Shoulder pain: What helps?

Photo of an athlete holding his shoulder in discomfort

Shoulder pain is typically felt on the outer side of the shoulder and is more noticeable when you lift your arm. It can be relieved with anti-inflammatory painkillers, steroid injections and physical therapy.

Shoulder pain usually arises under the “roof” of the shoulder, known as the acromion. The medical term for this kind of pain is “subacromial pain” (subacromial = under the acromion).

This pain can be caused by

  • Pinched or trapped tissue under the acromion (shoulder impingement)
  • Torn rotator cuff tendons due to “wear and tear”
  • Calcium deposits in certain shoulder tendons
  • Bursitis (an in the small, fluid-filled sacs often found near joints in the body)

It is often not possible to find out exactly what’s causing shoulder pain. That’s partly because there’s no clear link between the symptoms people have and things that can be seen in x-ray, ultrasound or MRI images. For instance, a lot of people don’t have shoulder pain even though these images show that there are tears in the rotator cuff (a group of muscles and tendons that surround the shoulder joint) or deposits in the shoulder tendons.

What can I do myself?

If you have shoulder pain, it’s a good idea to avoid activities that make the pain worse. These may include things like working on something above your head, lifting and carrying heavy objects, or doing sports that put a lot of strain on the shoulder. It’s also best to avoid sleeping on the affected side of the body.

Although you should go easy on the shoulder, it’s still important to continue moving it. Not moving the shoulder at all can make the muscles weaker and also cause it to become stiff. To gently mobilize the shoulder, you could do the following simple exercise, for example:

  • Place the hand on the “pain-free” side of your body on a table or chair for support,
  • lean forward a little and let the other arm hang down,
  • then gently swing the whole arm in small circular motions, or back and forth.

You can do this exercise two to three times a day for one to two minutes at a time.

Anti-inflammatory (inflammation-reducing) painkillers like ibuprofen can relieve shoulder pain somewhat. But they shouldn’t be taken for longer than two weeks. An alternative to tablets, with fewer side effects, is treatment with creams and gels containing diclofenac. These are applied to the shoulder two to three times a day. They are also suitable for people who can’t take tablets because their kidneys or liver don’t work properly or because they have a stomach ulcer.

When should you see a doctor?

Shoulder pain usually isn’t caused by anything serious, but it’s still a good idea to seek medical advice if:

  • the shoulder joint feels unstable or was recently dislocated,
  • the shoulder is red, warm or swollen,
  • the shoulder is injured following an accident,
  • numbness or signs of paralysis occur,
  • the pain is very bad, or
  • the arm is very weak or you can't move it properly.

What helps relieve severe pain?

If the pain is very bad, the doctor can inject steroids into the shoulder. This can reduce the pain and make it easier to move the shoulder. But it’s important not to have too many steroid injections because they can weaken the tendons and cartilage. In the two days after having the injection, you should avoid activities that put strain on the shoulder.

Steroid injections can irritate the skin where the needle is inserted and – if you have several injections – make the skin turn lighter. Serious complications such as an of the joint are rare, though.

Can physical therapy help?

Having weak shoulder muscles, ligaments and tendons can increase the likelihood of shoulder pain: The shoulder is a very movable joint that is mainly kept stable by the muscles. If the shoulder muscles are weak, the head of the upper arm bone (humerus bone) may “fall” out of the socket. This can be painful if it pushes against the surrounding soft tissue. Physical therapy can help to strengthen and stabilize the shoulder.

Physical therapy is a suitable treatment for shoulder pain under the acromion (subacromial pain). Research has shown that it can relieve the pain and improve the function of the shoulder.

The physical therapy exercises should aim to

  • improve the range of movement (mobility) of the shoulder,
  • strengthen the muscles in the shoulder blade and rotator cuff, and
  • improve your overall posture.

The physical therapist should also tell you how you can move the shoulder more gently. Research has shown that the treatment should last 8 to 16 weeks. The exercises that are recommended will depend on the symptoms and circumstances.

It is important

to do the exercises at home or at work, too. Research has found that continuing the exercises you learn in physical therapy on your own and doing them correctly is just as effective as doing the exercises under the supervision of a therapist.

Why is surgery often not recommended?

If the shoulder pain is thought to be caused by impingement, surgery can be done to widen the space under the acromion (the subacromial space). This is meant to get rid of the cause of pain. The surgery involves trimming off parts of the acromion and removing the bursa during an arthroscopy (keyhole) procedure. The medical term for this type of surgery is “subacromial decompression.” But it usually doesn’t help and, like all operations, it is associated with risks.

Two systematic reviews of studies looked into the pros and cons of subacromial decompression. In these studies, some people had this surgery and others only thought they had had the surgery (placebo). After comparing the outcomes, the researchers concluded that there were no differences between decompression surgery and placebo surgery. In other words: Subacromial decompression surgery didn’t lead to clear relief of the symptoms (see illustration: Shoulder pain with and without surgery).

Illustration: Shoulder pain with and without surgery

Surgery might help if the acromion is hooked (a “type III acromion”) rather than flat. The tip of the shoulder blade curves down more than usual here, which can make the space under the acromion even narrower (see illustration: Normal and hooked acromion). But only a small number of people in the studies had a hooked acromion. Because of this, it’s not clear whether surgery would help them.

