This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.

What causes shoulder pain?

Shoulder pain can arise from problems within the shoulder joint, the surrounding tendons and muscles, or from structures elsewhere that refer pain. Common causes include rotator cuff tendonitis or tears, bursitis, frozen shoulder (adhesive capsulitis), osteoarthritis and shoulder instability following dislocation. Referred pain from the neck (cervical spine) or internal organs is less common but possible. Risk factors include repetitive overhead activity, older age, prior injuries, poor posture and certain systemic conditions such as diabetes that can predispose to adhesive capsulitis.

How is shoulder pain assessed?

Assessment usually begins with a structured history and physical examination to localise pain, detect weakness or restricted movement, and identify signs of nerve involvement. Clinicians often ask about onset, activity-related patterns, prior trauma and any systemic symptoms. Simple bedside tests help evaluate range of motion and impingement signs. When necessary, imaging such as plain X-rays can assess bone changes, while ultrasound and MRI provide detailed views of soft tissues like the rotator cuff and labrum. Nerve conduction studies are occasionally used if nerve entrapment is suspected. Assessment in local services or by a specialist should guide a targeted management plan.

Non-surgical treatment options

Most shoulder pain is initially managed conservatively. Rest and activity modification reduce aggravating movements, while targeted physiotherapy focuses on strengthening rotator cuff and scapular stabilisers, improving flexibility, and correcting posture. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) can help short-term symptom control when appropriate for the patient. Corticosteroid injections into the subacromial space or glenohumeral joint may provide temporary relief for inflammatory conditions such as bursitis or severe tendonitis, though benefits vary and repeated injections have potential side effects. Other adjuncts include heat/ice, taping, and gradual graded exercise programmes. Evidence supports structured exercise and manual therapy for many mechanical shoulder disorders.

When is specialist care or surgery considered?

Referral to orthopaedic or shoulder specialists is considered if there is persistent pain despite adequate conservative care (commonly 6–12 weeks), significant functional loss, confirmed large tendon tears, recurrent instability or associated fractures. Surgical options depend on the diagnosis: arthroscopic decompression or rotator cuff repair for tears and impingement, stabilisation procedures for recurrent dislocation, and joint replacement for advanced arthritic changes. Surgical decision-making weighs the severity of symptoms, functional goals, comorbidities and imaging findings. Rehabilitation after surgery is critical and typically follows staged physiotherapy to restore motion and strength.

Rehabilitation and long-term strategies

Rehabilitation aims not only to reduce pain but to restore function and prevent recurrence. A phased exercise plan progresses from pain-relieving isometrics to range-of-motion work and then to progressive resistance and sport- or work-specific conditioning. Ergonomic adjustments at work, technique changes in sports, and ongoing maintenance exercises reduce strain on the shoulder. For chronic conditions like adhesive capsulitis, supervised stretching and graded mobilisation may take several months but often yield improvement. Smoking cessation, weight management and control of systemic conditions such as diabetes also support recovery.

Conclusion

Effective shoulder pain treatment begins with accurate assessment and a tailored plan that balances conservative measures with procedural or surgical options when indicated. Most people improve with structured physiotherapy, activity modification and targeted interventions, while specialist input is valuable for persistent or complex cases. Seek assessment from appropriate local services to identify the best approach for your situation.