Condition information
Understanding your pathway
What is shoulder pain?
Shoulder pain can limit reaching, dressing, lifting and comfortable sleep. It may arise within the joint, from nearby tendons or muscles, or be referred from another region. Persistent pain warrants a review of how the shoulder moves and how symptoms affect the activities that matter to you. [1][2]
What can contribute?
Possible causes include rotator cuff problems, bursitis, frozen shoulder, arthritis, injury and pain referred from the neck. Several contributors may coexist. Terms such as impingement describe a presentation rather than establish one cause in every person. Recent trauma and loss of movement influence the assessment and urgency. [1][3]
Common presentations and symptoms
Pain may occur with reaching overhead, lying on the affected side or moving the arm behind the back. Stiffness and weakness can occur for different reasons. A sudden loss of function after injury needs assessment rather than assuming that it is simply another flare of longstanding pain. [1][3]
Assessment and diagnosis
Assessment includes shoulder and, where relevant, neck examination. The pattern of active and passive movement helps guide the clinical impression. X-ray, ultrasound or MRI may be useful for a particular question, but are not automatic requirements. Imaging findings should be interpreted with symptoms and physical examination. [1][3]
Management options
Options depend on the diagnosis and may include exercises, physiotherapy, changes to aggravating activities and medication review. A targeted injection may sometimes support rehabilitation. Persistent weakness, significant injury or a structural problem may need orthopaedic assessment. No single injection is suitable for all causes of shoulder pain. [1][3][4]
When should I seek urgent care?
Call 000 for shoulder or arm pain accompanied by chest tightness, breathlessness or symptoms suggesting a heart attack. Seek urgent assessment after injury with deformity, severe swelling or inability to use the arm. A hot, swollen joint with fever also needs urgent medical review. [1][3]
Multidisciplinary care and self-management
Persistent pain can affect more than one part of life. Physiotherapy, psychological support and medical care may be combined according to your needs. Psychological care addresses the effects of pain and ways of coping; it does not imply that pain is imagined. Discuss an activity plan you can sustain rather than alternating between doing too much and stopping completely. [4][2]
Preparing for your consultation
Bring a current medicine list, relevant scan reports and details of treatments you have tried. Describe what each treatment changed, any adverse effects and the activities you most want to regain. You may wish to bring a support person. Ask what the assessment can clarify, what remains uncertain and which decisions can reasonably wait.
Follow-up and questions to ask
Agree how progress will be judged: for example, walking tolerance, sleep, work participation or confidence with a daily task. Ask when to review the plan and what changes should prompt earlier contact. Discuss potential benefits, limitations, costs and alternatives before starting treatment. If a plan is not helping, review its purpose instead of assuming that more of the same treatment is always needed. [5]
Sources and further reading
Sources support the statements cited above. Overseas guidance may describe different services or eligibility rules. A procedure leaflet explains a technique and its risks; it does not establish that the treatment is effective for every condition.
- Shoulder pain — Healthdirect Australia
- Chronic pain — Healthdirect Australia
- Local steroid injections to joints and soft tissues — The Dudley Group NHS Foundation Trust
- Options for chronic pain management — Healthdirect Australia
- Procedures in pain medicine clinical care standard — Faculty of Pain Medicine, ANZCA