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There’s no reason why shoulder pain should stop you leading a normal life. In many cases it can be easily managed.

Shoulder pain is a normal part of life. However, it can prevent you from carrying out your usual day-to-day activities and can make you feel worried and frustrated. The good news is that shoulder pain can be easily treated by you, at home.

In This Section

This website provides information, advice and resources from our clinicians to help you do this. Shoulder pain could be caused by a number of conditions:

  • Rotator cuff – shoulder or upper arm pain, particularly when lifting the arm, lying on it or using the sore muscles
  • Shoulder instability – dislocation or excessive movement of the shoulder joint
  • Acromioclavicular joint pain – painful joint on the tip of the shoulder where the collar bone and shoulder blade join
  • Frozen shoulder – is the painful and gradual stiffening of the shoulder capsule
  • Osteoarthritis – progressive wearing away of the cartilage of the joint leading to the two bones of the joint rubbing together causing pain
  • Referred shoulder pain – pain is experienced in an area away from the actual injury or problem e.g. pain in shoulder which is usually referred from the neck or upper back

Who gets rotator cuff related pain?

  • People who work or do sports / hobbies with their hands above shoulder height.
  • A shoulder injury or repetitive or unaccustomed activity may also cause the condition to develop.
  • Rotator cuff problems can develop as we get older.

Why do we get rotator cuff related pain?

The rotator cuff is a group of muscles which help to control the movement of the ball and socket joint of the shoulder, with the tendon attaching the muscle to the humerus bone (upper arm bone). These tendons can either be intact or torn.

A number of other terms such as supraspinatus tendinopathy, tendinitis and bursitis are used by different people, but the diagnosis and treatment are essentially the same, and is referred to as rotator cuff tendinopathy. Overuse or unaccustomed activity, or sometimes trauma, such as a fall onto the hand or shoulder, can cause them to become painful

What happens to the tendons?

In the majority of cases, the tendon becomes painful without any serious damage and responds well to self-management, such as modifying your activity and progressive strengthening exercises. However, in some instances, the tissues can become inflamed (usually in younger people under the age of 40), show signs of degeneration or develop a tear.

A tear can be acute (sudden onset) following trauma, or can be chronic (long-lasting) due to tendon degeneration. Chronic tears are much more common in patients over the age of 60. A tear that does not extend the full way through a tendon is called a partial thickness tear.

Tears are very common, with up to 34% of the population having them. They do not always lead to pain and weakness and therefore do not always require surgery to repair them.

In smaller degenerative tendon tears, physiotherapy involving progressive strengthening exercise programmes has been shown to be very effective, as long as they are continued on a daily basis for at least 3 months and possibly up to 6 months.

What are the symptoms?

Shoulder and outer arm pain particularly when lifting the arm, lying on it or using the sore muscle, e.g. taking a jacket on or off

How can I deal with it?

  • In the very early stages or with a flare up, have relative rest from the activity causing the pain.
  • Gentle exercises to prevent your shoulder from stiffening up and to strengthen your muscles. It is fine to have some discomfort during your exercises as long as the discomfort is not severe, and settles within 30 minutes of your exercise.
  • Pain relief as advised by your pharmacist or GP.

What should I do if this doesn’t help or if the symptoms are severe?

  • Physiotherapists will plan an individual rehabilitation programme in order to improve your day-to-day function and increase or maintain your movement and strength.
  • You may benefit from an injection if you fail to benefit from physiotherapy. However, this may not be done if you have a tear, and repeated injections are not recommended.
  • You may require investigations, eg X-rays, ultrasound, etc, if your shoulder is not improving.
  • You may require a surgical procedure if your symptoms are severe and fail to settle with self-management, pain management and adequate physiotherapy. However, in the vast majority of patients, management with physiotherapy is enough to settle symptoms.

How should I avoid?

