Shoulder pain: causes, treatment and symptoms

A shoulder that will not move properly, or that aches every time you reach for something, is hard to ignore. It can get in the way of dressing, driving, sleeping on one side, or simply lifting your arm above your head.

The good news is that most shoulder pain has a specific, identifiable cause, and once you know what that cause is, treating it becomes far more straightforward. This guide walks through the common causes, when to seek urgent help, and how an ultrasound scan gives you an answer, usually on the same visit.

01Your shoulder joint

Your shoulder is a ball-and-socket joint made up of three bones, the humerus (your upper arm bone), the clavicle (your collarbone) and the scapula (your shoulder blade), cushioned by cartilage and held together by your rotator cuff, four tendons that connect the surrounding muscles to the bone.

That arrangement is what gives your shoulder its exceptional range of motion: reaching forwards, backwards and overhead, and rotating your arm in almost any direction. It also means there is a lot that can go wrong, from a strained tendon to a joint that has simply worn with age.

02Common causes of shoulder pain

Shoulder pain has many possible causes, and the right treatment depends entirely on which one applies to you. The most common include:

• Bursitis, inflammation of the bursa, the fluid-filled cushioning sac in the joint, often from repetitive movement or injury.
• Tendinitis, inflammation of the rotator cuff tendons, which can develop gradually or after an injury.
• Rotator cuff tear, damage to one of the four rotator cuff tendons from overuse, ageing or injury, often felt most at night.
• Impingement, the rotator cuff tendons becoming pinched between the shoulder bones, usually worse when lifting the arm overhead.
• Frozen shoulder, a stiffening of the joint capsule that severely restricts movement, often following a period of reduced use.
• Osteoarthritis, wear of the cartilage between the joint surfaces, causing pain and stiffness.
• Rheumatoid arthritis, an autoimmune condition that inflames the joint lining.
• Bone spurs, small bony growths that can catch on the rotator cuff and lead to tendinitis or a tear.
• Cartilage tear, a tear to the cartilage rim of the joint, sometimes causing catching, locking or grinding sensations.
• Dislocation or separation, the joint, or the acromioclavicular (AC) joint where the collarbone meets the shoulder blade, forced out of position by a fall or blow.
• Fracture, a broken collarbone or upper arm bone, usually from a fall or a direct hit.
• Referred pain, pain felt in the shoulder that actually originates elsewhere, such as the gallbladder or liver.

Most shoulder pain has a clear mechanical cause, and a scan usually settles the question in the same visit, inflammation, a tear, or something else entirely.

Dr Shayan Ahmed, consultant radiologist

03How shoulder pain is diagnosed

Your specialist will start with a physical examination, checking the strength and flexibility of your shoulder through a series of movements, and ruling out pain that is actually coming from your neck or spine.

Where a closer look is useful, an ultrasound scan is usually the next step. It is a painless, non-invasive test that uses high-frequency sound waves to build a live picture of what is happening inside your shoulder. A scan can assess:

• The shoulder joint itself
• Your range of movement, and what is restricting it
• The tendons, muscles and ligaments around the joint
• Inflammation or fluid build-up
• Any lumps or abnormal growths
• Other findings that may need further investigation

04What to expect from your shoulder ultrasound

A shoulder ultrasound is painless and typically takes between 15 and 30 minutes. Your specialist doctor applies a clear, water-based gel and moves the probe over your shoulder, projecting live images of the joint, muscles and soft tissue onto a screen as they go.

There is no aftercare required, and you can go straight back to your day. Your doctor will usually be able to explain the findings, and often provide a working diagnosis, before you leave.

05Treating shoulder pain

Starting at home

For mild or recent shoulder pain, simple home measures are often enough:

• Ice, apply for 15 to 20 minutes, three to four times a day, always with a barrier between the ice and your skin.
• Rest, avoid the movements and activities that make the pain worse for a few days.
• Over-the-counter medication, non-steroidal anti-inflammatories (NSAIDs) can reduce pain and swelling.
• Compression. An elastic bandage can help control swelling.

When you need more help

If home measures are not enough, or the cause needs specific treatment, your options may include:

• Physical or occupational therapy, for rehabilitation, especially after an injury or surgery.
• A sling, to immobilise the shoulder while a dislocation, separation or fracture heals.
• Medication, including a corticosteroid injection directly into the shoulder for more persistent inflammation.
• Surgery, considered for cartilage tears, rotator cuff injuries or a frozen shoulder that has not responded to other treatment.

Whatever the cause, exercises to rebuild strength, flexibility and range of motion are usually part of the recovery, and getting the diagnosis right first is what makes that plan effective.

06What happens next

You do not need a GP referral to book a shoulder ultrasound with us. You can book directly, usually with a same-day or next-day appointment. Your results and images are explained to you in the room and published to your secure patient portal, usually the same day.

Do not let shoulder pain hold you back. Understanding what is causing it is the first step towards treating it properly. Book your scan today.