Common causes of shoulder pain

There are various reasons why shoulder pain, stiffness or weakness can occur. Treatment options for these will vary in relation to the different symptoms. Shoulder pain can range from an ache to a more severe sharp pain, where daily tasks such as brushing your hair or getting out the car are affected.

We explore some common causes of shoulder pain and what can be done to help ease the issue, from self-help to physio.

The NHS advise that “shoulder pain that does not improve after 2 weeks might be caused by something that needs treatment. But do not self-diagnose. See a GP if you're worried.”¹

Frozen shoulder

A frozen shoulder causes stiffness and pain and can last for months and even years. It isn’t clear as to why it happens, but it causes the tissues around the joint to tighten and shrink, resulting in pain.²

The two main symptoms are:

• pain in your shoulder which can be worse at night and disturbs sleep,
• stiffness in your shoulder which makes it difficult to move.²

Treatment depends on the severity of the pain and the ability to move the shoulder. Usually, regular pain relief would be advised in the first instance, along with moving your shoulder within ranges of discomfort, but avoiding moving to areas of sharp pain.

If this doesn’t ease the pain then:

• You should speak with your GP to discuss other forms of pain relief.
• Gentle exercises may be advised to try at home. If this doesn’t help then you might be referred to a physiotherapist.
• A physiotherapist would assess you and decide how many sessions would be needed, along with what type of exercises to undertake.

If this does not control the pain, you may be referred to a consultant to discuss other treatment options such as injections or surgical procedures.

Tendonitis

Tendonitis is when a tendon becomes inflamed after overuse or injury. It can affect how a tendon moves and cause joint pain and stiffness.³

The main symptoms of tendonitis are:

• pain in a tendon that gets worse when you move,
• difficulty moving the shoulder,
• feeling a grating or crackling sensation when you move the shoulder,
• swelling, sometimes with heat or redness.³

Similar to a frozen shoulder, over the counter painkillers would be advised first and in the case of it being a more severe pain then stronger pain relief would be prescribed by your GP.

Physiotherapy would be recommended if the pain is lasting a long time and is not eased by pain relief or you’re unable to freely move your shoulder.

Some people with severe tendonitis may be offered:

• Steroid injections, which may provide short-term pain relief.
• Surgery.³

Arthritis

Osteoarthritis and rheumatoid arthritis fall into this category, with both conditions resulting in pain and stiffness in the joints. Rheumatoid arthritis usually affects the hands, feet and wrists, though can also impact the shoulder.

Osteoarthritis – the severity of symptoms can vary from person-to-person, and between different affected joints. Symptoms can also range from being mild to more severe where everyday activities are made difficult.⁴

Rheumatoid arthritis – periods where symptoms become worse are known as flare-ups which can be difficult to predict. But with treatment, it's possible to decrease the number of flare-ups and minimise or prevent long-term damage to the joints.⁵

Both are long-term conditions that have no cure but symptoms can be managed with appropriate treatment.

• For osteoarthritis mild symptoms can be managed with regular exercise, and maintaining a healthy weight. More severe symptoms might be managed with pain relief and physiotherapy.
• For rheumatoid arthritis main treatment options include long-term medication to help relieve symptoms, physiotherapy and occupational therapy.⁶
• Surgery may be considered for both conditions where there are severe joint changes that significantly impact on your daily life and have not improved with other treatments.

How to help strengthen your shoulders

With any shoulder pain, you may be cautious to do exercise, in case it further aggravates your symptoms or causes harm. However, this is generally not the case and there is actually more evidence to show that you can make it worse if you stop using your shoulder completely.

This is particularly true for conditions like frozen shoulder, where the joint will stiffen and the muscles shorten, restricting your movement even further. Instead, try gentle exercises for 6 to 8 weeks to help resolve your symptoms.⁷

Exercising can help strengthen the shoulder muscles and prevent future injuries. Exercises can progress from using light weights to resistance bands and using your own body weight. Stretches can also be undertaken at home to help maximise your shoulder range of movement.⁹

The British Elbow and Shoulder Society have videos on their website of three exercises specifically for shoulder pain which they advise to undertake for 6 to 12 weeks. Build the exercises into your daily routine so you can do them most days. 1 rest day in the week is recommended.¹⁰

Shoulder pain can be the result of a number of causes – it can range from a condition as we age, be caused by an injury, or in some cases happen with no obvious cause at all. Most shoulder problems will improve with time, simple changes to lifestyle and appropriate exercises.¹¹

However, if your shoulder pain isn’t getting any better then speak to your GP who can assess you further and may refer you to a physiotherapist for treatment.

>For more on any muscle, bones or joint concerns then visit our musculoskeletal hub

References

1. Shoulder pain – NHS
2. Frozen shoulder – NHS
3. Tendonitis – NHS
4. Symptoms of osteoarthritis – NHS
5. Rheumatoid arthritis – NHS
6. Treating rheumatoid arthritis – NHS
7. How to ease shoulder pain yourself – NHS
8. Shoulder pain and how to treat it – Havard Medical School
9. How can I strengthen my shoulder? – Havard Medical School
10. Exercises for Shoulder Pain – British Elbow and Shoulder Society
11. Causes of shoulder pain – The Chartered Society of Physiotherapy