Shoulder pain will strike almost everyone in their lifetime – whether the result of an over-enthusiastic tennis serve or just hoisting a bag of shopping.
For most, the twinge or pulled muscle will repair itself after a few days or weeks of rest. But for roughly seven per cent of the UK population – rising to just over a quarter among pensioners – shoulder pain can be a severe, and inescapable, even life-ruining complaint.
And growing research shows the number of people struggling with chronic shoulder pain is only expanding.
An aging population, increasingly sedentary lifestyles and modern working habits that involve long hours sat in front of computer screens have left more Britons than ever struggling with sore, achy shoulders that can stop them working, exercising and even sleeping.
Now, experts speaking to The Mail on Sunday say there are simple steps that patients can take to banish the problem for good – and guard against future injuries.
Rule out potential serious causes first
First, however, it’s vital to ru le out any serious undiagnosed medical problems that could be causing the symptoms.
Doncaster-based GP Dr Dean Eggitt says: ‘Shoulder pain is extraordinarily common, and the vast majority of the time it’s due to damage to the muscles or joint.
‘But pain in the shoulder can be caused by issues elsewhere in the body – a phenomenon known as referred pain. So it’s very important to rule out any of these, often more serious, issues.’
Doncaster-based GP Dr Dean Eggitt says: ‘Shoulder pain is extraordinarily common, and the vast majority of the time it’s due to damage to the muscles or joint’
Research shows the number of people struggling with chronic shoulder pain is only expanding, with an aging population, increasingly sedentary lifestyles and modern working habits having a significant effect
Shoulder pain is even a symptom of lung cancer, with some studies suggesting it can affect as many as 18 per cent of patients. A blood clot in the lungs – known as a pulmonary embolism – can also cause shoulder pain, as can heart attacks. And a key warning sign of ectopic pregnancy – where an embryo grows outside the womb – is a sharp pain in the shoulder blade.
This happens because the nerves that serve the shoulder are closely linked to those from organs such as the lungs and heart.
Dr Adam Taylor, professor of clinical anatomy at Lancaster University, says: ‘Because of the way the body develops, these nerves share similar pathways. That means when something is wrong in the chest or abdomen, the brain can misread the signal and interpret it as pain in the shoulder.’
How to tell if the pain is ‘referred’
There’s a way to distinguish between referred pain and pain originating in the joint.
Dr Eggitt says: ‘The easiest way is to see if it hurts when you move the shoulder.
‘If someone can’t raise their hand above their head, for example, or lift it to the side without a pang of pain, then it’s likely to do with the shoulder itself. Whereas someone with referred shoulder pain may be able to move the joint around without accentuating – or dulling – the pain at all.’
The pain can also develop differently, adds Prof Taylor.
‘Pain referred to the shoulder from the internal organs often starts as a dull, achy pain that worsens over time,’ he says. ‘It’s often described as a pressure or crushing pain that can’t be alleviated by anything.
‘Musculoskeletal pain, meanwhile, usually has a trigger and may feel sharper, particularly when you move the limb in a certain way.’
If you’re worried your shoulder pain may be something more serious – particularly if it’s accompanied by other symptoms – Dr Eggitt says don’t hesitate to bring it up with your GP.
Sudden sharp shoulder pain – if accompanied by shortness of breath, nausea, lightheadness and chest pain – could be a sign of a heart attack.
Young women experiencing sharp pain in their shoulder blade, alongside pain on one side of the abdomen and vaginal bleeding, should also contact their GP or call 111 immediately to rule out ectopic pregnancy.
The three main types of shoulder pain
Shoulder pain can generally be divided into three types, explains Giuseppe Salustri, a physiotherapist at The Physio Box clinic in London.
Traumatic injuries are those that cause a sudden, acute pain – like falling on the shoulder while skiing or tumbling off a bike. These have a clear cause and will likely heal – depending on the severity – with time.
