Overview

Shoulder pain is common but it is rarely caused by arthritis. The shoulder is the most mobile joint in the body and can be affected by a number of conditions. The most likely cause for shoulder pain is related to the deep tendons of the shoulder, which will improve although can take several months to get better.

Shoulder pain usually responds very well to exercise therapy, and with a little guidance you can begin to rehabilitate your shoulder today. Find out more about your shoulder pain in the other sections for further help.

If you are not sure of the cause of your shoulder pain then click below to complete our Musculoskeletal Symptom Checker to learn about potential causes of your symptoms and the best ways to manage these in the Self Help section.

Non-Traumatic Shoulder Pain

Shoulder injuries can occur through several different ways. These do not always have to occur due to trauma such as a fall or injury playing sport.

Non-traumatic shoulder injuries could come about from doing more than normal for example moving house, housework, cleaning windows or gardening. They could also seemingly start from nothing, because of normal age-related changes or simply your genetic makeup.

Subacromial shoulder pain (also known as rotator cuff tendinopathy, rotator cuff related shoulder pain  or subacromial impingement syndrome) is the most common reason for shoulder pain.

The most common symptoms are pain in your shoulder or upper arm region, which gets worse when moving your arm above shoulder height or sleeping on the painful side at night. You might also feel a weakness in your arm and have reduced movement in your shoulder as well as some clicking.

It’s often due to degenerative changes (age related) in the rotator cuff tendons or as a sudden change in training load or activity. This could lead to changes in your tendon structure which leads to pain.

Investigations such as scans are not often required as this can be diagnosed by your physiotherapist and will often get better in time.

If you are really bothered by your pain, steroid injections can help although this is often not the first treatment used. Most people improve best with exercises to strengthen the muscles around the shoulder and some activity modification.

This leaflet provides information, answers and self-help strategies regarding shoulder subacromial pain.

Watch this short video explaining the benefits of a simple exercise treatment for subacromial shoulder pain followed by Exercise 1, Exercise 2 and Exercise 3 recommended by the UK’s leading shoulder physiotherapists and proven to reduce pain and improve your shoulder function. Alternatively, Click here for the rehabilitation exercise booklet demonstrating the same 3 exercises.

Explore a more comprehensive range of exercises which start at a more basic level and progress, recommended by our physiotherapists that you can carry out daily at home to improve pain and strength for subacromial shoulder pain. These include initial stage, early stage rehab, intermediate stage rehab, and advanced stage rehab.

Calcific tendinopathy is caused due to a build-up of calcium within the shoulder tendons. This does not always lead to any issues however it can cause pain and discomfort. It often starts without any form of injury and is described as a throbbing pain.

Eventually the body reabsorbs this so management is often using pain relief or anti-inflammatory medication. If the pain becomes too severe, steroid injections, can be effective in managing this. in rare cases, surgery may be required if there are large calcium deposits present that do not reabsorb over time. Doing some gentle exercises can help keep the shoulder moving and preventing other issues arising.

Explore a more comprehensive range of exercises which start at a more basic level and progress, recommended by our physiotherapists that you can carry out daily at home to improve pain and strength for calcific tendiopathy. These include initial stage, early stage rehab, intermediate stage rehab, and advanced stage rehab.

Osteoarthritis is a wear and repair process which can affect the shoulder as well as many other joints. This can be due to normal age-related changes or can occur after a previous injury such as a fracture of the upper arm or dislocation. It can also be more common if you have a family history of it or are overweight.

It is caused by changes in the cartilage (smooth surfaces) of the joints which wear and become rough and the space in the joint reduces. This can also cause inflammation in the joint and then when we move cause pain.

If you are over 45 years old and experience a deep ache over your shoulder and upper arm which is worse with certain movements with grinding, clicking or crunching you may have an arthritic shoulder.

