7 Causes of Shoulder Pain and How to Treat Them

What Is Shoulder Pain?

Shoulder pain is a common problem that can affect people of all ages. It may develop gradually from repetitive activity or overuse, or it can occur suddenly after an injury.

The shoulder is a complex joint that allows a wide range of movement. Because several muscles, tendons, ligaments, joints, and nerves work together to control the shoulder and arm, pain can have many different causes.

Shoulder pain may be felt around the front, side, or back of the shoulder and can sometimes extend into the upper arm. Depending on the underlying cause, you may also experience stiffness, weakness, reduced movement, or pain at night.

While many cases of shoulder pain improve with appropriate self-management and rehabilitation, persistent or severe symptoms should be assessed by a healthcare professional.

7 Common Causes of Shoulder Pain

Shoulder pain is a symptom rather than a single condition. The most appropriate treatment depends on what is causing the pain.

Here are seven common causes of shoulder pain:

1. Rotator cuff problems
2. Shoulder impingement
3. Frozen shoulder
4. Shoulder osteoarthritis
5. Shoulder bursitis
6. Shoulder instability
7. Shoulder injuries and muscle strains

Let’s look at each cause in more detail.

1. Rotator Cuff Problems

The rotator cuff is a group of muscles and tendons that helps stabilize the shoulder and control arm movement. Problems affecting these structures can develop gradually or occur after an injury.

Rotator cuff-related shoulder pain may be associated with repetitive overhead activity, changes in activity levels, age-related changes, or an acute injury.

Common Symptoms

You may experience:

• Pain when lifting or lowering your arm
• Pain when reaching overhead
• Weakness in the shoulder or arm
• Difficulty performing certain movements
• Pain when lying on the affected shoulder
• Discomfort that may be worse at night

The symptoms can vary considerably between individuals, and shoulder pain does not always indicate significant structural damage.

How Is It Treated?

Treatment usually depends on the severity and cause of the symptoms. Conservative management may include:

• Activity modification
• Progressive strengthening exercises
• Range-of-motion exercises
• Physiotherapy
• Pain management
• Gradual return to normal activities

A physiotherapist can assess your shoulder movement and strength and develop an exercise programme based on your specific symptoms.

For some significant tendon injuries, further medical assessment may be necessary.

2. Shoulder Impingement

Shoulder impingement occurs when tissues around the shoulder, particularly a tendon, become irritated and painful during movement. Symptoms can be more noticeable when lifting the arm, especially above shoulder level.

It may develop gradually or occur following changes in activity or an injury.

Common Symptoms

Typical symptoms include:

• Pain at the top or outside of the shoulder
• Pain when raising the arm
• Shoulder weakness
• Pain that may be worse at night
• Difficulty with overhead activities

How Is It Treated?

Treatment may include:

• Modifying activities that aggravate the pain
• Maintaining gentle shoulder movement
• Physiotherapy
• Progressive exercises to improve movement and strength
• Appropriate pain relief

A physiotherapist can guide you through exercises designed to improve shoulder movement and function.

Complete immobilization is generally not recommended because keeping the shoulder completely still can contribute to stiffness.

3. Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, causes persistent shoulder pain and stiffness. The condition can develop gradually and may make everyday movements such as dressing, reaching, or putting your hand behind your back difficult.

The two main symptoms are pain and restricted shoulder movement. Pain can also be worse at night and interfere with sleep.

Frozen shoulder can take months, and sometimes longer, to fully settle.

Common Symptoms

You may notice:

• Persistent shoulder pain
• Increasing stiffness
• Difficulty raising the arm
• Difficulty reaching behind your back
• Pain at night
• Reduced ability to perform everyday activities

How Is It Treated?

Treatment depends on the stage and severity of the condition and may include:

• Pain management
• Gentle range-of-motion exercises
• Stretching
• Physiotherapy
• Strengthening exercises as movement improves
• In some cases, steroid injections

Physiotherapy can help restore shoulder movement and function through an individualized rehabilitation programme.

It is important not to force painful or aggressive movements, particularly during the more painful stages.

