At a Glance
Shoulder pain is common – about 70% of all people experience it at least once in their lifetime
Most causes are harmless – muscle tension and overuse usually heal on their own
Movement is the best medicine – even when it initially hurts, gentle activity promotes healing
Surgery is rarely necessary – over 80% of shoulder pain improves with conservative therapy
Seek immediate medical attention for warning signs – sudden severe pain, numbness, or loss of strength are emergencies
Causes: Why Does My Shoulder Hurt?
The shoulder is the most mobile joint in our body – and that's exactly what makes it vulnerable. Unlike the hip, which is stable due to its ball-and-socket shape, the shoulder is primarily guided by muscles, tendons, and ligaments. This complex construction allows us to move our arm in all directions, but it also poses risks.
The Top 5 Pain Causes:
1. Muscle Tension and Overuse (approximately 40% of all cases)
Most common cause with desk work and one-sided strain
Typical: Pain in the neck-shoulder area
Often worsened by stress and poor posture
Good prognosis: Usually improves within days to weeks
2. Impingement Syndrome (Pinching Syndrome)
Tendons get pinched under the shoulder blade
Pain especially when lifting arm between 70-120 degrees ("painful arc")
Often affects people between 40-60 years old
Can lead to bursitis
3. Calcific Tendinitis (Calcium Deposits)
Calcium deposits in the tendons
Can trigger sudden, severe pain attacks
Frequently affects women between 30-50 years old
In many cases, the calcium dissolves on its own
4. Frozen Shoulder (Adhesive Capsulitis)
Painful movement restriction in all directions
Develops in three phases over 1-3 years
Often without identifiable cause
More commonly affects diabetics and women over 40
5. Rotator Cuff Injuries
Tears or inflammation of the stabilizing tendons
Common with overhead work or sports
Pain at night when lying on the shoulder
Ranges from small partial tears to complete ruptures
Rare but Important Causes:
Shoulder arthritis: Cartilage wear, usually in older people
Shoulder instability: After dislocation or with congenital connective tissue weakness
Nerve compressions: Radiating from the cervical spine
Systemic diseases: Rheumatism, polymyalgia rheumatica
Referred pain: From heart, lungs, or gallbladder
Where Exactly Does It Hurt? Pain Location Provides Important Clues
The exact location of your pain can reveal a lot about the cause. Here's a guide:
Pain on the Outside of the Shoulder
Most common cause: Bursitis or tendon irritation
Typical: Pain when lifting arm sideways
At night: Worsening when lying on the affected side
Pain at the Front of the Shoulder
Possible causes: Biceps tendon inflammation, anterior instability
Typical: Pain when reaching behind
Activities: Worsening with throwing motions
Pain at the Back of the Shoulder
Causes: Tense muscles, posterior capsule inflammation
Typical: Pain when moving arm forward
Accompanying: Often with neck tension
Pain Radiating Down the Arm
Causes: Nerve root irritation from cervical spine
Typical: Tingling, numbness, or weakness in the arm
Important: Neurological evaluation recommended
Symptoms and Their Significance
Symptom | Possible Cause | Urgency |
Pain when lifting arm sideways | Impingement, tendon irritation | Address medium-term |
Nighttime pain | Inflammation, calcific tendinitis | See doctor soon |
Sudden stabbing pain | Tendon tear, calcium breakthrough | See doctor immediately |
Loss of strength | Tendon tear, nerve damage | Urgent evaluation |
Numbness/tingling | Nerve compression | Neurological evaluation soon |
Shoulder "pops out" | Instability | Orthopedic consultation |
When Should I See a Doctor for Shoulder Pain?
Not every shoulder pain requires an immediate doctor visit. Here's clear guidance:
Go to the Doctor or Emergency Room Immediately for:
Accident injuries with visible deformity or inability to move
Sudden severe pain with loss of strength
Numbness or paralysis in the arm
Shoulder pain with chest pain (rule out heart attack!)
Fever and shoulder pain (possible joint infection)
Blue discoloration or cold feeling in the arm
See a Doctor Within a Few Days for:
Pain that doesn't improve after 1 week despite self-treatment
Increasing movement restriction
Night pain that disrupts sleep
Pain with swelling or warmth
Repeated pain attacks
Schedule a Doctor Visit for:
Chronic pain lasting over 4-6 weeks
Recurring complaints after exertion
If you're unsure or worried
For evaluation before planned sports activities
Which Doctor Is Right?
Family doctor: First point of contact, can usually help well and refer if needed
Orthopedist: Specialist for joint problems, for more complex complaints
Sports medicine doctor: For sports-related injuries
Rheumatologist: If inflammatory diseases are suspected
Diagnosis: How Does the Doctor's Examination Work?
The doctor will proceed systematically to find the cause of your shoulder pain.
Medical History Discussion:
How long have the pains existed?
What caused them?
How do they feel?
What makes them better or worse?
What medications are you taking?
Physical Examination:
Inspection: Swelling, redness, posture
Movement tests: Active and passive mobility
Strength tests of individual muscles
Special shoulder tests (e.g., impingement tests)
Imaging When Needed:
X-ray: Shows bone changes and arthritis
Ultrasound: Good for tendons, muscles, and bursae
MRI: Most detailed representation of all structures, usually only for unclear cases or before operations
A clear diagnosis isn't always possible immediately. Sometimes the doctor initially works with a suspected diagnosis and observes the progression.