  • Avoid excessive unaccustomed activity with the hands above shoulder height eg painting a ceiling, hanging curtains and trimming the hedge in short periods of time.
  • Take breaks from repetitive shoulder movements and heavy lifting.
  • Try to keep your weight within normal limits, as individuals who are overweight have an increased risk of rotator cuff problems and tendon problems in general.
  • If you exercise, ensure you balance your training programme to incorporate strength work for all muscle groups.
  • Try to keep physically active.

What is the shoulder capsule?

The shoulder capsule is tissue that surrounds the shoulder joint and supplies the joint with nutrients and lubricating fluid. It also helps to stabilise the shoulder preventing it from coming out of the joint.

Why did I get it?

Frozen shoulder affects one in 20 people and is more common in women than men. Most cases of frozen shoulder happen between the ages of 40 and 60. The exact cause of frozen shoulder is unknown. For some reason your body has an over reactive response to a minor injury and tries to heal your shoulder capsule with scar tissue. This leads to pain and stiffness. People with diabetes or history of recent shoulder surgery or recent injury have an increased chance of developing this condition. Frozen shoulder is often confused with other shoulder problems but a true frozen shoulder is categorised into three distinct phases.

  • Painful Phase
  • Stiffness Phase
  • Thawing Phase

What happens in my shoulder when I have a frozen shoulder?

  • Painful Phase – Your body increases the blood flow to your shoulder to try and lay down new tissue. This causes a pain similar to toothache and is why your shoulder is particularly painful at night and can feel incredibly painful to lie on. This stage normally lasts between two to nine months, but can take longer if you are diabetic.
  • Thawing Phase – During the thawing stage your shoulder will start to loosen and will slowly become easier to move. This happens because your body starts to break down the unnecessary scar tissue and the shoulder capsule starts to become more flexible. This last stage can last from five months to four years. In some cases your full range of motion may never fully return.
  • Stiffening Phase – Scar tissue starts to form in and around the shoulder capsule making it incredibly difficult to move. At this stage pain is often much more manageable and you are able to sleep better at night. In addition to the stiffness, your muscles may start to waste due to you not using the affected shoulder as much. This stage can last from four to 12 months. Thawing Phase – During the thawing stage your shoulder will start to loosen and will slowly become easier to move. This happens because your body starts to break down the unnecessary scar tissue and the shoulder capsule starts to become more flexible. This last stage can last from five months to four years. In some cases your full range of motion may never fully return.

What can I do to help my symptoms during the Painful Phase?

  • Activity modification/relative rest

Activity modification does not mean you stop moving or using your shoulder altogether. Although it sounds straightforward, avoiding activities over your head or behind your back can help to reduce the irritation of your shoulder.

  • Maintaining good posture

Your shoulder movement can be hugely affected by your posture. If you slouch, your ability to lift your arm above your head reduces by approximately 30 per cent. Sitting and standing in a good posture with your shoulders back will help your movement as well as prevent the tendons in your shoulder catching. Also try not to slouch and lean through our shoulders and elbows. This squashes all the structures in your shoulder against the ridge above the joint, causing pain and irritation.

  • Simple analgesia and anti-inflammatories

Simple analgesia such as paracetamol can be used to dull the pain but does not cure the problem. Anti-inflammatories such as ibuprofen can also be effective. It is best to consult your GP if you have not taken these before. Seek further advice from your GP if your symptoms become unmanageable.

  • Ice/Cryotherapy

Icing your shoulder can be a very effective way of reducing your pain. Place a wet flannel and a pack of frozen peas on your shoulder for 20 minutes up to every hour. Check the skin under the ice every five minutes to avoid an ice burn. Once the pain begins to settle you can then start to ice your shoulder less frequently.

  • Injection Therapy

Injection therapy can be a very effective way of reducing your pain during this stage if anti-inflammatories or ice are having little effect. This can be done by either your specialist GP or by an enhanced role physiotherapist. Injections are not for everyone and may not be suitable for those with certain medical conditions.

  • Simple range of movement exercises
  • Sleeping position

Sleeping on your shoulder can be very painful during this stage. Try to sleep on your back or on the opposite shoulder with a pillow under the armpit of the affected shoulder.

