Shoulder pain is common and can result from problems involving the muscles, tendons, joints, bursae, or nerves around the shoulder.
The shoulder is one of the most mobile joints in the body. This allows you to reach, lift, push, pull, and rotate your arm, but it also means the shoulder can be vulnerable to injury, irritation, and overuse.
Shoulder pain can be temporary or persistent and may interfere with:
- Dressing
- Reaching overhead
- Sleeping
- Driving
- Lifting
- Work
- Exercise
- Household activities
What Does Shoulder Pain Feel Like?
Symptoms may include:
- Aching
- Sharp pain
- Burning discomfort
- Stiffness
- Weakness
- Tenderness
- Pain when lifting the arm
- Pain when reaching behind the back
- Pain at night
- Difficulty sleeping on the affected side
- Reduced range of motion
- Clicking or catching sensations
The location and type of pain can provide clues about what may be causing it.
What Can Cause Shoulder Pain?
Common causes include:
- Rotator cuff tendinopathy
- Rotator cuff tears
- Bursitis
- Frozen shoulder
- Osteoarthritis
- Shoulder impingement
- Muscle strain
- Overuse
- Previous injury
- Shoulder instability
- Referred pain from the neck
Not every shoulder problem is caused by the shoulder joint itself.
Pain from cervical radiculopathy, for example, may travel from the neck into the shoulder or arm.
Rotator Cuff Problems
The rotator cuff is a group of muscles and tendons that help stabilize and move the shoulder.
Rotator cuff problems may include:
- Tendon irritation
- Tendinopathy
- Partial tears
- Full-thickness tears
Symptoms may include:
- Pain when raising the arm
- Pain when reaching overhead
- Weakness
- Night pain
- Difficulty lifting objects
- Pain when lying on the affected shoulder
Rotator cuff changes become more common with age, but not every tear causes severe symptoms.
Shoulder Bursitis
A bursa is a small fluid-filled sac that helps reduce friction around a joint.
When the bursa around the shoulder becomes irritated, symptoms may include:
- Pain with movement
- Tenderness
- Pain when lifting the arm
- Discomfort when lying on the shoulder
Bursitis can occur alone or alongside rotator cuff problems.
Frozen Shoulder
Frozen shoulder, also called adhesive capsulitis, causes increasing pain and stiffness in the shoulder.
People may notice difficulty:
- Reaching overhead
- Reaching behind the back
- Dressing
- Combing hair
- Putting on a jacket
- Sleeping comfortably
The condition often progresses through stages and can take time to improve.
People with diabetes and certain other medical conditions may have a higher risk of developing frozen shoulder.
Shoulder Osteoarthritis
Osteoarthritis can affect the shoulder joint and may cause:
- Aching
- Stiffness
- Reduced range of motion
- Grinding or clicking
- Pain with movement
- Difficulty performing daily activities
Symptoms may gradually worsen over time.
Shoulder Impingement
Shoulder impingement is a term often used when tissues around the shoulder become irritated during certain movements.
Symptoms may include:
- Pain with overhead activity
- Pain when lifting the arm
- Night pain
- Weakness
- Difficulty reaching
The exact cause can vary, and evaluation should consider rotator cuff function, strength, movement patterns, and other possible causes.
How Is Shoulder Pain Evaluated?
A healthcare professional may ask about:
- When the pain began
- Whether there was an injury
- Where the pain is located
- Activities that make it worse
- Weakness
- Numbness or tingling
- Night pain
- Previous shoulder injuries
- Difficulty with daily activities
A physical examination may evaluate:
- Range of motion
- Strength
- Tenderness
- Shoulder stability
- Neck movement
- Nerve function
- Functional movement
Is Imaging Always Necessary?
Not every person with shoulder pain needs imaging.
Depending on symptoms, a healthcare professional may consider:
- X-rays
- Ultrasound
- MRI
Imaging may be more useful when there is concern for:
- Fracture
- Significant rotator cuff injury
- Arthritis
- Persistent symptoms
- Severe weakness
- Surgical planning
Imaging findings should be interpreted together with the patient’s symptoms and physical examination.
What Can Help Shoulder Pain?
Treatment depends on the cause but often begins with conservative care.
This may include:
- Activity modification
- Exercise
- Physical therapy
- Heat or cold
- Non-opioid medications
- Gradual return to activity
The goal is usually to improve both pain and function.
Keep the Shoulder Moving
Complete inactivity may contribute to stiffness.
For many shoulder conditions, gentle movement is important.
However, activities that cause severe or persistent worsening of symptoms may need to be temporarily modified.
The goal is to maintain as much safe movement as possible without repeatedly aggravating the condition.
