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Shoulder Pain and Injury

Why the shoulder hurts?
The shoulder is the most mobile joint in the body. That mobility comes at a cost: it relies heavily on muscles, tendons, and ligaments for stability. When any of these structures are overused, injured, or degenerate, pain follows.

Common causes

 

  • Rotator cuff tendinopathy/tears – Overuse or acute trauma to the supraspinatus, infraspinatus, teres minor, or subscapularis. Causes night pain, weakness lifting the arm, and painful arc between 60–120 degrees.

 

  • Frozen shoulder (adhesive capsulitis) – Thickening of the joint capsule leads to progressive stiffness and pain. Often idiopathic, but linked to diabetes, thyroid disorders, and prolonged immobilization.
     

  • Shoulder impingement syndrome – Rotator cuff tendons get pinched under the acromion during overhead movement. Classic in swimmers, painters, and cricketers.
     

  • Labral tears & SLAP lesions – The cartilage rim around the socket can tear from falls, heavy lifting, or overhead sports. Causes clicking, instability, and deep joint pain.
     

  • Shoulder instability/dislocations – Traumatic anterior dislocations are most common. Recurrent episodes damage the labrum and capsule, especially in patients under 25.
     

  • AC joint injuries – Falls onto the shoulder or outstretched hand sprain/separate the acromioclavicular joint. Pain at the top of the shoulder, worse with cross-body movement.
     

  • Osteoarthritis – Wear of the glenohumeral cartilage in older adults. Pain with motion, crepitus, and loss of rotation.
     

  • Referred pain – Cervical spine issues, gallbladder, or cardiac problems can mimic shoulder pain. A thorough history rules these out.

How to Diagnose?

  • Clinical Examination

Range of motion, strength testing, and special tests: Neer’s & Hawkins for impingement, apprehension test for instability, O’Brien’s for SLAP.

 

  • Imaging

X-ray first to assess bone alignment, arthritis, and calcific deposits. MRI or MR arthrogram for rotator cuff and labral tears. Ultrasound offers dynamic assessment of tendons.
 

  • Diagnostic injection

Lidocaine into the subacromial space or AC joint. Temporary pain relief confirms the source.

Non-surgical first for most cases

  • Activity modification – Avoid overhead loading and aggravating movements

  • NSAIDs & analgesics – Control inflammation and pain

  • Physiotherapy – The cornerstone. Scapular stabilization, rotator cuff strengthening, and capsular stretching restore mechanics. 6–12 weeks resolves 70–80% of tendinopathies and impingement.

  • Corticosteroid injections – For adhesive capsulitis or bursitis when pain limits rehab

  • PRP/Orthobiologics – Selected for partial-thickness cuff tears or chronic tendinopathy

Treatment Pathways
Recovery timeline
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RED FLAGS THAT NEED URGENT ATTENTION

Sudden severe pain after trauma, visible deformity, inability to move the arm, loss of sensation, or fever with swelling. These suggest fracture, acute dislocation, or septic arthritis and require immediate evaluation.

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Surgical options when conservative care fails

  • Arthroscopic rotator cuff repair – For full-thickness tears with weakness in patients wanting active function

  • Subacromial decompression – Removes bone spur and inflamed bursa in impingement

  • Labral repair & Bankart procedure – For recurrent dislocations and SLAP tears in young, active patients

  • Total shoulder replacement – Advanced arthritis with intact rotator cuff

  • Reverse shoulder replacement – Arthritis with massive cuff tears or failed prior surgery

  • Tendinopathy/impingement : 6–12 weeks of physio

  • Frozen shoulder : 12–18 months total, but pain improves in 3–4 months with stretching.

  • Rotator cuff repair : Sling 4–6 weeks, return to light work 3 months, full strength 6–12 months

  • Shoulder replacement : Hospital stay 1–2 days, regain function by 3–6 months

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