Osteoarthritis can either effect the ball and socket joint or the acromio-clavicular joint (ACJ). Depending on where you feel the pain could help to diagnose your shoulder issue. If the pain is around the upper arm and the arm feels stiff to move particularly first thing in the morning it could be the shoulder joint. If the pain is more at the top of the shoulder, with pain around the end of the collar bone or radiating up to the neck, it could be as a result of the ACJ.

If your pain is severe, a steroid injection may help ease it. Exercise therapy is extremely beneficial in the long-term to manage your pain and improve/maintain function.

Click Here for further information on Osteoarthritis and ways to manage it effectively.

Explore some simple exercises recommended by our physiotherapists that you can carry out daily at home to improve pain and stiffness for shoulder osteoarthritis. These include early stage rehab, intermediate stage rehab, and advanced stage rehab.

Some people can be born with loose or unstable shoulders, usually affecting both sides, where they can sometimes voluntarily make their shoulders partially or fully come out of their socket. This usually affects younger people, especially teenagers, who are also going through a number of hormonal changes which can exacerbate the shoulder problem. They may also have extra movement in other joints or have already been diagnosed with joint Hypermobility Syndrome.

Avoiding making the shoulder pop out of the socket, where possible, will help although often physiotherapy will be required to improve movement patterns, muscle strength and control of the shoulder with rehabilitation exercises if the condition is causing pain and functional problems.

Surgery is rarely an option for this type of shoulder instability and usually improves with physiotherapy rehabilitation including a good exercise programme.

Explore a more comprehensive range of exercises which start at a more basic level and progress, recommended by our physiotherapists that you can carry out daily at home to improve pain and strength for non-traumatic instability shoulder pain. These include early stage rehab, intermediate stage rehab, and advanced stage rehab.

Acromioclavicular joint pain (ACJ) occurs where your collar bone (clavicle) meets the shoulder blade (scapula). This can often be pinpoint location of where you experience pain. ACJ pain can occur from a range of factors such as osteoarthritis, lots of activities which require your arm to be above your head or through injury/trauma to the area. If this is as a result of a fall you may need to visit your physiotherapist, GP or A&E to determine there is no serious injury.

Symptoms include pain and tenderness at the top of the shoulder and pain when reaching the arm across the body, reaching up high and reaching behind your back. Simple pain relief and ice can be helpful at reducing pain as well as exercise therapy.

Steroid injections can help to ease the pain. Range of movement and strengthening exercises will improve the strength and mobility of the shoulder.

Explore a more comprehensive 4-stage exercise rehabilitation programme recommended by our physiotherapists that you can carry out daily at home to improve pain and strength for ACJ pain. These include initial stage, early stage rehab, intermediate stage rehab, and advanced stage rehab.

Frozen shoulder, also known as ‘adhesive capsulitis’, is a common condition where the shoulder becomes stiff and painful. Frozen shoulder can be characterised as either primary or secondary frozen shoulder.

A primary frozen shoulder occurs usually for no apparent reason and can be impacted based on your age or medical conditions you have. A secondary frozen shoulder often occurs following surgery or shoulder injury. The typical age range for this is between 35-65 years of age with most people being in their fifties.

The cause of frozen shoulder is currently unknown although it is widely believed that the restriction in movement is caused by inflammation, tightening and thickening of the lining of the shoulder joint, called the capsule. There are a number of health conditions which can increase the risk of developing a frozen shoulder such as Parkinson’s disease, diabetes and hypothyroidism.

Although the condition will get better in most cases, even without any treatment, it can take 2-3 years to fully resolve. There are three main phases of frozen shoulder.

  1. Freezing stage (lasting two to nine months)
  2. Frozen Stage (lasting four to twelve months)
  3. Thawing Stage (which lasts from five to twenty-six months)

Steroid injections can be useful in the early stages of the condition where pain is the main limiting factor and impacting upon your quality of life and sleep. These are less effective in stages 2 and 3 of a frozen shoulder.

Watch this useful short animated video explaining the condition including symptoms, duration and treatment options.