4. Shoulder Osteoarthritis

Osteoarthritis occurs when the tissues within a joint undergo degenerative changes over time. When it affects the shoulder, it can cause pain, stiffness, and reduced movement.

Shoulder osteoarthritis becomes more common with age, although symptoms and severity can vary from person to person.

Common Symptoms

Symptoms may include:

• Shoulder pain during movement
• Stiffness
• Reduced range of motion
• Difficulty with everyday activities
• Pain that gradually develops
• Clicking or grinding sensations

Shoulder arthritis is one of the possible causes of persistent shoulder pain and stiffness.

How Is It Treated?

Treatment focuses on managing symptoms and maintaining shoulder function.

Depending on your symptoms, treatment may include:

• Exercise therapy
• Strengthening exercises
• Mobility exercises
• Activity modification
• Pain management
• Physiotherapy
• Medical treatment when appropriate

Regular movement and strengthening can help maintain physical function. A physiotherapist can help select exercises that are appropriate for your level of pain and mobility.

5. Shoulder Bursitis

A bursa is a small fluid-filled sac that helps reduce friction between tissues around a joint. When a bursa becomes irritated, it can contribute to shoulder pain.

Shoulder bursitis may occur alongside other shoulder conditions, including rotator cuff-related problems or impingement.

Common Symptoms

You may experience:

• Pain around the shoulder
• Pain when lifting the arm
• Tenderness
• Pain when lying on the affected side
• Reduced shoulder movement because of pain

How Is It Treated?

Treatment may involve:

• Temporarily reducing activities that aggravate symptoms
• Maintaining comfortable shoulder movement
• Physiotherapy
• Progressive strengthening
• Pain management
• Medical assessment if symptoms persist

The goal is to manage the irritation while gradually restoring normal shoulder movement and function.

6. Shoulder Instability

Shoulder instability occurs when the shoulder does not remain adequately stable within the joint during movement. It can develop after a previous dislocation or injury, although some people naturally have greater joint mobility.

Instability can cause sensations of the shoulder slipping, clicking, or feeling as though it may give way.

Common Symptoms

Symptoms may include:

• A feeling that the shoulder is unstable
• Clicking or locking
• Pain during certain movements
• Weakness
• Repeated shoulder dislocations or subluxations
• Reduced confidence when using the arm

NHS guidance lists instability among the possible causes of shoulder pain, particularly when symptoms include tingling, numbness, weakness, or clicking or locking.

How Is It Treated?

Treatment depends on the severity and underlying cause.

Physiotherapy may focus on:

• Strengthening the muscles around the shoulder
• Improving shoulder control
• Proprioception and movement awareness
• Gradual return to activities
• Reducing the risk of recurrent instability

People with recurrent dislocations or significant instability may require further medical assessment.

7. Shoulder Injuries and Muscle Strains

Shoulder pain can also occur following an injury, such as a fall, sudden movement, lifting something heavy, or an increase in physical activity.

Injuries can affect muscles, tendons, ligaments, or other structures around the shoulder.

Common Symptoms

Depending on the injury, you may experience:

• Sudden shoulder pain
• Swelling
• Bruising
• Weakness
• Reduced range of motion
• Pain when moving the arm
• Tenderness around the injured area

More serious injuries, including dislocations, fractures, or significant tendon tears, require medical assessment.

How Is It Treated?

Treatment depends on the type and severity of the injury.

For less serious strains, treatment may include:

• Temporary activity modification
• Gentle movement
• Progressive rehabilitation
• Strengthening exercises
• Physiotherapy
• Gradual return to normal activities

If the shoulder has changed shape, you cannot move your arm, or the pain started after a significant injury, seek prompt medical assessment.

How Is the Cause of Shoulder Pain Diagnosed?

Because several conditions can cause similar symptoms, identifying the cause of shoulder pain usually starts with a clinical assessment.