  • What can I do to help my symptoms during the stiffness phase?

Active assisted range of movement exercises Keeping your shoulder moving during this stage is very important but you should avoid pushing too far into very painful movement, as this can be counter productive. Active assisted stick exercises are a great way to keep your shoulder moving as well as trying to keep your muscles working.

  • What can I do to help my symptoms during the stiffness phase?

At a point that is different for every frozen shoulder, you will feel your shoulder starting to move more. During this time it is important to regularly exercise your shoulder and use it as much as possible in day to day activities. When exercising at this stage it is important to start working into the resistance/tightness but this should never be painful. If you are unsure, seek advice from your GP or a physiotherapist.

What should I avoid?

  • Correct your posture – if you slouch, your ability to lift your arm above your head reduces by approximately 30 per cent. Sitting and standing in a good posture with your shoulders back will help your movement as well as prevent the tendons in your shoulder catching
  • Avoid excessive unaccustomed activity with the hands above shoulder height e.g. doing tasks like painting the ceiling, hanging curtains and trimming the hedge in short periods of time
  • Take breaks from repetitive shoulder movements and heavy lifting
  • Try not to slouch as this squashes all the structures in your shoulder against the ridge above the joint, causing pain and irritation
  • If you exercise, ensure you balance your training programme to incorporate strength work for all muscle groups

Surgical input and Adhesive Capsulitis When do I need to seek further advice?

If you suffer from any of the following it is important you see your GP before starting any form of self-management.

  • Night pain which severely affects your sleep
  • Shoulder pain associated with a fever or night sweats
  • Restricted movement that is heavily affecting your ability to function day to day
  • Swelling or redness
  • Pain following an injury or traumatic event (fall, sports injury, epileptic fit, electric shock)
  • Pins and needles or numbness Left shoulder pain which is associated with shortness of breath or clamminess

What is Shoulder Instability?

The shoulder is one of the most commonly dislocated joints. Shoulder instability means that the shoulder can dislocate (be pulled out of joint) or sublux (moves more than it should do) during day-to-day activities. Both dislocation and subluxation can happen for a variety of reasons. How it happens has an impact on the type of treatment you will receive.

What causes Shoulder Instability

As mentioned above, there are a variety of causes for shoulder instability. However, it can be divided into three main categories largely dependent on how your shoulder dislocates or subluxes for the first time.

  • Traumatic dislocation: This is where the shoulder undergoes an injury with enough force to pull the shoulder out of joint. E.g. a violent tackle in rugby or a fall onto an outstretched hand. It is much more common in men under the age of 30. Usually the shoulder requires putting back in (reduction) in Accident and Emergency. Following a first time dislocation, the arm is usually put in a sling and you may be sent for a course of physiotherapy. The shoulder joint is a ball and socket joint, which is held together by a combination of ligaments and muscles. There is also a rim of cartilage around the socket called the labrum. The labrum acts to deepen the socket to make the shoulder even more stable. When a shoulder is dislocated, sometimes the rim of cartilage is pulled away from the socket damaging the labrum. This often does not heal and therefore the shoulder can remain unstable. Once your shoulder has been damaged in this way, you may find that your shoulder dislocates again fairly easily. This damage to the labrum is often called a ‘Bankart lesion’; named after the doctor who first described this injury. Sometimes, if enough force is present during a dislocation, a small part of bone from the shoulder socket (glenoid fossa) may break off with the labrum. This is often called a ‘Bony Bankart lesion’. Shoulder stabilisation surgery is an operation to repair the damage to the labrum and therefore re-stabilise the shoulder joint. This type of repair may also be called a Bankart repair or a Latarjet procedure by your surgeon, and is discussed later.
  • Positional non-traumatic: This condition refers to the ability to dislocate your shoulder without any form of trauma. This may start off as a voluntary dislocation, perhaps as a party trick, but if repeated, eventually it can happen during everyday activities. It can affect both shoulders and can be associated with people who have lax joints. This type of instability is due to abnormal muscle patterning around the shoulder, meaning the strong power muscles around the shoulder, such as the pectoral muscles, are constantly ‘switched on’. These muscles then pull the already loose shoulder out of joint during movement. The main treatment with for this type of instability is specialist physiotherapy, which looks at retraining movement patterns of the shoulder.
  • Non-traumatic dislocation: Repeated shoulder movements may gradually stretch out the soft tissue cover around the joint (the joint capsule). This can happen with athletes such as throwers and swimmers. Following capsular stretching, the rotator cuff muscles can become weak – affecting how the muscles around the shoulder interact with each other and in turn, leading to an imbalance of the shoulder. In this type of shoulder instability, referral for specialist physiotherapy is the first form of management and treatment can be effective for as long as exercises are continued.