It’s non-traumatic injuries that are the most common in physiotherapy clinics, says Mr Salustri.
‘These can be from overuse or general wear-and-tear,’ he says. ‘And while there are many ways that people can develop them, they tend to be broadly due to a mismatch between loading – how much someone is trying to lift, or force they’re trying to apply – and strength – how much the tissues and tendons are actually able to tolerate.’
These injuries tend to develop more slowly, can’t be linked to a specific event or trauma, and persist for longer.
Finally, the type that many people have never heard of, says Mr Salustri, are neurogenic injuries – which stem from the nerves in the neck but feel like shoulder pain.
When it is actually your neck that hurts
Mr Salustri says: ‘The nerve is a bit like a fire alarm system – if it gets triggered then the pain will be referred off to the different areas of the shoulder depending on where the nerve is trapped.’
This can be cured with the same type of treatment as non-traumatic shoulder pain – and is generally caused by the same factors – but is really a form of neck pain.
‘I often see patients in clinic who had been treated for months for shoulder pain because no one made sure it wasn’t a neck issue,’ says Mr Salustri.
‘This needs to be checked for first,’ he adds.
A pinched nerve will feel more like a radiating pain, tingling or numbness that can travel down the nerve, and is often linked to neck movement.
An issue with the shoulder, meanwhile, is usually localised to one part of the shoulder – worsening with certain arm movements.
Most common injury – rotator cuff damage
Once neck issues are ruled out, a physiotherapist will determine what type of shoulder injury they’re dealing with.
The most common by far are rotator cuff injuries – inflammation or tearing of the tendons that stabilise the shoulder.
These injuries become much more common as people get older, says Dr Eggitt, due to wear-and-tear as well as age-related degeneration, which can cause tendons to weaken, lose elasticity and suffer reduced blood flow.
A rotator cuff injury often feels like a sharp pain right in the roof of the shoulder, which causes weakness and discomfort when moving the arm in certain ways, such as reaching overhead.
Athletes and workout buffs are also particularly prone to rotator cuff injuries, says Mr Salustri, as they can be caused by repetitive overhead lifting or press-ups. ‘If you do a lot of shoulder exercises without having enough strength in the rotator cuff, then you can cause inflammation between the ball and socket,’ he says.
How to treat it and speed up recovery
Strengthening exercises and stretches can help by easing strain on the tendon and boosting blood flow to aid repair.
Minor injuries can often be treated with exercises alone, but shockwave therapy can significantly reduce pain and improve function when physiotherapy alone isn’t enough
Minor injuries can often be treated with exercises alone, such as pendulum swings – gently moving the arm back and forth while supported – or wall ball rolls. More severe cases may require a steroid injection or shockwave therapy, which uses soundwaves to stimulate healing and break down scar tissue. ‘When pain becomes chronic – lasting more than six weeks – the tissue often stops repairing itself,’ says Mr Salustri. ‘Shockwave therapy can restart that process.’
Though currently only available privately, studies suggest it can significantly reduce pain and improve function when physiotherapy alone isn’t enough – with one trial reporting benefits in 80 per cent of patients.
It’s not all about strength training
Repairing rotator cuff injuries isn’t just about building strength, however, says Mr Salustri – improving the time it takes for the muscle to fire into action is just as important.
Simply throwing and catching a ball against a wall, while keeping the elbow at 90 degrees is one of the best exercises, says Mr Salustri
Known as activation time, this can be trained through simple exercises. One of the best, says Mr Salustri, is simply throwing and catching a ball against a wall, while keeping the elbow at 90 degrees.
‘Activation time declines with age, so it’s very important to keep working on it as you get older, to help prevent injuries in the future, as well as repair existing ones,’ he explains.
How HRT could help clear up those aches
When Lauren Chiren, 57, developed debilitating shoulder pain in her early 40s, she put it down to her intensive marathon training routine and her busy life as a working mum.
