| What We Treat
Shoulder Pain
Shoulder pain that hasn’t been given a name yet? You don’t need a diagnosis before you come in — working out what’s actually driving your pain is the first job of the assessment, and it changes everything that follows.
Overview
What’s Actually Causing It?
The shoulder is the most mobile joint in the body, and that mobility comes at the cost of stability. Pain can come from the tendons, the joint surfaces, the capsule, the joint at the top of the shoulder, or occasionally be referred from the neck. The good news is that these causes behave quite differently from one another, so a careful history and examination will usually narrow it down well without needing a scan.
Tap a structure, or use the buttons, to see how each pattern typically behaves.
Rotator Cuff Related Shoulder Pain
By far the most frequent cause in adults. Pain sits over the outer shoulder and upper arm, is worse reaching up, out or behind, and often aches at night when lying on that side. Movement is usually available but painful and weak rather than blocked.
Symptoms
What Your Physio Will Want to Know
The pattern of your symptoms does most of the diagnostic work. These are the details that separate one cause from another:
Where It Sits
Outer shoulder and upper arm points towards the cuff; the bony tip points towards the AC joint; below the elbow suggests the neck is involved.
Painful or Blocked
A shoulder that hurts but still moves behaves very differently from one where the movement itself has genuinely gone.
Night Pain
Common with cuff problems and frozen shoulder. Constant, unrelenting night pain that’s unrelated to position is a different matter and needs checking.
How It Started
A single fall or wrench, a gradual build-up over months, or a sudden change in training or DIY all point in different directions.
What Aggravates It
Reaching overhead, reaching behind your back, lying on it, carrying, or turning your head are each useful clues.
Arm Symptoms
Pins and needles, numbness or weakness in the hand suggests a nerve, not the shoulder joint itself.
Causes & Risk Factors
The Usual Suspects
In a typical week in clinic, most undiagnosed shoulder pain turns out to be one of these:
Rotator Cuff Related Shoulder Pain
The most common cause by a distance. An umbrella term covering tendon irritation, partial tears and bursal involvement, all of which respond well to loading.
Frozen Shoulder
Capsular thickening producing genuine, multi-directional loss of movement, particularly external rotation.
Acromioclavicular Joint Problems
Localised pain at the tip of the shoulder, either after trauma or from long-term wear.
Shoulder Osteoarthritis
Slower onset, morning stiffness, crunching or grinding, and gradually reducing range in an older shoulder.
Referred Neck Pain
Cervical spine problems that project pain into the shoulder region, sometimes without much neck pain at all.
How We Can Help You
Treatment & Management
The first appointment is about answering the question “what is this, and what will it respond to?” — and then getting straight on with treating it.
What the evidence says
Scans are less helpful than most people expect for shoulder pain. Rotator cuff tears, bursal thickening and joint wear are extremely common findings in people with no pain at all, and their prevalence rises steeply with age — so an abnormal scan doesn’t automatically explain your symptoms.
This is why national guidance across musculoskeletal care consistently favours a clinical assessment first, with imaging reserved for cases where the result would genuinely change what happens next.
When to Seek Help
Red Flags — Don’t Ignore These
Most shoulder pain is musculoskeletal and safe to work with. A small number of presentations are not. Contact your GP promptly — or call 999 for the emergency signs below — if you notice:
⚠ Seek prompt medical assessment if you notice:
- Chest pain, breathlessness, sweating, or pain spreading to the jaw or down the arm (possible cardiac cause — call 999)
- A hot, red, swollen joint with fever or feeling generally unwell (possible joint infection — seek emergency care)
- Significant trauma followed by inability to lift the arm at all, or an obvious change in the shape of the shoulder
- New, unexplained lump, swelling or muscle wasting around the shoulder or shoulder blade
- Constant, unrelenting night pain unrelated to position, particularly with unexplained weight loss or a history of cancer
These symptoms can point to a cause that needs medical rather than physiotherapy assessment. Please don’t wait for a physiotherapy appointment — contact your GP, call 111, or attend A&E as appropriate.
Common Questions
Frequently Asked Questions
Do I need a scan before I come in?
Almost never. A careful assessment identifies the pattern in the large majority of cases, and scans of painful shoulders frequently show changes that are also present in pain-free shoulders. If imaging would genuinely change the plan, you’ll be told so and helped to arrange it.
Should I rest it or keep using it?
Complete rest usually backfires — shoulders stiffen quickly and deconditioned tendons tolerate less. The useful middle ground is modifying the specific movements that flare things while keeping the shoulder generally active. Your physio will help you work out where that line sits for you.
How long will it take to settle?
It depends entirely on the cause. Cuff-related pain often improves meaningfully within 6–12 weeks of consistent loading; frozen shoulder runs on a much longer timeline; a post-traumatic problem depends on what was damaged. Getting the diagnosis right is what allows an honest answer.
Could it be coming from my neck?
Quite possibly — it’s common enough that the neck is screened in every shoulder assessment. Pins and needles or numbness below the elbow, pain that changes with head position, and a shoulder that moves fully despite hurting are the classic clues.
Let’s Find Out What’s Actually Going On
One thorough assessment, a clear explanation, and a plan you can start straight away — without needing a diagnosis before you walk through the door.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.