Explore a more comprehensive range of exercises which start at a more basic level and progress, recommended by our physiotherapists that you can carry out daily at home to improve pain and stiffness for frozen shoulder, especially in the Frozen and Thawing Stage. These include early stage rehab, intermediate stage rehab, and advanced stage rehab.

Traumatic Shoulder Pain

A traumatic shoulder injury generally occurs following a fall or sporting injury where sudden pain/discomfort is felt immediately. Some of the common reasons are detailed below.

A shoulder dislocation is when your upper arm fully pops out of the socket, whereas a shoulder subluxation is when it partially and temporarily ‘slips’ out of the socket.

A shoulder dislocation can occur if you fall on to your arm heavily, especially in older people. Most people dislocate their shoulder while playing a contact sport, such as rugby, or in a sports-related accident.

The following symptoms following an injury, suggest you might have dislocated your shoulder:

  • shoulder will suddenly look square rather than round
  • unable to move your arm and it will be very painful
  • see a lump or bulge (the top of the arm bone) under the skin in front of your shoulder

If you think you’ve dislocated your shoulder, go to your nearest A&E department. Click Here for more information on how a shoulder dislocation is diagnosed and treated.

Following a dislocation, you may feel that your shoulder feels unstable or you then go on to have recurrent dislocations. Chronic shoulder instability is often treated without surgery involving physiotherapy and activity modification.

The exercises below demonstrate a comprehensive exercise rehabilitation programme recommended by our physiotherapists that you can carry out daily at home to improve pain, strength and stability following a confirmed shoulder dislocation or subluxation at appropriate time intervals.

Rotator cuff tears can be a common form of shoulder pain and weakness and can occur in a wide range of people at different ages and levels of fitness and health. They can also be common findings in shoulders without pain.

The rotator cuff is a group of 4 muscles located around your shoulder that are involved in lifting and rotational movements of the shoulder. Injuries or tears to these muscles and their associated tendons are common throughout different stages of life and normally classified as either degenerative or traumatic.

Degenerative tears are usually more longstanding and build up over time.  These can also be influenced by things such as ageing, lifestyle factors and general health. Whereas traumatic tears of the rotator cuff are more sudden and usually occur through a specific injury, such as a fall or sports.

Tears of the rotator cuff vary in shape and sizeSmaller degenerative tears are usually managed in the same way as another common shoulder problem called Subacromial Shoulder Pain – Click Here for more information and exercises on how to manage this condition.

Larger tears, both degenerative or traumatic, often cause more weakness of the shoulder although not necessarily more pain. Management of a large rotator cuff tear will depend on a variety of factors, such as age, functional level, type of tear and pain levels. Only a small percentage of people with this type of injury will need scans or specialist referral, and most can be well managed with physiotherapy and rehabilitation.

Click Here for our information leaflet, which details more about this injury and has some basic exercises that may help with managing your symptoms. You can also see the Anterior Deltoid Programme which a progressive exercise programme is used by our physiotherapists to help gradually re-strengthen the shoulder and improve function following a large rotator cuff tear.

Proximal humeral fractures occur because of a fall onto the shoulder or arm. They can become more common as we get older, and our bones become weaker. Common symptoms of this are severe pain, swelling and a difficulty in moving the arm.

If you think you’ve fractured your arm, go to your nearest A&E department right away.

They are often treated conservatively (without surgery) and you will be put in a sling and you will likely need physio once it has healed to try and regain the function in your arm.

Fracturing your clavicle (collar bone) is often because of a direct trauma to the area either through fall or sporting injury. Common symptoms of this are severe pain, swelling, visible deformity and a difficulty in moving the arm.

If you think you’ve fractured your arm, go to your nearest A&E department right away.

Treatment varies from conservative (without surgery) or surgical management depending on the severity of the fracture. Your consultant should advise what you can or cannot do and if you should be referred to physiotherapy.

Post-Operative Information

If you have had surgery on your shoulder, it is important to check your surgeon has sent the operation note and post op protocol to your physio. This is because each surgery and surgeon can have a specific protocol they would like to follow.

There are some key features you need to look out for and be aware of in your recovery from surgery.

