Shoulder Pain: Causes from Rotator Cuff to Frozen Shoulder

At-a-Glance

• Shoulder pain affects up to 26% of adults at any given time, making it one of the most common joint complaints
• Most common causes include rotator cuff problems, frozen shoulder, arthritis, and tendinitis
• Pain location (front, top, side, or back of shoulder) helps identify the underlying cause
• Many cases improve with rest, physical therapy, and targeted exercises
• Sudden severe pain after injury or pain with shortness of breath requires immediate evaluation

What It Feels Like

Shoulder pain can range from a dull ache deep in the joint to sharp, stabbing pain with movement. The shoulder's wide range of motion means pain can occur during many daily activities.

Common descriptions include:

• Deep, aching pain in the shoulder joint
• Sharp pain with overhead reaching or lifting
• Stiffness and reduced range of motion
• Pain radiating down the arm
• Weakness when lifting or rotating arm
• Pain that worsens at night, disrupting sleep
• Catching or popping sensations
• Inability to reach behind back or overhead

The pain may be constant or only occur with specific movements, and can significantly impact daily activities like dressing, reaching, or carrying objects.

Common Causes

Rotator Cuff Tendinitis and Tears

The rotator cuff is a group of four muscles and tendons that stabilize the shoulder. Inflammation (tendinitis) or tears can cause significant pain and weakness.

Signs it might be rotator cuff problems:

• Pain on top and outer side of shoulder
• Pain worsens with overhead activities
• Weakness when lifting arm to the side or rotating
• Pain at night, especially when lying on affected shoulder
• Difficulty reaching behind back
• Gradual onset (tendinitis) or sudden pain after injury (tear)
• Age over 40 (degenerative tears)

Risk factors:

• Repetitive overhead activities (painting, swimming, tennis)
• Age-related degeneration
• Poor posture
• Previous shoulder injury

What helps:

• Rest from aggravating activities
• Ice for acute pain
• NSAIDs for pain and inflammation
• Physical therapy (strengthening and stretching)
• Corticosteroid injections
• Surgery for complete tears or failed conservative treatment

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder causes progressive stiffness and pain, severely limiting shoulder movement. It typically develops in three stages over 1-3 years.

Signs it might be frozen shoulder:

• Gradual onset of pain and stiffness
• Severely limited range of motion in all directions
• Pain worsens at night
• Difficulty with daily activities (dressing, reaching)
• More common in people with diabetes, thyroid disorders
• Often affects ages 40-60
• More common in women

Three stages:

1. Freezing (2-9 months): Increasing pain and stiffness
2. Frozen (4-12 months): Pain may decrease but stiffness remains severe
3. Thawing (5-24 months): Gradual improvement in motion

What helps:

• Physical therapy (gentle stretching)
• NSAIDs for pain
• Corticosteroid injections
• Hydrodilatation (injecting fluid to stretch capsule)
• Manipulation under anesthesia in severe cases
• Patience—most cases eventually improve

Shoulder Impingement Syndrome

Impingement occurs when the rotator cuff tendons get pinched between bones during arm movement, causing pain and inflammation.

Signs it might be impingement:

• Pain when raising arm overhead
• Pain on outer side and front of shoulder
• Painful arc (pain between 60-120 degrees of arm elevation)
• Weakness with overhead activities
• Pain reaching behind back
• Night pain

What helps:

• Avoid overhead activities temporarily
• Ice after activities
• NSAIDs
• Physical therapy (posture correction, strengthening)
• Corticosteroid injections
• Surgery (subacromial decompression) if conservative treatment fails

Shoulder Arthritis

Osteoarthritis or rheumatoid arthritis can affect the shoulder joint, causing pain, stiffness, and reduced motion.

Signs it might be arthritis:

• Deep, aching pain in the joint
• Stiffness, especially in the morning
• Grinding, clicking, or popping sensations (crepitus)
• Pain worsens with activity
• Reduced range of motion
• Swelling (more common with rheumatoid arthritis)
• History of previous shoulder injury (post-traumatic arthritis)

What helps:

• NSAIDs or acetaminophen
• Physical therapy
• Heat for stiffness, ice for inflammation
• Activity modification
• Corticosteroid injections
• Shoulder replacement in severe cases

Bursitis

Bursae are fluid-filled sacs that cushion the shoulder. Inflammation (bursitis) often occurs alongside rotator cuff problems.

Signs it might be bursitis:

• Pain on outer side of shoulder
• Swelling and warmth
• Pain worsens with overhead movement
• Tenderness when pressing on shoulder
• Often occurs with rotator cuff tendinitis

What helps:

• Rest from aggravating activities
• Ice packs
• NSAIDs
• Physical therapy
• Corticosteroid injections
• Rarely, surgical removal of bursa

AC Joint Separation or Arthritis

The acromioclavicular (AC) joint is where the collarbone meets the shoulder blade. Injuries or arthritis here cause pain at the top of the shoulder.

Signs it might be AC joint problems:

• Pain at the very top of shoulder
• Tenderness when pressing on the bump at top of shoulder
• Pain when reaching across body
• Pain when lying on affected shoulder
• Visible bump if severe separation
• History of fall onto shoulder (separation)

What helps:

• Ice and rest for acute injuries
• NSAIDs
• Sling for comfort (short-term)
• Physical therapy
• Corticosteroid injections
• Surgery for severe separations or arthritis

Biceps Tendinitis

Inflammation of the long head of the biceps tendon causes pain in the front of the shoulder.

