Osteoarthritis of the shoulder joint itself is less common than in hips and knees, and produces deep pain with crepitus.
Referred pain from the neck is common and frequently missed, producing shoulder pain with no local tenderness.
What helps
Continued movement within tolerance. Immobilising a painful shoulder risks stiffness that becomes a second problem.
Structured strengthening under physiotherapy guidance, which has the best evidence for cuff-related pain.
Adjusting aggravating activities temporarily rather than stopping activity entirely.
Sleeping position adjustment, since night pain is a major complaint — a pillow supporting the arm frequently helps.
When to seek assessment
Inability to lift the arm at all after an injury, which may indicate a significant tear.
Obvious deformity, or symptoms following a fall or dislocation.
Pain with fever, redness or swelling.
Numbness, tingling or weakness extending down the arm.
Progressive loss of movement not improving over several weeks.
This article is general information and not medical advice. Consult a qualified healthcare professional about your own symptoms.
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