Physical Therapy
Physical therapy may help improve:
- Range of motion
- Shoulder strength
- Rotator cuff function
- Scapular strength
- Posture
- Movement patterns
- Return to work or exercise
A physical therapist can provide an individualized program based on the underlying problem.
Exercise
Appropriate exercises may include:
- Range-of-motion exercises
- Rotator cuff strengthening
- Shoulder blade strengthening
- Gentle stretching
- Postural exercises
- Gradual resistance training
There is no single exercise program that is appropriate for every shoulder problem.
Exercises should be tailored to symptoms, strength, mobility, and medical history.
Heat and Cold
Heat
Heat may help:
- Reduce stiffness
- Relax surrounding muscles
- Make movement more comfortable
Cold
Cold may help temporarily reduce:
- Pain
- Swelling
- Discomfort after activity
Protect the skin and avoid placing extreme temperatures directly on the body.
What About Medication?
Medication may be used as one part of a broader treatment plan.
Depending on symptoms and medical history, a healthcare professional may discuss:
- Acetaminophen
- Topical NSAIDs
- Oral NSAIDs
- Other non-opioid pain medications
NSAIDs may not be appropriate for everyone.
Additional caution may be needed in people with:
- Kidney disease
- Heart disease
- High blood pressure
- History of stomach ulcers
- Gastrointestinal bleeding
- Certain medication interactions
Discuss medication risks and benefits with your healthcare professional.
Shoulder Injections
For some patients, a healthcare professional may consider an injection.
These may sometimes be used for conditions such as:
- Bursitis
- Rotator cuff-related pain
- Frozen shoulder
- Arthritis
Injections may provide temporary relief for some people but are not appropriate for everyone.
Discuss:
- Potential benefits
- Risks
- Expected duration of relief
- Alternatives
- Whether rehabilitation should be combined with the injection
What About Opioids?
Opioids are generally not a first-line treatment for most chronic shoulder pain.
Treatment usually emphasizes:
- Exercise
- Rehabilitation
- Activity modification
- Non-opioid medication
- Treatment of the underlying condition
Opioids can carry risks including:
- Sedation
- Constipation
- Falls
- Physical dependence
- Opioid use disorder
- Respiratory depression
- Overdose
When Is Surgery Considered?
Surgery may be considered when:
- There is a significant traumatic injury
- Severe weakness persists
- A major rotator cuff tear is present
- Pain and disability continue despite appropriate conservative treatment
- Severe arthritis significantly limits function
The decision depends on:
- Symptoms
- Strength
- Function
- Imaging
- Age
- Activity level
- Overall health
- Personal goals
Focus on Function
Pain intensity alone does not show the full impact of shoulder pain.
Consider whether treatment helps you:
- Reach overhead
- Dress independently
- Sleep better
- Lift objects
- Drive
- Perform household tasks
- Return to exercise
- Work more comfortably
- Use your arm with greater confidence
Functional improvement can be an important sign of progress.
Questions to Ask Your Healthcare Professional
Consider asking:
- What may be causing my shoulder pain?
- Is the pain coming from my shoulder or my neck?
- Do I need imaging?
- Would physical therapy help?
- What exercises are safe?
- Should I avoid certain activities temporarily?
- Would an injection be appropriate?
- How can I improve my sleep if shoulder pain is worse at night?
- When should I see an orthopedic specialist?
- What functional goals should I track?
When Should You Seek Medical Attention?
Contact a healthcare professional if:
- Shoulder pain persists or worsens
- You develop increasing weakness
- You cannot raise the arm normally
- Pain significantly limits daily activities
- Symptoms follow an injury
- Night pain becomes persistent
Seek prompt or urgent evaluation if:
- The shoulder appears visibly deformed
- You cannot move the arm after a significant injury
- Severe swelling develops
- The shoulder becomes red, hot, and very painful
- Pain occurs with fever
- New numbness or weakness develops in the arm
- There are signs of circulation problems in the arm or hand
Shoulder Pain Can Sometimes Come From Somewhere Else
Not all shoulder pain comes from the shoulder.
Seek urgent medical attention if shoulder or arm discomfort occurs with symptoms such as:
- Chest pressure or chest pain
- Shortness of breath
- Sweating
- Nausea
- Dizziness
- Pain spreading to the jaw, back, or arm
These symptoms may indicate a medical emergency.
Living Well With Shoulder Pain
Many shoulder conditions improve with conservative care.
Recovery often involves:
- Gradual movement
- Strengthening
- Improving range of motion
- Avoiding unnecessary inactivity
- Modifying aggravating activities
- Participating in rehabilitation
- Setting realistic functional goals
Instead of asking only:
“How much does my shoulder hurt?”
also consider:
“Am I able to reach, lift, sleep, and use my arm more comfortably?”
These functional changes can provide a better picture of whether treatment is helping.
