Shoulder Pain

The shoulder trades stability for range: it moves further than any other joint in the body, and it depends on muscle rather than bone to stay controlled. That is why the rotator cuff — four muscles that hold the ball centred in the socket — is the source of most shoulder pain.

What it usually feels like

Pain on the outer upper arm rather than the joint itself. Reaching overhead, out to the side, or behind the back provokes it. Lying on that side at night is uncomfortable. Many people describe a painful arc — pain appearing partway through raising the arm and easing again near the top.

The common causes

• Rotator cuff tendinopathy — the tendon overloaded beyond what it can tolerate. By far the most common.
• Subacromial pain — the tendon and bursa irritated in the space beneath the bony arch.
• Rotator cuff tear — partial tears are common with age and frequently symptomless; full tears cause more definite weakness.
• Instability — more common in younger people and throwing athletes.
• Frozen shoulder — distinguished by loss of movement in every direction, including when someone else moves the arm.

How physiotherapy helps

Assessment first, because these are treated differently. Then, for the great majority:

• Progressive loading of the rotator cuff — the single most effective intervention
• Restoring shoulder blade control, which is almost always part of the problem
• Hands-on treatment for the associated stiffness in the shoulder and upper back
• Adjusting the aggravating loads temporarily rather than stopping using the arm

How long it takes

Rotator cuff problems typically need eight to twelve weeks of consistent strengthening. Improvement in the first two weeks is common; stopping there is the usual reason it returns.

When to seek help urgently

Inability to lift the arm at all after a fall, obvious deformity, or shoulder pain accompanied by chest pain or breathlessness — the last needs emergency assessment, not a physiotherapist.