Shoulder pain - Treatment 

Treating shoulder pain 

Dislocated shoulder

If your shoulder is dislocated (the ball has come out of the socket), visit the nearest accident and emergency (A&E) department immediately.

The healthcare professionals at the hospital will put the ball of your upper arm bone (humerus) back into the joint socket. This procedure is called a reduction.

After a reduction, you will need to rest your arm by wearing a sling (supportive bandage) for a few weeks. You may also be prescribed pain relief medication. 

Your physiotherapist will show you exercises to help regain the strength in your shoulder muscles.

Read more information about a dislocated shoulder.

Pain: keep active

If you're in pain, keeping active will help as stiffening up can make pain worse.

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for shoulder pain

The type of treatment offered for your shoulder pain will depend on the underlying cause and your symptoms.

Options such as heat or ice packs and painkillers may help reduce pain and treat minor injuries at home. 

You should see your GP if your pain is the result of an injury, it's particularly bad, or if there is no sign of the pain improving after a couple of weeks.

Your GP may refer you to an orthopaedic surgeon (a specialist in conditions that affect the bones and muscles) or rheumatologist (a specialist in conditions that affect the muscles and joints) if you have: 

  • a frozen shoulder that does not improve after six months
  • a rotator cuff disorder that does not improve after three to six months
  • an acromioclavicular joint disorder that does not improve after three months
  • a rotator cuff tear
  • shoulder instability and you are under 30 years old  

Treatment options

The main treatment options for shoulder pain include:

  • avoiding activities that make your symptoms worse
  • using ice packs
  • painkillers
  • anti-inflammatories
  • physiotherapy 
  • surgery (in some cases)

These are described in more detail below, and you can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

As well as pain, you may also have reduced strength or movement in your shoulder. In this case, a combination of different treatments may be used.

Read more about treating frozen shoulder.

Avoiding activities

Depending on what is causing your shoulder pain, your GP may recommend you avoid certain activities or movements that may make your symptoms worse.

For example, in the early, painful stage of frozen shoulder, you may be advised to avoid activities that involve lifting your arms above your head. However, you should continue using your shoulder for other activities, because keeping it still could make your symptoms worse.

If you have shoulder instability, you may be advised to avoid any movements that are likely to make the instability worse, such as overarm throwing.

If you have sprained your acromioclavicular joint (the joint at the top of your shoulder), you may be advised to avoid moving your arm across your body. You may also be given a sling (a supportive bandage) to wear to support your arm for up to a week after your injury.

Ice packs

If you injure your shoulder, for example while playing sport, you can apply an ice pack to the affected area to reduce inflammation and pain.

You should apply the ice pack for 10-30 minutes. A bag of frozen peas, or similar, will also work well. Wrap the ice pack in a towel to avoid it directly touching your skin and causing ice burn.

Painkillers

If your pain is mild, taking painkillers such as paracetamol or codeine may be enough to control it. Always follow the dosage instructions on the packet to ensure the medicine is suitable and that you do not take too much.

If your shoulder pain is more severe, your GP may recommend or prescribe a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, diclofenac or naproxen.

As well as easing the pain, NSAIDs can also help reduce swelling in your shoulder capsule. They are most effective when taken regularly rather than when your symptoms are most painful.

Corticosteroid tablets

Corticosteroids are medicines that contain steroids, which are a type of hormone. Hormones are powerful chemicals that have a wide range of effects on the body, including reducing swelling and pain.

You may be prescribed corticosteroid tablets for frozen shoulder. Some evidence suggests these may provide short-term pain relief for a few weeks. However, it is not clear whether corticosteroid tablets are any better than other treatment options, such as corticosteroid injections.

Corticosteroid tablets can also cause a number of side effects. 

Read more about the side effects of corticosteroids.

Corticosteroid injections

If your shoulder pain is severe, such as in certain cases of frozen shoulder, painkillers may not be enough to control the pain. In this case, you may have corticosteroids injected into and around your shoulder joint.

Corticosteroid injections can help relieve pain caused by frozen shoulder and increase your range of movement for several weeks at a time, particularly during the first stage of symptoms. However, the injections cannot cure your condition completely and your symptoms will gradually return.

