Shoulder Pain: Symptoms, Causes and Treatment

Shoulder pain is a frequent complaint, affecting people of all ages and activity levels. Whether it’s a sudden discomfort after lifting something heavy, or a nagging ache that disrupts sleep, understanding shoulder pain is crucial for both prevention and effective management. This article explores the symptoms, causes, and treatment options for shoulder pain, empowering you with the knowledge to make informed decisions about your health.

Symptoms of Shoulder Pain

Shoulder pain presents in various ways, often making it challenging to distinguish the underlying cause. Recognizing the symptoms is the first step toward proper care and recovery.

Location	Triggers	Associated Signs	Sources
Front/Upper Arm	Arm Movement	Night Pain	1, 5
Top/Lateral	Overhead Activity	Full Passive ROM	5
Anterior	Forward Elevation	Localized Tenderness	4
Radiating	Neck Problems	Tingling in Fingers	1

Table 1: Key Symptoms

Common Patterns of Pain

Shoulder pain is most often felt in the front of the shoulder or the upper arm. It typically becomes noticeable when moving the arm, especially during activities like reaching overhead, lifting, or performing rotational movements. Importantly, most shoulder issues do not cause pain when the arm is at rest. However, pain can worsen at night, particularly when lying on the affected side, disrupting sleep and impacting quality of life 1 5.

Pain Triggers and Activity

• Overhead Movements: Activities such as lifting objects above the head, throwing, or even combing hair can provoke shoulder pain, especially in cases of subacromial impingement or rotator cuff problems 5.
• Specific Positions: Some people notice pain mainly during certain positions, like forward elevation or internal rotation of the arm. This is particularly true for less common conditions such as coracoid impingement 4.

Associated Signs

• Radiating Pain: If pain travels down the arm to the hand and is accompanied by tingling in the fingers, the source is more likely to be the neck (cervical spine) than the shoulder itself 1.
• Range of Motion (ROM): Most people with shoulder pain retain a full passive range of motion, meaning the joint can be moved through its normal range if someone else moves the arm for them. However, active movements—when you use your own muscles—are typically limited or painful 5.
• Night Pain: A hallmark of many shoulder problems, particularly those involving the rotator cuff or subacromial space, is pain that worsens at night 1 5.

Causes of Shoulder Pain

Understanding what leads to shoulder pain can help guide both prevention and treatment strategies. The shoulder is a complex joint, and a variety of structures—muscles, tendons, bursae, and bones—can be involved.

Primary Cause	Description	Frequency	Sources
Rotator Cuff Injury	Tendinopathy, tears, or inflammation	Very Common	2 3 5 6
Subacromial Impingement	Compression of rotator cuff/bursa	Very Common	2 5 6
Bursitis	Inflammation of the subacromial bursa	Common	5 6
Coracoid Impingement	Subscapularis tendon impingement	Uncommon	4
Referred Neck Pain	Nerve compression in the neck	Variable	1

Table 2: Main Causes of Shoulder Pain

Rotator Cuff and Subacromial Impingement

The most common source of shoulder pain is the rotator cuff, which consists of four muscles and their tendons that help stabilize and move the shoulder joint. Problems can range from tendinopathy (degenerative changes) and inflammation to partial or complete tears. These often lead to subacromial impingement, where the tendons or bursa get pinched under the acromion, the “roof” of the shoulder 2 3 5 6.

• Subacromial Impingement Syndrome (SIS): This umbrella term describes a cluster of symptoms stemming from mechanical compression of the rotator cuff or subacromial bursa. While SIS has been the dominant diagnostic label for decades, recent discussions suggest it’s more of a symptom cluster than a distinct anatomical diagnosis 6.

Bursitis

Inflammation of the subacromial bursa—a fluid-filled sac that reduces friction—can cause pain, especially during movement. Bursitis often coexists with rotator cuff pathology and presents with similar symptoms 5 6.

Coracoid Impingement

A less common but important cause is coracoid impingement, where the subscapularis tendon gets pinched between the coracoid process and the lesser tuberosity of the humerus. This typically results in localized anterior shoulder pain, especially with specific movements like forward elevation or internal rotation 4.