If you are due to have surgery on your shoulder, then there is some useful information of what you can do pre-op.

More information can be found here

Analgesia (Pain Relief) and Rehabilitation

In order for day-to-day activity to become more bearable and for your rehabilitation to be more manageable, you may be advised to trial taking pain relief.

More information on this can be found here. 

Self help

Evidence has shown that people who understand their Musculoskeletal health problem and take an active involvement to help themselves have a much better outcome.

Here are some really helpful leaflets, videos, exercises and useful links to other websites that have been approved by our physiotherapists so that you can start getting better today.

This information is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment if required. All content is for general information purposes only.

Click Here to access our getUBetter app, which is an easy, safe and effective way to support your recovery.

Leaflets

Shoulder Subacromial Pain
Frozen Shoulder
Source: Chartered Society Of Physiotherapy

Videos

Subacromial Shoulder Pain
PlayPlay

Excellent short video explaining a simple exercise treatment for Subacromial Shoulder Pain recommended by the UK’s leading shoulder physiotherapists and proven to reduce pain and improve your shoulder function
Source: British Elbow and Shoulder Society

Exercise 1 for Subacromial Shoulder Pain – Wall slides
PlayPlay

Exercise 1 for Subacromial Shoulder Pain – Wall slides
Source: British Elbow and Shoulder Society

Exercise 2 for Subacromial Shoulder Pain – Push-ups against the wall
PlayPlay

Exercise 2 for Subacromial Shoulder Pain – Push-ups against the wall
Source: British Elbow and Shoulder Society

Exercise 3 for Subacromial Shoulder Pain – Shoulder rotation
PlayPlay

Exercise 3 for Subacromial Shoulder Pain – Shoulder rotation
Source: British Elbow and Shoulder Society

Frozen Shoulder (Adhesive Capsulitis), Animation. - copy
PlayPlay

Useful short animated video explaining frozen shoulder including symptoms, duration and treatment options
Source: Alila Medical Media

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Exercises

Source: British Elbow and Shoulder Society
Shoulder Exercises: Isometric – Strengthening Patient Exercise Sheet
Shoulder Exercises: Early Stage – Strengthening Patient Exercise Sheet
Shoulder Exercises: Intermediate Stage – Strengthening Patient Exercise Sheet
Shoulder Exercises: Advanced Stage – Strengthening Patient Exercise Sheet
Shoulder Exercises: Early Stage – Unstable Patient Exercise Sheet
Shoulder Exercises: Early Stage – Unstable Patient Exercise Sheet
Shoulder Exercises: Advanced Stage – Unstable Patient Exercise Sheet
Anterior Deltoid Programme
Shoulder Exercises: Advanced Range of Movement – Patient Exercise Sheet
Shoulder Exercises: Intermediate Range of Movement – Patient Exercise Sheet
Shoulder Exercises: Early Range of Movement – Patient Exercise Sheet

Useful Links

  • Information and exercise videos for the most common cause of shoulder problems – Subacromial shoulder pain, produced by leading shoulder surgeons and physiotherapist in the UK.
  • Excellent website on common shoulder disorders Including an interactive guide to help diagnose your shoulder problem and treatments that might be needed.
  • Further information on Frozen shoulder including the ‘do’s and don’ts’ to ease pain from frozen shoulder yourself as well as when to seek medical advice and other treatments
  • Useful additional information on subacromial shoulder pain, also known as Shoulder impingement , including symptoms, causes, when to get help and treatment options

Further Support

If your shoulder pain is still not improving despite following the advice and guidance provided on the website and you score a ‘Medium’ or ‘High Risk’ when completing the Is my shoulder pain likely to persist?, you may require further help and support from the Physiotherapy Service. Please click on the ‘Physiotherapy Self-Referral’ box to refer yourself to the service for further management of your back problem.

