Shoulder pain: causes and treatment without surgery

Shoulder pain is most often caused by overload or inflammation of the shoulder tendons, known as the rotator cuff. Other common causes are frozen shoulder, osteoarthritis and pain referred from the neck. In most cases shoulder pain is managed without surgery: with exercise, a change in load and, if needed, an injection.

Why does my shoulder hurt

The shoulder is the most mobile joint in the body. The price of that mobility is that its stability comes not from bone but from muscles and tendons. That is why most shoulder pain comes from soft tissue rather than from bone.

Cause	Who it often affects	Typical sign
Tendon overload or inflammation	People who often raise their arm overhead	Pain lifting the arm and at night when lying on that side
Tendon tear	Older people through wear, younger people after an injury	Lifting the arm becomes weak
Frozen shoulder	Middle age, often alongside diabetes	Movement is restricted in every direction
Osteoarthritis	Older age	Stiffness, grinding, gradually increasing pain
Dislocation	After an injury, often in younger people	The shape of the shoulder changes, movement is impossible
Pain referred from the neck	Any age	Pain runs down the arm, often with numb fingers

The rotator cuff is the set of tendons of four muscles that hold the head of the upper arm bone in the socket of the shoulder blade. When you raise your arm overhead, these tendons move through a narrow space and become irritated with frequent repetition. That is why shoulder pain is common among painters, cooks, swimmers and anyone who holds their arm overhead for long periods.

Tendon problem or frozen shoulder: how to tell them apart

Frozen shoulder (adhesive capsulitis) is inflammation and tightening of the shoulder joint capsule, in which the joint gradually becomes restricted in every direction. It resembles a tendon problem, but the treatment and the timeline differ.

The simplest distinguishing sign is whether someone else can lift your arm:

Sign	Tendon problem	Frozen shoulder
You cannot lift the arm yourself	Often	Yes
Someone else lifts your arm	Usually possible, with pain	Restricted, the joint feels locked
Reaching behind your back	Painful	Very difficult
Course	Weeks or months, responds well to exercise	Months, in three phases

Frozen shoulder usually goes through three phases: pain dominates first, then stiffness, and finally movement gradually returns. In most cases it resolves on its own, but slowly, and the aim of treatment is to make that path easier.

Why does my shoulder hurt at night

Night pain is one of the most typical signs of irritated shoulder tendons. Lying on the shoulder puts pressure on the tendon, and at rest inflammation is felt more because nothing distracts from it.

Until treatment takes effect, a few simple things help: sleep on the healthy side or on your back, put a pillow under the painful arm, and do not raise the arm overhead before sleep. I have written about night pain in general separately: night pain.

How shoulder pain is treated without surgery

Most shoulder pain is managed without an operation. The plan usually has several parts:

What	What it does
Change in load	Temporarily reduces the movement that irritates the tendon, especially overhead work
Exercises	Strengthen the stabilising muscles of the shoulder blade and shoulder that keep the tendon in place
Physiotherapy	Restores range of motion and corrects the mechanics of the shoulder
Medication	Controls pain and inflammation for a short time
Injection	In some cases reduces inflammation and buys time for exercise

The most important part is exercise. Injections and medication reduce pain, but they cannot correct the mechanics of the shoulder; exercise is what restores the balance between the muscles that control the joint. More on injections: injection therapy.

Patience is essential. Tendons heal slowly, results usually start to show within a few weeks, and full recovery sometimes takes several months. That is why the plan has a follow-up date from the start: we look at what has changed and adjust the plan if needed.

When does a shoulder need a surgeon

Only a small share of shoulder pain needs an operation. Most often these are situations like:

• a tendon has torn after an injury and lifting the arm has become noticeably weak, especially in an active person;
• the shoulder has dislocated more than once;
• osteoarthritis is so advanced that pain and restriction make daily life difficult;
• properly conducted non-surgical treatment has not brought results.

I do not operate on shoulders: I perform surgery only on the hip joint. In these cases I refer you to a shoulder surgeon and give you everything we found at the consultation to take with you. Why the boundary is drawn this way, I explain here: seeing an orthopaedic trauma surgeon.

When you should not wait

• Left shoulder or arm pain comes with chest pain, shortness of breath or a cold sweat. Call emergency services (112 in Georgia): a heart attack sometimes starts exactly this way.
• After an injury the shape of the shoulder has changed or the arm cannot move;
• after an injury lifting the arm has suddenly become weak: in some cases timing matters;
• the shoulder is red and hot and you have a fever;
• the arm has gone numb, weak or changed colour.

Key points

• The most common source of shoulder pain is the tendons, not the bone.
• A frozen shoulder is restricted in every direction; with a tendon problem someone else can usually still lift your arm.
• Exercise is the main part of shoulder treatment; injections and medication support it but cannot replace it.
• Only a small share of cases needs surgery, and then I refer you to a shoulder surgeon.
• Left shoulder pain together with chest pain is an emergency.

On joint pain in general: joint pain. If your shoulder has hurt for more than a week, book a consultation.