Illustration: Normal and hooked acromion (side view of the right shoulder)

If a doctor recommends having shoulder arthroscopy surgery, it’s a good idea to discuss the pros and cons of this treatment with each other. She or he should then also inform you that you can get a second medical opinion from a different doctor.

Many experts only recommend considering surgery if the person has already had thorough treatment with physical therapy or steroids and it didn’t lead to an improvement.

Surgery can lead to complications such as wound healing problems, thrombosis and – in very rare cases – nerve damage. Overall, complications occur in about 1 out of 100 operations. And about 1 out of 100 people have a frozen shoulder after the operation. The risk of this is greater in women and people who have diabetes.

When can shock wave therapy help?

Some people who have shoulder pain have deposits in their shoulder tendons (calcific tendinitis of the shoulder). You can see them in x-ray images. These deposits often go away on their own after a while.

One treatment for deposits is known as shock wave therapy. The medical term for this treatment is “extracorporeal shock wave therapy” or ESWT for short. It involves passing high pressure sound waves through the skin from outside the body, targeting the deposits in order to break them up.

Some doctors still use shock wave therapy even if no deposits have formed. They hope that the shock waves will stimulate the healing process by releasing certain growth and increasing blood flow.

One systematic review of studies suggests that shock wave therapy can relieve pain and improve the functioning of the shoulder joint. These studies compared ESWT with a placebo (fake) treatment. But the review does not provide for clear recommendations. That is because the studies were relatively small, and some showed contradictory results. The shock wave therapy was also tested at different dosages. In addition, the effect on the symptoms was sometimes so small that it is unclear whether it was always even noticeable.

Because shock wave therapy can be painful, people are often given painkillers and/or an anesthetic beforehand. But the treatment can still be painful. Shock wave therapy can lead to bruising and reddening of the skin.

Important:

If you live in Germany, it's important to know that the costs of shock wave therapy are currently not covered by German statutory health insurers. You have to pay for this kind of treatment yourself. The costs can add up to several hundred euros, depending on the exact method used, the number of sessions and how long they last.

What other treatments are there – and can they help?

Many other treatments are available for subacromial shoulder pain, but they haven’t been proven to work. They include the following:

  • Acupuncture
  • Hyaluronic acid injections
  • Injections of platelet-rich plasma (PRP) made from your own blood
  • Interferential current therapy
  • (Kinesiology) Taping
  • Light therapy
  • Low-level laser therapy
  • (Pulsed) Electromagnetic field therapy
  • Massages
  • Microwave diathermy
  • Transcutaneous electrical nerve stimulation (TENS)
  • Trigger point therapy
  • Ultrasound waves

The costs of most of these approaches aren’t covered by German statutory health insurers, so you have to pay for them yourself.

Deutsche Vereinigung für Schulter- und Ellenbogenchirurgie (DVSE), Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU). Subacromiales Impingement (S2e-Leitlinie) AWMF-Registernr.: 087-060. 2021.

Diercks R, Bron C, Dorrestijn O et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop 2014; 85(3): 314-322.

Garving C, Jakob S, Bauer I et al. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int 2017; 114(45): 765-776.

Gill TK, Shanahan EM, Allison D et al. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Int J Rheum Dis 2014; 17(8): 863-871.

Gray M, Wallace A, Aldridge S. Assessment of shoulder pain for non-specialists. BMJ 2016; 355: i5783.

Karjalainen TV, Jain NB, Page CM et al. Subacromial decompression surgery for rotator cuff disease. Cochrane Database Syst Rev 2019; (1): CD005619.

Kulkarni R, Gibson J, Brownson P et al. Subacromial shoulder pain. Shoulder Elbow 2015; 7(2): 135-143.

Lähdeoja T, Karjalainen T, Jokihaara J et al. Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. Br J Sports Med 2020; 54(11): 665-673.

Liaghat B, Ussing A, Petersen BH et al. Supervised Training Compared With No Training or Self-training in Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 102(12): 2428-2441.

Liu TC, Leung N, Edwards L et al. Patients Older Than 40 Years With Unilateral Occupational Claims for New Shoulder and Knee Symptoms Have Bilateral MRI Changes. Clin Orthop Relat Res 2017; 475(10): 2360-2365.

Page MJ, Green S, Mrocki MA et al. Electrotherapy modalities for rotator cuff disease. Cochrane Database Syst Rev 2016; (6): CD012225.

Steuri R, Sattelmayer M, Elsig S et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med 2017; 51(18): 1340-1347.

Surace SJ, Deitch J, Johnston RV, Buchbinder R. Shock wave therapy for rotator cuff disease with or without calcification. Cochrane Database Syst Rev 2020; (3): CD008962.

Tran G, Cowling P, Smith T et al. What Imaging-Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review. Arthritis Care Res (Hoboken) 2018; 70(8): 1169-1184.

Whittle S, Buchbinder R. In the clinic. Rotator cuff disease. Ann Intern Med 2015; 162(1): ITC1-15.

Yu H, Côté P, Shearer HM et al. Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration. Phys Ther 2015; 95(3): 306-318.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by gi-kontakt@iqwig.de. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Updated on April 22, 2024

Next planned update: 2027

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

Stay informed

Subscribe to our newsletter or newsfeed. You can find our growing collection of films on YouTube.