Remember that most causes of shoulder pain are not due to anything serious, although there are rare cases where you would need to seek urgent medical help. Contact your GP or NHS 111 for immediate advice if you have any of the following symptoms:

  • Nerve like pain in your arm and hand with pins and needles, numbness, coldness, cramp
  • Previous history of cancer, constant unremitting pain, severe night pain, unexplained weight loss, unexplained lumps
  • Early morning stiffness lasting more than 45 minutes, rapidly worsening pain and stiffness, your shoulder feels warm to touch and you are suffering from fatigue
  • History of recent surgery or a recent open wound. Your shoulder feels hot and swollen and you feel unwell with possible fever and chills.
  • Trauma with sudden pain and weakness or sudden deformity and loss of movement

Click here for further support and guidance.

FAQs


If you find it easy.If you can complete your whole program without challenge. If you do not have any flare ups.

Progress - Increase the weight and/or increase the repetitions. If you have only recently progressed. If you feel there is still a challenge, but your pain does not worsen.

Maintain - You might need a bit longer doing what you’re doing. If you find it too difficult. If your pain is worsening. If you lose good technique/movement pattern.

Regress - Reduce the load. Reduce the repetitions. Reduce the depth/angle of the movement(s).


 

It is okay to push into some discomfort during your exercise programme. This is because we are pushing the muscles and soft tissues to adapt to a new stress or strain. Aim to avoid causing pain that does not settle back to baseline within 24 hours. Pain does not mean you have caused damage; it is often your body letting you know that you have challenged it.

When exercising with an injury, it is often thought that pain equals harm. This is not necessarily true.We often use a 0-10 scale to grade how bad the pain is that you are experiencing.

This graphic shows this as a traffic light system.When you are completing your exercises consider how the pain feels.
0-3 or green is regarded as a safe zone and activity should continue.

4-5 or orange is an acceptable level of discomfort to be feeling when exercising and is safe to continue with and should settle within 24 hours of stopping.

6-10 or the red zone is seen as too much and you should think about modifying the exercise, reducing the weight being used or avoiding that exercise all together and trying again the next day.

Staying active during injury will not do harm, it is important to be aware of what is considered reasonable. If the worsening pain persists for a few days after exercise please consult your physiotherapist or healthcare professional.

Flare ups of pain are a common part of the recovery process. Be reassured, this is a temporary increase in pain that will often improve with rest and by gradually resuming your activities. Using ice packs or a warm pack can help to reduce pain and inflammation. Try these, covered in a thin towel for 15 minutes, a few times per day. Sometimes you may need pain relief to help your pain to settle. You should discuss this with your GP or pharmacist if you have any questions.
One of the most common questions we get asked is “Does getting pain when exercising mean I am causing damage?” For the most part, no it does not. This simple guide can be useful to determine what the safe level of pain is when doing your rehab. More information can be found here.
There is often not a single simple explanation for your shoulder pain, and findings on scans often reveal changes which are normal signs of ageing rather than the root cause of your pain.
For instance, degenerative changes in the rotator cuff tendons, cartilage damage and arthritis, are all often found when scanning individuals with no shoulder pain or weakness.
Shoulder pain is likely to be caused by a multitude of factors which can often be addressed with exercise.
Research has proven that exercise is often as effective as surgery for treating shoulder pain. However, exercise doesn’t just improve your pain, it does so much more:
  • Promotes healing
  • Strengthens your muscles and tendons
  • Increases your confidence and trust in your shoulder
  • Reduces your pain and fear to move
  • Builds your capacity and tolerance for activity
  • Helps you return to living a full and busy life once more

Tears of the rotator cuff are very common and are a normal part of the ageing process. Most rotator cuff tears do not cause any pain or problem.

The rotator cuff tendons are all connected to create a large broad flat structure around the top of your arm bone, rather like a blanket. So when one tendon is torn, you can picture it like a hole in this blanket. A hole in a blanket doesn’t mean a blanket becomes useless, and this is the same for a tear in your rotator cuff.

Exercises strengthen the rest of the blanket to compensate for this ‘hole’ and are very safe to do. Exercise will reduce your pain and fear as well as improve your function.