The most common causes of shoulder pain are problems of the rotator cuff tendons, disorders of the shoulder joint itself (frozen shoulder, arthritis), problems of the joint at the end of the collarbone, and pain referred from the neck [3]. Most people improve with simple measures such as changing activities, rest, physiotherapy and medication; recovery can take six months or longer [1][2]. See a doctor if the pain has not eased within two weeks, and seek emergency help without waiting if chest pain or breathlessness comes with it [1][6][7].
What causes shoulder pain?
The shoulder is not a single joint; several joints work together with tendons and muscles to give the arm a wide range of movement [2].
The four most common causes in primary care are rotator cuff disorders, disorders of the shoulder joint itself, disease of the joint between the collarbone and the shoulder blade (the acromioclavicular joint), and pain referred from the neck [3]. Injuries such as fractures and dislocations also cause shoulder pain; tumours, infection and nerve-related problems are much less common causes [2]. Sometimes pain felt in the shoulder does not come from the shoulder but from somewhere else, such as the neck, the heart or the diaphragm [3][5].
What can shoulder pain be a sign of?
How the pain began, which movements make it worse and what other symptoms come with it point towards the likely cause; the diagnosis itself is made by examination [1][2]. Rotator cuff problems, frozen shoulder, calcium deposits in the shoulder (calcific tendinitis), shoulder dislocation and a broken collarbone are covered in separate articles in this guide; only the distinguishing features are given below:
- Pain that is worse while using the arm or shoulder: suggests tendinitis, bursitis or impingement [1]. In rotator cuff problems the pain is felt at the front or side of the shoulder and can come on suddenly with lifting and reaching [4]
- Pain and stiffness that do not go away over months or years: suggest frozen shoulder or arthritis [1]. In frozen shoulder all movements are restricted, including those made for the person by someone else [3]
- Sudden, very bad pain, being unable to move the arm, sometimes a change in shape: suggest a dislocated shoulder, a broken bone (the arm or the collarbone) or a torn tendon [1]
- Pain on top of the shoulder, where the collarbone and the shoulder meet: suggests a problem of that joint, such as a dislocation or a ligament injury [1]
- Tingling, numbness or weakness in the arm; a feeling that the shoulder is clicking or locking: suggest that the shoulder joint is not holding in place (instability) [1]
Why does shoulder pain run down the arm?
In rotator cuff problems the pain can spread from the front of the shoulder to the side of the arm [4]. Another source of pain running into the arm is the neck: typically there is pain and tenderness in the lower neck and the area above the shoulder blade, the pain is referred to the shoulder and arm, and there may be tingling in the arm [3]. If there is tingling in the hand or arm as well as pain in the shoulder, the problem is likely to come from the neck [5].
Pain coming from the neck is assessed by the relevant specialty; its treatment is not the subject of this article.
Left shoulder, right shoulder and pain when breathing
The sources do not divide the causes by right or left shoulder; the distinction is made by how the pain began, which movements change it and what other symptoms come with it [1][2][3].
Left shoulder pain is often looked up out of worry about the heart; a shortage of blood supply to the heart muscle is one of the causes of pain felt in the shoulder that lie outside the shoulder [3]. According to the NHS, sudden pain or discomfort in the chest that does not go away; pain that spreads to the left or right arm, the neck, jaw, stomach or back; or chest pain together with sweating, feeling sick, light-headedness or shortness of breath can be signs of a heart attack and need emergency help straight away [6]. This is not an orthopaedic problem.
Pain that gets worse on breathing in may not come from the shoulder either. In inflammation of the lining of the lungs (pleurisy) there is sharp chest pain on breathing in; the pain may spread to the shoulders and back and may be worse when coughing or sneezing [7]. Pain referred from the diaphragm can also be felt in the shoulder [3]. These complaints are assessed not by orthopaedics but by the relevant specialties; emergency help is needed if there is difficulty breathing [7].
What helps shoulder pain at home?
The following measures usually need to be kept up for two weeks before the pain starts to ease [1]; the main ones are [1][5]:
- Not stopping use of the shoulder completely, and moving it gently; a balance between rest and activity helps to stop the shoulder getting stiff
- Avoiding the things that seem to make the pain worse
- Pain relief so that you can keep moving: a pharmacist or doctor can advise which option, tablets or a cream or gel, is suitable; it should not be used for more than two weeks without medical advice
- Heat or cold: after a minor injury, or if the shoulder is swollen and warm, ice wrapped in a damp towel for no longer than 20 minutes; for most other pain, heat
- Posture: standing up straight with the shoulders down and gently back; not slouching when sitting
Exercise and night pain
The NHS advises trying shoulder exercises for 6 to 8 weeks to stop the pain returning, and not making up strenuous exercises of your own [1]. Which exercise is suitable depends on the problem; a physiotherapist puts together a programme designed for it [5]. If there is sudden or sharp pain during an exercise, it should be stopped [5].