A healthcare professional may ask about:

• When the pain started
• Whether there was an injury
• Which movements make the pain worse
• Whether you have pain at night
• Your activity levels
• Your previous shoulder problems
• Any weakness, numbness, or tingling

They may also assess your:

• Shoulder range of motion
• Muscle strength
• Joint movement
• Functional ability
• Symptoms during specific movements

Imaging such as an X-ray, ultrasound, or MRI is not automatically required for every case of shoulder pain. Whether imaging is appropriate depends on your symptoms and clinical findings.

How Is Shoulder Pain Treated?

There is no single treatment that works for every type of shoulder pain. Treatment should be based on the underlying cause, symptoms, and functional limitations.

Common treatment approaches include:

Physiotherapy

Physiotherapy can play an important role in managing many causes of shoulder pain.

A physiotherapist can assess your shoulder and create an individualized rehabilitation programme.

Depending on your condition, treatment may include:

• Range-of-motion exercises
• Strengthening exercises
• Mobility work
• Movement retraining
• Activity modification
• Education about managing symptoms
• Manual therapy when appropriate
• Gradual return to sport, work, or other activities

Exercise-based rehabilitation is commonly used to improve shoulder movement, strength, and function.

Activity Modification

You do not necessarily need to stop using your shoulder completely.

Instead, it may be helpful to temporarily reduce or modify activities that consistently aggravate your symptoms while maintaining comfortable movement.

Exercise

Appropriate exercise can help maintain shoulder mobility and build strength.

However, shoulder exercises should be matched to your condition. Performing strenuous or poorly selected exercises without guidance may aggravate symptoms.

A physiotherapist can help determine the appropriate starting point and progression.

Heat or Cold

Heat or cold packs may provide temporary relief for some people.

If you use a heat or cold pack, wrap it in a towel and avoid applying it directly to the skin. NHS guidance suggests using packs for limited periods rather than leaving them on for prolonged periods.

Medication

Depending on your symptoms and medical history, a doctor or pharmacist may recommend pain-relieving medication.

Because medicines are not suitable for everyone, it is important to seek appropriate professional advice before using them, particularly if you have other medical conditions or take regular medication.

Injections

In some shoulder conditions, a healthcare professional may consider an injection to help manage pain.

For example, steroid injections may sometimes be used for conditions such as shoulder impingement or frozen shoulder when clinically appropriate.

Surgery

Surgery is not necessary for most cases of shoulder pain.

However, certain injuries or persistent conditions may require specialist assessment to determine whether surgery is appropriate.

Can Physiotherapy Help With Shoulder Pain?

Yes. Physiotherapy can help manage many causes of shoulder pain and is often an important part of rehabilitation.

Your physiotherapist can assess your symptoms, shoulder mobility, strength, and functional limitations before developing an individualized treatment plan.

Depending on your condition, rehabilitation may focus on:

• Reducing movement-related pain
• Restoring range of motion
• Improving shoulder strength
• Improving movement control
• Returning to work or sport
• Preventing future episodes where possible

Physiotherapy is commonly used for musculoskeletal problems, including shoulder pain, and may involve exercise, manual therapy, and advice on managing symptoms.

The specific treatment should depend on your assessment rather than using the same exercise programme for every person with shoulder pain.

How Can You Relieve Shoulder Pain at Home?

If your symptoms are mild and there are no warning signs, some simple strategies may help.

Keep Your Shoulder Moving

Avoid completely stopping shoulder movement. Gentle, comfortable movement can help prevent stiffness.

Modify Painful Activities

Temporarily reduce activities that repeatedly trigger your symptoms, particularly repetitive or strenuous overhead movements.

Try Gentle Exercises

Appropriate shoulder exercises can help maintain mobility and gradually improve strength. If you are unsure which exercises are suitable, a physiotherapist can guide you.

Use Heat or Cold

A wrapped heat or cold pack may provide temporary relief.

Adjust Your Sleeping Position

If shoulder pain is disturbing your sleep, supporting your arm with a pillow or avoiding lying directly on the painful shoulder may make you more comfortable.

Gradually Return to Normal Activities

As your symptoms improve, gradually increase your normal activities rather than suddenly returning to heavy lifting, intensive exercise, or repetitive overhead movements.