Referred Pain from the Neck

Shoulder pain that radiates beyond the shoulder—especially down to the hand—or is associated with tingling, is often a sign of cervical spine involvement. Here, nerve compression in the neck, rather than the shoulder itself, is the culprit 1.

Treatment of Shoulder Pain

Treating shoulder pain requires a tailored approach based on the underlying cause, symptom severity, and patient needs. Most cases improve with conservative measures, but persistent or severe symptoms may require further intervention.

Treatment	Effectiveness	Notes	Sources
Exercise Therapy	High for pain/function	Most evidence supports use	7 8 9 10
Manual Therapy	Moderate, esp. when combined	Short-term benefit	8 9
Medications	NSAIDs/corticosteroids effective	Symptom relief, not a cure	8
Acupuncture	Effective for chronic pain	Standard points as effective as tailored	11
Advanced Interventions	Surgery, injections	Reserved for refractory cases	2 4

Table 3: Treatment Approaches

Exercise Therapy and Physiotherapy

Therapeutic exercise is the cornerstone of shoulder pain management. Studies consistently show that targeted exercises not only reduce pain but also improve function and range of motion. Physiotherapy programs often include:

• Strengthening: Focused on the rotator cuff and scapular stabilizers.
• Stretching: To improve flexibility and restore normal joint mechanics.
• Motor Control: Emphasizing proper movement patterns and alignment 7 8 9 10.

A consensus among physiotherapists is that active exercise should be the primary intervention, with a limited number of well-chosen exercises performed in a controlled, pain-free range. Regular reassessment ensures ongoing progress and individualized care 9.

Manual Therapy

Manual therapy, such as joint mobilizations and soft tissue techniques, can provide added pain relief—particularly when combined with exercise. However, its benefits are typically short-term, making it an adjunct rather than a standalone treatment 8 9.

Medications

• NSAIDs: Nonsteroidal anti-inflammatory drugs offer short-term relief for pain and inflammation.
• Corticosteroid Injections: These can be more effective than placebo for reducing pain, especially when administered under ultrasound guidance 8.
• Other Modalities: Therapies like laser, taping, and extracorporeal shockwave therapy may provide additional benefit, but the quality of evidence is low 8.

Acupuncture

Acupuncture has shown promising results for chronic shoulder pain. Both individualized acupuncture and standard point protocols lead to significant improvement in pain and disability scores. This suggests acupuncture may be a useful adjunct to other conservative treatments 11.

Surgical and Advanced Interventions

Surgery and other advanced interventions, such as operative decompression for coracoid impingement, are generally reserved for cases unresponsive to conservative therapy. The majority of patients experience improvement with nonoperative measures 2 4.

Deeper Dive: Choosing the Right Treatment

When to Seek Medical Attention

• Severe pain or sudden loss of function
• Obvious deformity or swelling
• Pain that radiates down the arm with numbness or tingling (may indicate nerve involvement)
• Failure to improve after several weeks of conservative care

The Role of Imaging

Imaging (such as X-rays or MRI) is used selectively—mainly for traumatic injuries, suspected tendon tears, or when initial treatment fails 3.

The Importance of Self-Management

• Consistency: Adherence to exercise programs is key.
• Gradual Return: Activities should be reintroduced slowly to avoid re-injury.
• Lifestyle Modifications: Avoid aggravating movements and maintain good posture.

Conclusion

Shoulder pain is a multifaceted problem with a range of symptoms, causes, and treatments. Early recognition and evidence-based management can greatly improve outcomes.

Key Takeaways:

• Shoulder pain typically arises with movement, especially overhead activity, and is often worse at night 1 5.
• The most common causes are rotator cuff injuries and subacromial impingement, but other conditions and referred pain from the neck should be considered 2 3 4 5 6.
• Conservative treatments—particularly targeted exercise and physiotherapy—are highly effective for most people 7 8 9 10.
• Medications, manual therapy, acupuncture, and other modalities can provide additional relief in select cases 8 9 11.
• Surgery is rarely needed and reserved for persistent, severe, or structurally significant cases 2 4.
• Regular reassessment, patient education, and self-management are essential components of successful treatment.

By understanding your symptoms, identifying the likely causes, and following an evidence-based treatment plan, you can restore shoulder health and return to the activities you enjoy.