Shoulder pain

Medically reviewed by Dr. K. G. Gopalakrishna, Consultant Orthopaedic Surgeon · Last reviewed: August 2026

The shoulder has the greatest range of motion of any joint in the body, which comes at the cost of stability - it relies heavily on surrounding muscles and tendons rather than bone alone. That trade-off is exactly why shoulder pain is so common, and why identifying which structure is actually involved matters before deciding what to do about it.

What's actually there

The shoulder joint is a ball-and-socket connection between the upper arm bone (humerus) and a shallow socket on the shoulder blade. Four muscles and their tendons - together called the rotator cuff - wrap around the joint, holding the ball centered in the socket and powering arm-raising movements. Above the joint sits a bony arch, and a bursa (a small fluid-filled cushion) sits between the rotator cuff and this arch to reduce friction.

Common causes

• Wear-related: Rotator cuff tendons can thin and fray with age, sometimes tearing partially or fully without any specific injury. Osteoarthritis of the shoulder joint itself is less common than in the knee or hip but does occur.
• Injury-related: A fall onto an outstretched arm or a direct blow can dislocate the shoulder or tear the rotator cuff. Repeated overhead throwing or lifting can cause a sudden tear in a tendon that was already worn.
• Inflammatory or overuse: Shoulder impingement - where the rotator cuff gets pinched under the bony arch during overhead movement - is very common, especially with repetitive overhead activity. Frozen shoulder causes progressive stiffness and pain, often without any clear triggering injury.
• Referred pain: Neck problems can send pain into the shoulder and upper arm; heart-related pain can occasionally be felt in the left shoulder, which is why sudden unexplained shoulder pain with chest symptoms needs urgent attention.
• Gym and training-related: Overhead pressing, heavy bench pressing, and pull-ups place significant strain on the rotator cuff, especially with poor shoulder positioning or increasing weight before the joint is ready for it.

What it tends to feel like

Pain when lifting the arm overhead or reaching behind the back, especially with a specific painful arc partway through the movement, points toward impingement or a rotator cuff issue. Progressive stiffness where the shoulder simply won't move freely in any direction, even with someone else moving it for you, is the hallmark of frozen shoulder. Sudden, severe pain and an inability to move the arm after a fall suggests a dislocation or significant tear.

When to seek care urgently

• The shoulder appears visibly deformed after a fall or injury
• You cannot move the arm at all after an injury
• Sudden shoulder pain accompanied by chest pain, breathlessness, or sweating
• The joint is hot, red, and rapidly swelling with no clear injury

What's usually tried first

• Activity modification - avoiding the specific overhead or reaching movements that provoke pain
• Physiotherapy focused on rotator cuff strengthening and shoulder blade positioning, which resolves a large share of impingement cases
• Structured stretching for frozen shoulder, since it tends to improve slowly over months rather than quickly
• Anti-inflammatory medication for short-term flare-ups
• For impingement or frozen shoulder that isn't settling, a guided injection can meaningfully reduce pain and help physiotherapy progress

Myths vs facts

• Myth: A torn rotator cuff always needs surgery.
  Fact: Many partial tears, and even some full tears, improve significantly with physiotherapy alone. Surgery is considered when this doesn't work or the tear is large.
• Myth: Frozen shoulder means you should rest the arm completely until it loosens up.
  Fact: Complete rest tends to prolong frozen shoulder. Gentle, guided movement within tolerable limits generally helps it resolve faster than avoiding movement entirely.

When surgery enters the conversation

Most shoulder impingement and early rotator cuff issues improve with physiotherapy over several weeks to months. Surgery - usually keyhole arthroscopy - is considered for a significant full-thickness rotator cuff tear that hasn't responded to physiotherapy, a recurrent dislocation, or frozen shoulder that remains severely limiting despite months of structured treatment.

Recovery, broadly:

• Rotator cuff repair, weeks 1-6: arm protected in a sling, passive movement only, guided by a physiotherapist.
• Weeks 6-12: gradually increasing active movement and light strengthening.
• Months 3-6: building full strength, most people returning to normal activity by around 4-6 months depending on tear size and job demands.

Looking after your shoulder

• Keep the rotator cuff and shoulder blade muscles strong, even without existing pain
• Avoid sudden increases in overhead activity, whether at the gym or at work
• Take breaks during repetitive overhead tasks rather than pushing through discomfort
• Get a shoulder that's gradually stiffening checked early, since frozen shoulder is easier to manage before it becomes severely limited
• Keep shoulder blades set and avoid flaring elbows too wide on presses; build overhead and bench strength gradually rather than maxing out early
• Don't ignore a shoulder that keeps dislocating - repeated dislocations increase the risk of further damage each time

FAQs: questions worth asking your doctor