Shoulder pain that has lasted months usually has a specific, identifiable cause. A London shoulder surgeon explains what persistent pain tends to mean and when it is worth getting assessed.
Shoulder pain that has been there for months does not usually mean something sinister. What it usually means is that a specific structure in the shoulder is irritated, torn, tight or worn, and that whatever you have tried so far has not addressed it.
That is a more hopeful answer than it sounds, because it means there is something identifiable to find. Most persistent shoulder pain we see turns out to have a clear cause, and most of it is treated without an operation.
This guide covers why shoulder pain lingers when other pains fade, what the common causes are, what an assessment actually involves, and where the line is between reasonable patience and waiting too long.
A few things make the shoulder unusually good at holding onto a problem.
It never gets to rest. You cannot put a shoulder down. It is involved in dressing, driving, carrying, reaching and turning over in bed, so an irritated tendon is disturbed dozens of times a day.
It stiffens quickly and quietly. Shoulders that hurt get used less, and shoulders that get used less get tight. That tightness then becomes a second problem sitting on top of the first, and it can outlast the thing that started it.
The diagnosis is genuinely easy to get wrong. Frozen shoulder and rotator cuff problems are regularly mistaken for each other, and the treatments differ. Our most-read guide covers how to tell them apart: frozen shoulder vs rotator cuff.
Often it is not the shoulder. Neck problems refer pain into the shoulder and down the arm convincingly enough that people treat the shoulder for months.
Rotator cuff problems. The most common cause of persistent shoulder pain in adults. Tendon irritation, impingement, partial tears and full tears all produce a similar picture: pain reaching overhead or behind your back, difficulty lying on that side, and weakness that is often mistaken for stiffness. Whether a tear needs repairing depends on the tear, which we cover in can a rotator cuff tear heal on its own?
Frozen shoulder. A deep, constant ache that is worst at night, followed by progressive stiffness in every direction, including when someone else moves the arm for you. It has a long natural course, which is why people end up putting up with it for so long. Keyhole surgery for frozen shoulder covers what happens when injections and physiotherapy are not enough.
Calcific tendinitis. Calcium deposited in a cuff tendon, which can grumble quietly for months and then flare into severe pain. It is often treatable without an operation.
Acromioclavicular joint arthritis. Wear in the small joint on the top of the shoulder. Typically a well-localised pain on the top, worse reaching across your body.
Shoulder arthritis. Wear of the ball-and-socket joint itself, giving deep pain, grinding and gradual loss of movement, usually in older patients or after previous injury.
Instability. Shoulders that have dislocated or that slip partway can ache persistently between episodes, and the pain is sometimes what brings people in rather than the instability. See keyhole shoulder stabilisation.
Referred pain from the neck. Pain that runs below the elbow, or comes with pins and needles or numbness, raises this. So does pain that changes with neck position rather than arm position.
Working out which of these you have is the whole point of an assessment, and it is an assessment rather than a commitment to surgery. You can book an appointment with Mr Baring here.
Most people with long-standing shoulder pain have already done something about it. Physiotherapy, usually. Sometimes an injection. Often both, more than once.
Here is the honest position on that. Physiotherapy is the right first treatment for a large proportion of shoulder problems, and for many people it works. But there is a category of shoulder where more physiotherapy alone is not going to change the outcome, and that includes a tendon that has torn fully off the bone, a calcium deposit sitting in a tendon, and a worn joint surface. In those shoulders, another block of the same exercises mostly buys time.
The trap is that repeating a treatment feels more cautious than getting a diagnosis, when it is often the opposite. A scan and an examination take an afternoon. Six more months of doing the wrong thing takes six months.
Two more honest points, because this cuts both ways:
And to say it plainly: it's just wear and tear is not a diagnosis. Wear is extremely common on scans in people with no pain at all. If someone has told you that and nothing has improved, it is reasonable to ask what specifically is causing your symptoms.
In my experience: Mr Toby Baring
What do people with long-standing shoulder pain typically say when they finally come in, and what would you say back?
The sentence I hear most often is that they did not want to waste anyone's time. People arrive apologising, having had the pain for a year, having stopped swimming, stopped sleeping on that side and quietly rearranged their life around it. What I would say to anyone in that position is that a shoulder assessment is a diagnostic exercise, not a route into surgery. I examine the shoulder, look at a scan, and tell you what is actually wrong with it. Sometimes that means an operation. More often it means an injection, or a specific physiotherapy plan, or reassurance that what you have will settle. All three of those are better than another year of not knowing.
You should come out with a name for the problem and a plan, including what happens if the first step does not work.
As a rule of thumb, get a shoulder assessed if:
Sooner if the pain followed an injury, or if it comes with any of these: fever or feeling generally unwell, unexplained weight loss, a history of cancer, a hot swollen joint, or pain that is constant and unaffected by position or movement. These are uncommon, and they are exactly what an assessment is designed to identify or rule out.
Mr Baring sees patients in London, usually within days rather than months, and can arrange the imaging needed to reach a diagnosis quickly. A consultation is an assessment, not a commitment to surgery, and for many people it ends with an injection and a physiotherapy plan.
Consultations are covered by all major private medical insurers, including Bupa, AXA Health, Aviva and Vitality, and self-paying patients are welcome.
Book an appointment or call 07561 812 682.
How long is too long to have shoulder pain? Six weeks without clear improvement is a reasonable point to get it looked at, and sooner if it is disturbing your sleep, the shoulder is stiffening, or the arm is weak. Many people wait a year or more, usually because they assume nothing can be done.
Can shoulder pain go away on its own? Plenty of it does. Muscle strains and mild tendon irritation often settle within a few weeks with sensible use and time. What tends not to resolve on its own is a contracted capsule, a full-thickness tendon tear, a calcium deposit or a worn joint.
Why does my shoulder hurt but scans show nothing? It happens, and it does not mean the pain is imaginary. Scans can miss the timing of an inflammatory problem, the pain can be coming from the neck, or the imaging may not have been the right type for the structure involved. An examination by someone who assesses shoulders all week is often more informative than another scan.
Do I need a GP referral to see a shoulder specialist? You can book a private consultation directly. If you plan to use private medical insurance, most insurers do require a GP referral first, so it is worth checking your policy before booking.
Will I be told I need surgery? Not necessarily, and most people are not. A large proportion of persistent shoulder pain is treated with injections, physiotherapy or a change of approach. Where surgery is recommended, you should be told why, what the alternatives are and what the risks are, and then given time to think.
Is shoulder pain ever a sign of something other than a shoulder problem? Occasionally. Neck problems refer pain into the shoulder, and pain in the shoulder region can rarely come from the chest, gallbladder or lung. Sudden severe shoulder or arm pain with chest tightness, breathlessness or sweating needs emergency assessment rather than a shoulder appointment.
Mr Toby Baring is a consultant orthopaedic surgeon specialising in shoulder and elbow surgery, with a particular interest in arthroscopic rotator cuff repair, shoulder instability surgery and shoulder replacement.Read more about Mr Baring or book an appointment.