Signs it might be biceps tendinitis:

• Pain in front of shoulder
• Tenderness in the biceps groove
• Pain worsens with overhead activities
• Pain when lifting or carrying
• May hear or feel popping or clicking
• Often occurs with rotator cuff problems

What helps:

• Rest from aggravating activities
• Ice
• NSAIDs
• Physical therapy
• Corticosteroid injections
• Surgery (biceps tenodesis) for chronic cases

Serious Causes Requiring Immediate Attention

Heart Attack

Shoulder pain, especially left shoulder, can be a symptom of heart attack, particularly in women.

Warning signs:

• Shoulder or arm pain with chest discomfort
• Shortness of breath
• Nausea or vomiting
• Lightheadedness or cold sweat
• Pain in jaw, neck, or back
• Unusual fatigue

Action: Call 911 immediately if you suspect a heart attack.

Shoulder Dislocation

Complete displacement of the shoulder joint is extremely painful and requires immediate medical attention.

Warning signs:

• Severe pain after injury
• Visible deformity (shoulder looks out of place)
• Inability to move arm
• Swelling and bruising
• Numbness or tingling in arm

Action: Seek emergency care. Do not attempt to relocate the shoulder yourself.

Fracture

Broken collarbone, shoulder blade, or upper arm bone requires prompt medical care.

Warning signs:

• Severe pain after fall or direct blow
• Visible deformity or swelling
• Inability to move arm
• Bruising
• Grinding sensation

Action: Seek emergency care for X-rays and treatment.

Septic Arthritis (Infected Joint)

Bacterial infection in the shoulder joint is rare but serious.

Warning signs:

• Severe pain and swelling
• Fever and chills
• Warmth and redness
• Inability to move shoulder
• Feeling ill

Action: Seek emergency care. Requires antibiotics and drainage.

When to See a Doctor

Schedule a doctor's appointment if:

• Pain persists for more than 2-3 weeks despite home treatment
• Pain interferes with sleep or daily activities
• Weakness or inability to perform normal activities
• Swelling or deformity
• Pain worsens despite rest and self-care
• You have a history of cancer (shoulder pain can be a site of metastasis)

Diagnosis

Your doctor may perform:

• Physical examination: Range of motion, strength testing, special tests
• X-rays: Detect fractures, arthritis, bone spurs, calcifications
• MRI: Visualize rotator cuff tears, labral tears, soft tissue injuries
• Ultrasound: Assess rotator cuff, biceps tendon, bursitis
• CT scan: Detailed bone imaging
• Arthrogram: Dye injection before MRI for better visualization
• EMG/nerve conduction studies: If nerve compression suspected

Treatment and Management

Conservative Treatment

Rest and Activity Modification:

• Avoid overhead activities and heavy lifting
• Modify daily activities to reduce pain
• Use opposite arm when possible

Ice and Heat:

• Ice for acute pain and inflammation (15-20 minutes, 3-4 times daily)
• Heat for chronic stiffness (before stretching)

Medications:

• NSAIDs (ibuprofen, naproxen)
• Acetaminophen for pain
• Topical pain creams

Physical Therapy:

• Stretching exercises to improve flexibility
• Strengthening exercises (rotator cuff, scapular stabilizers)
• Posture correction
• Manual therapy techniques
• Modalities (ultrasound, electrical stimulation)

Injections:

• Corticosteroid injections for inflammation
• Hyaluronic acid for arthritis
• Platelet-rich plasma (PRP) for tendon healing

Surgical Options

• Arthroscopy: Minimally invasive repair of rotator cuff, labrum, or impingement
• Rotator cuff repair: Reattach torn tendons
• Shoulder replacement: For severe arthritis
• Reverse shoulder replacement: For massive rotator cuff tears with arthritis
• AC joint resection: Remove arthritic portion of AC joint

Self-Care and Prevention

Exercises and Stretches

Pendulum exercise:

• Lean forward, let arm hang
• Gently swing arm in circles
• Helps with frozen shoulder

Doorway stretch:

• Stand in doorway, arms on frame
• Lean forward to stretch chest and front of shoulder

Sleeper stretch:

• Lie on affected side
• Rotate arm down toward floor
• Stretches posterior capsule

Rotator cuff strengthening:

• External rotation with resistance band
• Internal rotation with resistance band
• Scaption (raising arms at 45-degree angle)

Scapular strengthening:

• Rows
• Scapular squeezes
• Wall push-ups

Posture and Ergonomics

• Avoid slouching or rounded shoulders
• Keep computer monitor at eye level
• Take frequent breaks from desk work
• Sleep on back or unaffected side
• Use supportive pillow

Prevention Strategies

• Warm up before sports or exercise
• Strengthen rotator cuff and scapular muscles
• Avoid repetitive overhead activities when possible
• Use proper lifting technique
• Maintain healthy weight
• Address pain early before it becomes chronic

Frequently Asked Questions

The Bottom Line

Shoulder pain is extremely common and can significantly impact daily activities, from dressing and grooming to work and recreation. The shoulder's complex anatomy and wide range of motion make it vulnerable to various injuries and conditions.

Most shoulder pain results from rotator cuff problems, frozen shoulder, impingement, or arthritis. The good news is that many cases respond well to conservative treatment: rest, physical therapy, targeted exercises, and anti-inflammatory medications.

The key to successful treatment is accurate diagnosis and early intervention. Ignoring shoulder pain often leads to chronic problems and reduced function. Physical therapy, particularly exercises to strengthen the rotator cuff and scapular stabilizers, is crucial for both treatment and prevention.

Certain warning signs—severe pain after injury, inability to move the shoulder, or shoulder pain with chest discomfort—require immediate medical attention. For persistent pain that doesn't improve with home care, professional evaluation can identify the cause and guide appropriate treatment.

Remember: This information is educational and doesn't replace professional medical advice. If you're experiencing persistent or severe shoulder pain, consult a healthcare provider for proper evaluation and treatment.