Shoulder Pain Relief: What You Can Do, And What Therapy Options Are Available
What Can I Do Myself for Acute Shoulder Pain?
The first 48 hours are crucial. With the right measures, you can promote healing and relieve pain.
The RICE Method – First Aid for Acute Pain
Rest – Protect the shoulder, but don't immobilize completely
Ice – Cool for 15-20 minutes, several times daily
Compression – Light pressure with bandage (not too tight!)
Elevation – Support arm on pillow
Heat or Cold – What's Better?
Use Cold for:
Acute injuries (first 48 hours)
Swelling
Inflammatory processes
Sharp, bright pains
Use Heat for:
Muscle tension
Chronic pain
Stiffness
Dull, aching pains
Using Pain Medication Strategically
Ibuprofen (400-600mg)
Works as pain reliever and anti-inflammatory
Maximum 3 times daily
Take with food
Diclofenac Gel
Local application for superficial pain
Massage in 3-4 times daily
Fewer side effects than tablets
Acetaminophen
For ibuprofen intolerance
Less effective for inflammation
Maximum 4 times daily 500-1000mg
Important: Don't use pain medication for more than 5-7 days without medical consultation!
Movement – The Foundation of Healing
Even if it hurts initially: gentle movement is better than staying still!
Pendulum Exercises (Codman Exercises)
Support yourself with your healthy hand on a table
Let the painful arm hang loosely
Swing gently forward/back, then sideways
5-10 repetitions, several times daily
Wall Climbing
Stand sideways to the wall
"Climb" up the wall with your fingers
Go as high as pain-free possible
Slowly come back down
These simple exercises keep the joint mobile and promote blood circulation.
Treatment: What Therapy Options Are Available?
Most shoulder pain can be treated without surgery. Surgical interventions are rarely necessary.
Conservative (Non-Surgical) Treatment:
Physical therapy: Movement therapy, strengthening, posture training
Medications: Pain relievers, cortisone injections for inflammation
Physical therapy: Heat, cold, electrical therapy
Alternative methods: Acupuncture, taping (research evidence still uncertain for some)
Surgical Treatment:
Surgery is only considered if conservative measures haven't helped after 3-6 months or for severe injuries.
Arthroscopy (joint endoscopy): Minimally invasive technique through small incisions
Open surgery: Necessary for larger repairs
Examples: Removal of calcium deposits, repair of torn tendons, widening of the shoulder roof
Healing Time: How Long Until It Gets Better?
Healing time depends heavily on the cause and your individual factors.
Typical Healing Times:
Muscle tension: A few days to 2 weeks
Bursitis: 2-6 weeks
Impingement syndrome: 6 weeks to 6 months
Rotator cuff tear: 3-6 months, after surgery 6-12 months
Frozen shoulder: 1-3 years (often even without treatment)
Factors That Influence Healing:
Your age (younger people heal faster)
General fitness and muscle strength
Accompanying diseases like diabetes
Following therapy recommendations
Occupational and sports stress
Patience is important – shoulder problems often need time to heal.
Prevention: How Can You Prevent Shoulder Pain?
Many shoulder problems can be avoided through simple measures.
Movement and Sports:
Regular, gentle movement (swimming, cycling)
Strengthening shoulder muscles, especially the rotator cuff
Overhead sports (tennis, handball) only with good technique
Don't forget to warm up before sports
Workplace and Daily Life:
Position screen at eye level
Take breaks every 30-60 minutes with shoulder circles
Carry heavy objects close to the body
Avoid or divide overhead work
Sleep and Recovery:
Don't sleep on the shoulder
Suitable pillow for good neck posture
Reduce stress (often leads to tension)
Frequently Asked Questions: Myths and Facts About Shoulder Pain
How long does it take for shoulder pain to go away?
This depends on the cause:
Muscle tension: 3-7 days
Tendon inflammation: 2-6 weeks
Impingement: 6-12 weeks
Frozen shoulder: 1-3 years
After surgery: 3-6 months
Important: With proper treatment, healing time is often significantly shortened!
Can I continue working with shoulder pain?
In most cases yes, but with adjustments:
Use ergonomic aids
Take regular breaks
Avoid stressful activities
Discuss accommodations with employer
For severe pain: sick leave
What's the best sleeping position with shoulder pain?
Recommended:
Back position with pillow under the arm
Healthy side with pillow between arms
Upper body slightly elevated
Avoid:
Lying on the painful shoulder
Arm over head
Stomach position with twisted neck
Do heat patches help with shoulder pain?
Yes, for tension and chronic pain:
8-12 hours of effect
Promote blood circulation
Loosen muscles
Ideal for on-the-go
Use cold for acute inflammation instead!
When do I need an MRI of the shoulder?
An MRI is useful for:
Suspected tendon tear
Unclear pain lasting over 6 weeks
Before planned surgery
After unsuccessful therapy
Not necessary for:
Clear muscle tension
Beginning complaints
Clear diagnosis
Can stress cause shoulder pain?
Absolutely! Stress leads to:
Muscle tension
Poor posture
Increased pain perception
Delayed healing
Stress management is therefore an important part of therapy!