How can I manage it?

Following a first-time dislocation, your arm may be put in a sling. Your doctor or physiotherapist will advise you on when to remove it to exercise.

  • Changes to your activity/rest You can start to move the arm when your doctor or physiotherapist advises you to. You should then slowly try and increase your range of movements over the next three to four weeks. Making changes to the activities you do does not mean that you have to stop moving or stop using your shoulder altogether. Try to avoid activities that involve lifting your arm over your head, or contact sports for the first three months after the dislocation. This can prevent further dislocations happening in the future.
  • Simple painkillers (analgesia) and/or anti-inflammatories Simple painkillers such as paracetemol can be used to dull the pain, but they do not cure the problem. Anti-inflammatories can also be effective. It is best to consult your GP if you have not taken these before.
  • Maintaining good posture Your shoulder movement can be hugely affected by your posture. Sitting and standing in a good position with your shoulders back will help your movement as well as prevent the tendons in your shoulder from catching.
  • Ice/Cryotherapy Icing your shoulder can be a very effective way of reducing your pain. Place a wet flannel and a pack of frozen peas on your shoulder for 20 minutes every hour. Check the skin under the ice every five minutes to ensure that you don’t get an ice burn. Once the pain begins to settle, you can then start to ice your shoulder less frequently.

What can I do about it?

Regular movement of your shoulders will help improve your strength and range of movement. Strengthening the muscles strengthens the tendons in your shoulder helping to reduce pain.

Sleeping Position

  • Sleeping on your shoulder can be very painful following dislocation. Try to sleep on your back or on the opposite shoulder with a pillow under the armpit of the affected shoulder.
  • You should wear your sling in bed at night until you have been advised to remove it by your doctor or physiotherapist.

How can I stop dislocating my shoulder in the future?

If your shoulder has dislocated more than once, you need to see your GP for advice about referring you to a specialist shoulder surgeon. If you suffer from any of the following symptoms, then it is important to see your GP before starting any form of self-management.

  • Night pain that severely affects your sleep
  • Shoulder pain associated with a fever or night sweats
  • Restricted movement that is heavily affecting your ability to function day-today
  • Left shoulder pain that is associated with shortness of breath or clamminess
  • Swelling or redness
  • Pain following an injury or traumatic event (e.g. fall, sports injury, epileptic fit, electric shock)
  • Pins and needles, or numbness

Patients who have had previous trauma or shoulder surgery are most likely to develop osteoarthritis in later life. Symptoms include swelling, stiffness, aching and sharp, stabbing pains.

If you are suffering from osteoarthritis of the shoulder then you should:

  • Do exercises to keep the joints healthy and stimulate the natural lubricating fluid. For example, you could to the below exercises twice per day

Easy

  • Polishing – Gently lean forwards onto a kitchen worktop or table with your good hand. Start by polishing in small circles, gradually increasing the movement as you feel more comfortable. Repeat for 60 seconds.
  • Pendular – Gently lean forwards onto a stable surface like a table. Gently swing your arm forward and backwards, side-to-side and then in small circles. Start with small movements and increase the movement as it starts to feel more comfortable. Repeat for 30 seconds in each direction.