How Long Does Shoulder Pain Take to Improve?

Recovery depends on the cause of your shoulder pain.

Some new shoulder problems improve over several weeks, while conditions such as frozen shoulder can take considerably longer to resolve.

If your shoulder pain is not improving, is getting worse, or is affecting your sleep, work, or daily activities, consider getting assessed by a healthcare professional.

When Should You See a Physiotherapist or Doctor?

You should consider professional assessment if:

• Your shoulder pain is getting worse
• Symptoms are not improving after a few weeks
• Shoulder pain is affecting your sleep
• You have difficulty moving your arm
• You have persistent weakness
• Pain is affecting your work, sport, or daily activities
• Your shoulder pain keeps coming back

A physiotherapist can assess your symptoms and help determine whether rehabilitation is appropriate or whether you need further medical assessment.

When Is Shoulder Pain an Emergency?

Most shoulder pain is not caused by a serious condition. However, some symptoms require urgent medical attention.

Seek urgent medical help if:

• You suddenly develop severe shoulder pain
• You cannot move your arm
• Your shoulder or arm has changed shape
• There is significant swelling after an injury
• You have persistent numbness or pins and needles
• Your arm or shoulder feels unusually hot or cold
• Your pain started after a significant fall or accident
• You have severe pain in both shoulders
• You feel feverish or generally unwell

Shoulder or arm pain accompanied by chest pain, shortness of breath, palpitations, or pain spreading toward the jaw can sometimes indicate a medical emergency rather than a musculoskeletal problem. In this situation, seek emergency medical attention.

Frequently Asked Questions About Shoulder Pain

What is the most common cause of shoulder pain?

There is no single cause of all shoulder pain. Common causes include rotator cuff-related problems, impingement, frozen shoulder, arthritis, bursitis, instability, and injuries. The correct diagnosis depends on your symptoms and clinical assessment.

Can shoulder pain go away on its own?

Yes. Many cases of shoulder pain improve with time, appropriate activity modification, and gradual movement. However, persistent or worsening symptoms should be assessed by a healthcare professional.

Is physiotherapy good for shoulder pain?

Physiotherapy can be helpful for many shoulder conditions. Treatment may include exercises, mobility work, strengthening, movement education, and other techniques selected according to your condition.

Should I rest my shoulder if it hurts?

Complete rest is generally not recommended for most shoulder problems. Gentle movement is usually encouraged, while activities that significantly aggravate symptoms can be temporarily reduced or modified.

When should I worry about shoulder pain?

Seek urgent medical attention if shoulder pain is severe, follows a significant injury, causes an inability to move the arm, is associated with major swelling or deformity, or occurs with persistent numbness or other concerning symptoms. Shoulder or arm pain accompanied by chest pain or breathing difficulties also requires urgent assessment.

Do I need an MRI for shoulder pain?

Not necessarily. Imaging is not routinely needed for every case of shoulder pain. A healthcare professional can determine whether an X-ray, ultrasound, MRI, or another investigation is appropriate based on your symptoms and examination.

What exercises are best for shoulder pain?

The best exercises depend on the cause of your shoulder pain and your current mobility and strength. A physiotherapist can recommend exercises that are appropriate for your condition and progress them as you improve.

Final Thoughts

Shoulder pain can have many different causes, from rotator cuff problems and impingement to frozen shoulder, arthritis, bursitis, instability, and injuries. Because several conditions can produce similar symptoms, identifying the underlying cause is an important part of choosing the right treatment.

For many people, staying active, modifying aggravating activities, and following an appropriate exercise programme can support recovery. Physiotherapy can provide individualized assessment and rehabilitation to help improve movement, strength, and function.

If your symptoms persist, worsen, or significantly interfere with your daily life, work, or sleep, professional assessment can help you determine the most appropriate next step.

If you are experiencing persistent shoulder pain, a physiotherapy assessment can help identify the cause and guide your recovery. Contact PhysiCare to discuss your symptoms and find out whether physiotherapy is right for you.