‘My joints were more achy than normal – my left shoulder was the most painful,’ she says. ‘I assumed if I laid off working out for a while, things would feel better.’
While the joint pain did disappear, her shoulder pain persisted, making it difficult for Lauren, pictured left, from Bristol, to do even the simplest tasks. Having been a personal trainer for more than a decade, she immediately sought treatment from physiotherapists and an osteopath.
But while they provided relief for a couple of days, her shoulder would always seize up again.
It wasn’t until three years later, when she sought help for brain fog, that Lauren finally found a solution: hormone replacement therapy (HRT).
‘My doctor diagnosed me with early menopause and put me on HRT, which helped me immensely,’ she says. ‘What I was shocked to discover, however, was it also dealt with my shoulder pain, which disappeared.’
And the effects remained even once Lauren came off HRT a few weeks later – largely due, she believes, to diet and exercise changes that she introduced in that period.
‘I started doing a lot more mobility work, as well as increasing the amount of fats and protein in my diet,’ she says. ‘And the shoulder pain never came back. I had never realised the huge role that hormones play in our joint health.’
Why frozen shoulder affects more women
In some cases, however, shoulder pain has nothing to do with muscle strength at all.
Frozen shoulder, which affects around one in 20 adults, occurs when the capsule surrounding the joint becomes inflamed and stiff, causing pain and severely limiting movement.
It typically affects people aged 40 to 60, particularly women, and develops gradually – starting with a painful ‘freezing’ phase before the joint becomes increasingly stiff.
The exact cause isn’t always clear, but it’s thought to be linked to inflammation and thickening of the joint capsule, sometimes triggered by injury, surgery or long periods of immobility. Unlike a rotator cuff injury, where movement is painful but possible, frozen shoulder can feel like a physical block stopping the joint from moving properly. Not being able to unclasp a bra or lift the arm out to the side are key warning signs, says Mr Salustri.
Strength exercises can help – but experts say treatment often needs a broader approach. Research suggests a strong link with hormonal changes around menopause, with around 70 per cent of cases occurring in women in this age group.
‘Oestrogen has natural anti-inflammatory effects and helps keep tendons elastic,’ says Dr Eggitt. ‘When levels drop, the shoulder becomes more vulnerable to injury.’
As a result, hormone replacement therapy (HRT) can help some people, particularly when combined with strengthening exercises, adds Mr Salustri.
For any type of shoulder injury, however, the hardest part of healing is often pushing through the pain to be able to stretch and strengthen the muscles.
‘Many patients come to me afraid to move their shoulder at all because of the agony,’ says Mr Salustri. ‘And this is where the NHS is lacking – because of the lack of time for outpatients, people are often sent away with exercises but no guidance on how to develop and implement a routine.’
What your doctor can offer to ease the pain
One option is to seek help privately, where physiotherapy clinics can offer pain relieving injections or shockwave therapies to speed up healing.
But NHS GPs should also be able to offer a steroid injection to help with shoulder pain relief.
Dr Eggitt says: ‘My advice for all patients struggling with chronic shoulder pain is to ask your GP for a simple injection – a steroid injection with an added pain reliever – that can help with pain for around three months.
‘This should help with participation in physiotherapy, and hopefully, by the time it wears off, the inflammation and muscle pain will already have gone down sufficiently because of the exercises.’
As for the best cure for shoulder injuries? Preventing them in the first place, say experts.
Those sitting at desks all day can implement easy postural fixes to reduce pressure on their shoulders – such as rolling out the back with a foam roller twice a day.
It’s also just as important to engage the back muscles – both while sitting and exercising – to prevent rounding the back or hunching, which can damage the shoulder joint.
Example exercises are available on the NHS website, as well as the British Elbow & Shoulder Society webpage. Patients can also ask their GP to recommend strengthening stretches.
‘There’s no right age to start strengthening the shoulder muscles,’ says Mr Salustri.
‘Physical decline is inevitable, and the only way to fight that is strength work.’