Intermediate

  • Isometric flexion – Stand facing a wall. Place your fist on the wall with your elbow at a right angle. Gently press against the wall, tightening your shoulder muscle without moving your body. Hold for 3 seconds, repeat 10 times.
  • Isometric medial rotation – Stand facing a door way or open corner like in the picture. Place your fist or open hand on the wall. Gently press against the wall tightening your shoulder muscle without moving your body. Hold for 3 seconds, repeat 10 times.
  • Isometric extension – Stand with your back to a wall. Place your elbow on the wall with your elbow at a right angle. Gently press against the wall with your elbow. You should be tightening your shoulder muscle without moving your body. Hold for 3 seconds, repeat X10.
  • Isometric lateral rotation – Stand sideways on, with your affected shoulder against the wall. Place your fist on the wall with your elbow at a right angle. Gently press against the wall with your fist without moving your body. Hold for 3 seconds, repeat 10 times.

Advanced

  • Stand holding a stick or pole. Gently lift your arm into the air, using your better arm and the stick to help. Do not push into pain. Repeat 10-30 times
  • Stand holding a stick or pole. Gently lift your arm into the air, using your better arm and the stick to help. Do not push into pain. Repeat 10-30 times Stand holding onto a stick or pole. Gently lift your shoulder out to the side. Do not push into pain. Repeat 10-30 times. Stand holding onto a stick or pole. Gently reach as far as possible backwards without leaning forwards. Use the stick to help. Do not push into pain. Repeat 10-30 times. Stand holding the stick with your elbows bent at a right angle. While keeping your elbows tucked in, rotate your hand away from your body. Do not push into pain. Repeat 10-30 times
  • Stand holding onto a stick or pole. Gently lift your shoulder out to the side. Do not push into pain. Repeat 10-30 times. Stand holding onto a stick or pole. Gently reach as far as possible backwards without leaning forwards. Use the stick to help. Do not push into pain. Repeat 10-30 times. Stand holding the stick with your elbows bent at a right angle. While keeping your elbows tucked in, rotate your hand away from your body. Do not push into pain. Repeat 10-30 times
  • Stand holding a stick or pole. Gently lift your arm into the air, using your better arm and the stick to help. Do not push into pain. Repeat 10-30 times Stand holding onto a stick or pole. Gently lift your shoulder out to the side. Do not push into pain. Repeat 10-30 times. Stand holding onto a stick or pole. Gently reach as far as possible backwards without leaning forwards. Use the stick to help. Do not push into pain. Repeat 10-30 times. Stand holding the stick with your elbows bent at a right angle. While keeping your elbows tucked in, rotate your hand away from your body. Do not push into pain. Repeat 10-30 times
  • Use heat treatment – use a warm hot water bottle, a wheat bag or the shower.
  • Your GP may give you an injection to settle the pain if severe Have physiotherapy
  • Have physiotherapy

What should I avoid?

Unfortunately osteoarthritis is a problem we will all have to deal with at some point in our lives. But if you keep yourself fit and active, correct your posture and keep your shoulder strong and flexible you can help to alleviate and manage your shoulder symptoms.

  • Making changes to the amount of overhead activities you do can ease the pain.
  • If the pain is persistent, physiotherapy will also help.
  • Physiotherapy
  • Painkillers can manage the symptoms, but seek advice from your GP or pharmacist before taking.
  • Your Physiotherapist or GP will give you an injection to settle the pain if severe
  • Surgery to remove the end of the collar bone may be considered if the pain is severe and does not improve with other management techniques

What should I avoid?

  • Avoid excessive overhead activities

As with frozen shoulder, bad posture is the main cause of referred pain in your shoulder and it can often be managed by merely improving your posture and keeping your neck moving. Here are some of the options involved:

  • Move your neck and shoulders within comfortable limits aiming to improve range of movement and strength
  • Exercises and stretches to keep the joints healthy and prevent nerves getting trapped or irritated
  • Pain relief as advised by your pharmacist or GP

What should I avoid?

  • As with frozen shoulder, bad posture is the main cause of referred pain in your shoulder and often can be managed by merely improving your posture and keeping your neck moving
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