The evidence is limited: according to a BMJ review from 2005, the evidence for the treatments commonly used in primary care is relatively weak; physiotherapy incorporating supervised exercise and steroid injections give similar short-term benefit [3].
As rotator cuff problems progress, night pain can become severe and disturb sleep [4]. If the shoulder is painful when lying down, the following can be tried [5]:
- Lying on the good side with a pillow under the neck
- Supporting the painful arm with a folded pillow in front of the body
- Placing a pillow behind the back to avoid rolling onto the painful side
Which specialty sees it, and how is it assessed?
Shoulder pain is assessed by orthopaedics and traumatology. The doctor asks how and when the pain started and whether it has happened before; on examination they look for deformity, swelling and tenderness and check the range of movement and muscle strength [2].
When needed, an X-ray shows the bones, while MRI and ultrasound show the soft tissues; EMG may be requested to assess nerve function [2]. Structural changes can also be seen in people who have no symptoms; for this reason early imaging is not expected to add to treatment [3].
Why does shoulder pain not go away, and how long does it last?
Shoulder pain can take six months or longer to get better [1]. Persistence and recurrence are common; increasing age, female sex, severe or recurrent symptoms at presentation and neck pain alongside are associated with a poorer course [3].
Most people improve with simple measures such as changing activities, rest, physiotherapy and medication [2]. When measures at home are not enough, the doctor may suggest stronger medicines or an injection, physiotherapy or exercises to do at home [1]. For certain problems, such as recurring dislocations and some rotator cuff tears, surgery may be recommended [2].
When not to wait
See a doctor if the pain is getting worse or does not improve within two weeks, or if it has become very difficult to move the arm [1]. If there is chest pain that does not go away, pain spreading to the arm, neck or jaw, or chest pain together with sweating, feeling sick or shortness of breath, call emergency services immediately (112 in North Cyprus and Türkiye) [6]. Assessment without delay is also needed for [1][3]:
- Sudden or very severe shoulder pain
- Being unable to move the arm
- A change in the shape of the arm or shoulder, or marked swelling
- Tingling that does not go away, or loss of feeling
- The arm or shoulder being hot or cold to touch
- Pain that began after an injury or accident, such as a fall
- Severe pain in both shoulders at once
- Fever or feeling generally unwell
- An unexplained lump or swelling; shoulder pain in someone who has been diagnosed with cancer
Frequently asked questions
- Which doctor should I see for shoulder pain?
- Shoulder pain is assessed by a specialist in orthopaedics and traumatology, who asks how the pain began, checks range of movement and muscle strength and requests imaging if needed [2]. If chest pain or breathlessness comes with it, the problem is not orthopaedic and emergency help is needed [6][7].
- How can shoulder pain be eased at home?
- The advice is to keep using the shoulder gently rather than keeping it completely still, to avoid the things that make the pain worse, to use heat or cold and to take a painkiller recommended by a pharmacist or doctor; it usually takes two weeks for the pain to start to ease [1]. See a doctor if there is no improvement within two weeks [1].
- Can left shoulder pain come from the heart?
- It can; pain from the heart can also be felt in the shoulder [3]. If there is chest pain or pressure that does not go away, pain spreading to the arm, neck or jaw, or chest pain together with sweating, feeling sick or shortness of breath, it may be a heart attack; call emergency services immediately [6].
- Why does my shoulder hurt when I breathe in?
- In inflammation of the lining of the lungs (pleurisy), the sharp chest pain that comes on with breathing in can spread to the shoulders and back [7]. This is not an orthopaedic problem; emergency help is needed if there is difficulty breathing [7].
- How should I lie when my shoulder hurts at night?
- As rotator cuff problems progress, night pain can become severe [4]. Lying on the good side, supporting the painful arm with a folded pillow in front of the body and placing a pillow behind the back to avoid rolling onto the painful side can be tried [5].
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Shoulder pain. NHS (nhs.uk), 2023. nhs.uk
- Shoulder Pain and Common Shoulder Problems. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Shoulder pain: diagnosis and management in primary care. BMJ (Mitchell C, et al.), 2005. pubmed.ncbi.nlm.nih.gov
- Shoulder Impingement/Rotator Cuff Tendinitis. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Shoulder pain (information booklet VA2039). Versus Arthritis (copy hosted by Belfast Health and Social Care Trust), 2020. belfasttrust.hscni.net
- Chest pain. NHS (nhs.uk), 2023. nhs.uk
- Pleurisy. NHS (nhs.uk), 2026. nhs.uk
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
More in this area
- Bursitis: what is it, what causes it? Elbow bursitis, symptoms and treatment
- Broken collarbone (clavicle fracture): sling or surgery?
- Frozen shoulder: how long does it last, and when are injections or surgery considered?
- Shoulder pain and rotator cuff problems: is surgery needed?
- Calcific tendinitis of the shoulder: why it happens and how it is treated
- Dislocated shoulder: what happens after it is put back, and is surgery needed?
- Tendinitis (tendon inflammation): what causes it and what helps it settle?
- Tennis elbow: what do steroid injections, PRP and surgery add?