Shoulder

In young people, the most common cause is shoulder instability. This normally occurs after an injury and causes the shoulder to partially or fully dislocate.  Some children and young adults who are naturally double-jointed experience this without injuring themselves. 

In middle age, people commonly experience pain from the tendons in the shoulder called the rotator cuff. This can start after strenuous activity or trauma such as a fall but can start for no reason at all. People typically find that it is painful raising their arm overhead and the arm may feel weaker than usual. It can be confusing as this problem is known by various names such as subacromial shoulder pain, rotator cuff, tendinopathy and bursitis but they all describe the same symptoms. Poor exercise technique can cause shoulder pain.

The other common cause of shoulder pain in middle age is a frozen shoulder that gives quite significant pain, especially at night, and restricts the amount a person can move their shoulder in any direction.

In later years, people may develop arthritis of the shoulder. This also can restrict the movement of the joint and cause pain. Subacromial shoulder pain also becomes more common as people age. These problems can normally be managed in the first instance without the need to attend hospital.
 

Successful treatment of shoulder pain depends on having an accurate diagnosis so if your symptoms are not improving with simple exercises and adapting your activities then see your GP or physiotherapist for an assessment. 

Receiving the correct treatment for your shoulder pain depends on your diagnosis.

Some treatments such as massage, manual therapy, electrotherapy and acupuncture have very little value in treating shoulder pain and are not recommended.

Typically this depends on severity of your pain and nature of your shoulder problem.

There is not specific restrictions to when you can exercise, unless you have had shoulder surgery or shoulder trauma and any movement causes agony - in this case you should contact a health professional like doctor or physiotherapist.

In all other cases movement in tolerable small amounts might actually be beneficial, especially if you can work through the whole range of movement with little pain.

Subacromial shoulder pain is the most common cause especially in 30 to 70 year olds.

Try to remain as active as possible, take painkillers if needed and do strengthening exercises to help your shoulder recover.

The British Elbow and Shoulder Society has produced a useful guide about Subacromial Pain​​​​​ that you can follow. 

Frozen shoulder typically affects people in their 50s.  As it causes significant pain it is difficult to exercise without adequate pain relief. A steroid injection followed by gentle stretching and strengthening exercises is effective for the majority but sometimes keyhole surgery is offered if symptoms fail to respond.

The British Elbow and Shoulder Society has produced a useful guide about Frozen Shoulder.

Shoulder arthritis can often be well managed with a combination of lifestyle modification and exercise to maintain strength and flexibility. Painkillers and steroid injections can be useful during a flare-up. In severe cases surgery, such as a joint replacement, may be advised.

If your shoulder pain does not get any better, a physiotherapist can help you.

If you have had a significant injury or are in very severe pain you should attend your local emergency department. In most cases this is not required. 

Seek medical advice for shoulder pain if pain is severe and prolonged.

You can follow the advice and simple exercises on this site for six weeks to see if your symptoms start to improve. If your symptoms are not improving, please consult your GP or local physiotherapist for an assessment.

Physiotherapists are experts in diagnosing and treating joint and muscle problems. You should receive a thorough examination after discussing your symptoms. Often a diagnosis can be made without the need for any x-rays or scans but these can sometimes be recommended.

In most cases a bespoke exercise programme will be prescribed for your specific problem. In some cases, you may be referred to see a shoulder specialist or even a surgeon if the problem is more significant or has failed to improve with treatment.

The natural reaction when in pain is to completely stop activities that aggravate the symptoms, but it is much better to continue to use your shoulder.

You may need to adjust how you do things to make it more comfortable. This may mean doing jobs in short bursts with regular breaks rather all in one go.

If the pain is more severe, try to avoid strenuous activity but take simple painkillers like paracetamol and keep the shoulder moving to prevent it stiffening up.

If the pain is not settling, book in to see your GP or physiotherapist. They will be able to assess the cause of your shoulder pain and advise on how best to deal with it.

Please visit these pages for exercises for your shoulder:
•    https://www.csp.org.uk/conditions/shoulder-pain/video-exercises-shoulder-pain
•    https://bess.ac.uk/subacromial-pain/ 

You can also make use of the following exercises where appropriate:
•    Shoulder strengthening programme - word document or PDF
•    Shoulder mobility programme - word document or PDF
•    Shoulder resistance band exercises - word document or PDF
 

Shoulder instability is usually treated without surgery unless there is a significant injury that has damaged the shoulder joint. This is most common in young people after sporting injuries or after epileptic fits.  It is important to try and restore normal movement and activity as soon as possible after a shoulder dislocation. 

Exercises to strengthen the shoulder and improve balance reactions help to reduce the risk of repeated dislocations. The most commonly used exercise programme in the UK is the Derby Shoulder Instability Rehabilitation Programme on YouTube. 

Coping with long-term shoulder pain can be difficult, but it can be managed with help from a physiotherapist.

It is important to remind yourself that most of the common causes of shoulder pain will get better naturally over time. Be patient though as this can take several months. 

Keeping active with shoulder pain helps keep your shoulder ‘loose’.