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Musculoskeletal Symptom

Shoulder pain

Shoulder pain is extremely common, affecting up to 26% of adults at any one time, and is the third most common musculoskeletal complaint seen in primary care. The shoulder is one of the most mobile joints in the body, which makes it particularly vulnerable to injury and overuse. Most shoulder pain responds well to physiotherapy, manual therapy and graded exercise.

What is Shoulder pain?

The shoulder is a complex joint involving the glenohumeral joint (ball and socket), the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic articulation — all of which need to work in coordination. This complexity means many different structures can be involved in shoulder pain.

Common causes of shoulder pain include rotator cuff disorders (tendinopathy, tears or impingement — accounting for the majority of presentations), frozen shoulder (adhesive capsulitis), acromioclavicular joint problems, biceps tendinopathy, and referred pain from the neck or thoracic spine.

Shoulder pain from rotator cuff disorders and impingement is often described as pain on the outer aspect of the shoulder, worsening with overhead movements and lying on the affected side at night.

Signs and symptoms

Shoulder pain symptoms vary by cause, but common presentations include:

  • Pain on the outer aspect of the shoulder — often worse with overhead movements, reaching behind the back, or lying on the affected side
  • Reduced range of movement — difficulty raising the arm fully or reaching across the body
  • Pain and stiffness that is worse at night, disturbing sleep
  • Weakness — difficulty lifting objects or performing overhead tasks
  • In frozen shoulder: progressive loss of movement in all directions, often with a characteristic pattern of restriction

How therapy can help

Most shoulder conditions respond well to conservative management:

  • Physiotherapy — the foundation of shoulder pain management. Specific exercise programmes addressing rotator cuff strength, scapular control and shoulder mechanics have strong evidence across all common shoulder conditions
  • Osteopathy and sports therapy — manual therapy to address joint restrictions, soft tissue tension and movement patterns
  • Massage therapy — particularly for shoulder pain with a significant muscle tension component (common in desk workers and those carrying stress in their shoulders)
  • Acupuncture — evidence for short-term pain relief in rotator cuff disorders and frozen shoulder
  • Shockwave therapy — specifically effective for calcific tendinopathy (calcium deposits in the rotator cuff)

Seeking help

A physiotherapist or GP is the appropriate first contact for most shoulder pain. Specific investigations (ultrasound, MRI) may be needed to clarify the diagnosis for surgical planning or steroid injection decisions. If shoulder pain follows significant trauma, involves severe weakness, or is associated with deformity, urgent medical assessment is indicated.

Therapies that may help with Shoulder pain

We don't currently have any therapies mapped to this condition.

Frequently asked questions

What is a frozen shoulder and how long does it last?

Frozen shoulder (adhesive capsulitis) involves progressive tightening of the joint capsule, causing pain and significant loss of movement in all directions. It typically progresses through three phases: freezing (painful, increasing restriction), frozen (less painful but restricted), and thawing (gradual improvement). The natural history is resolution within 1–3 years, though physiotherapy and steroid injections can significantly speed this.

Is rotator cuff injury serious?

This depends on the extent of the injury. Partial-thickness tears and tendinopathy typically respond well to physiotherapy. Full-thickness tears may require surgical assessment, particularly in younger, active people or those with significant weakness. A physiotherapist or orthopaedic surgeon can assess the appropriate management for your specific injury.

Why is my shoulder pain worse at night?

Night pain is very common in rotator cuff disorders and frozen shoulder. Lying on the affected shoulder compresses irritated tissues. Even lying on the unaffected side places the shoulder in a position that can tension the rotator cuff. A physiotherapist can advise on sleeping positions and pillows to reduce night pain.

Can shoulder pain be caused by referred pain from the neck?

Yes — the neck (cervical spine) and upper thoracic spine can refer pain into the shoulder and upper arm. If shoulder exercises do not improve the pain, or if neck stiffness and arm symptoms are also present, cervicogenic referral should be considered. A physiotherapist will assess both the neck and shoulder as part of a comprehensive evaluation.

When does shoulder pain require surgery?

Surgery is considered for full-thickness rotator cuff tears in appropriate candidates, persistent impingement that has not responded to physiotherapy and injection, acromioclavicular joint problems, and shoulder instability. Most shoulder pain does not require surgery and responds well to conservative management.