Research also suggests that corticosteroid injections can provide pain relief for up to eight weeks for tendonitis (inflammation of a tendon). They may also improve your ability to use your shoulder, although they may not be as effective as some other treatments, such as NSAIDs.

One study found corticosteroid injections may be most effective if used within 12 weeks of tendonitis symptoms starting. However, some experts believe the use of corticosteroid injections should be delayed for as long as possible.

Cautions

After having a corticosteroid injection, you may experience side effects at the site of the injection. These may include:

  • temporary pain
  • lightening of your skin
  • thinning of your skin 

Having too many corticosteroid injections can damage your shoulder. Therefore, you may only be able to have this treatment up to three times in the same shoulder in one year.

Read about corticosteroids for more information about this type of medication.

Hyaluronate injections

Hyaluronate is another medicine that can be injected into your shoulder to treat shoulder pain. One review of a number of studies found that hyaluronate was effective at reducing pain.

However, the National Institute for Health and Care Excellence (NICE) does not recommend hyaluronate to treat osteoarthritis (a condition that affects the joints). It found that hyaluronate only had small benefit and that corticosteroid injections were a better treatment choice. Therefore, hyaluronate may not be used for this condition.

Physiotherapy

If you are referred to a physiotherapist, they should explain to you what treatment they will use and how it will work. Learn more about physiotherapy.

Possible treatments include: 

TENS is a type of physiotherapy where small electrical pads (electrodes) are stuck to the skin over your shoulder. The TENS machine delivers small pulses of electricity through the electrodes, which numb the nerve endings and control your pain.

As well as these treatment methods, your physiotherapist may also recommend shoulder exercises specific to your needs. For example, if you have shoulder instability, you may be given exercises that will strengthen your shoulder.

Shoulder exercises

If you have shoulder pain, it is important to keep your shoulder joint mobile by doing gentle, regular exercise. Not using your shoulder can cause your muscles to waste away and may make any stiffness worse. Therefore, if possible, you should continue using your shoulder as normal.

If your shoulder is very stiff, exercise may be painful. Your GP or physiotherapist can give you exercises to do without further damaging your shoulder.

You may be given exercises to do on your own, or you may complete the exercises with supervision from your GP or physiotherapist. You may also have manual therapy, where the healthcare professional moves your arm for you. Manual therapy uses special techniques to move the joints and soft tissues in your shoulder.

One review of a number of studies found long-term physiotherapy was as effective as surgery for impingement syndrome (any type of damage to the tendons in the rotator cuff).

Surgery for frozen shoulder

If other treatments for frozen shoulder have not worked, you may be referred for surgery. There are two possible surgical procedures explained in more detail below.

Manipulation

Manipulation involves having your shoulder moved while you are under general anaesthetic. During the procedure, your shoulder will be gently moved and stretched while you are asleep.

Afterwards, you will usually need to have physiotherapy to help maintain mobility in your shoulder. Manipulation may be used if you are finding the pain and disability from your shoulder difficult to cope with.

Arthroscopic capsular release

An alternative procedure to manipulation is arthroscopic capsular release. This is a type of keyhole, or non-invasive, surgery. The surgeon will carry out the procedure after making an incision that is less than 1cm (0.4in) long. A special probe opens up your contracted shoulder capsule and any bands of scar tissue are removed. This should greatly improve your symptoms.

As with manipulation, you will need physiotherapy after the surgery to help you regain a full range of movement in your shoulder joint.

Surgery for a rotator cuff tear

Surgery may be used to treat rotator cuff tears if the tear is large or if other treatment options have not worked after three to six months. It is possible that having surgery earlier will lead to a quicker recovery, although at the moment there is not enough research into whether early surgery is beneficial or not.

During the procedure, a small amount may be shaved off the bones in your shoulder. Damaged tendons and bursae (fluid-filled sacs found over joints and between tendons and bones) may also be removed. This creates more space within the joint to allow your rotator cuff to move freely.

The operation can be performed as:

  • open surgery – a large incision is made in your shoulder
  • mini-open surgery – a small incision is made in your shoulder 
  • arthroscopic surgery – a type of keyhole surgery that uses a camera to look inside your shoulder joint

Evidence suggests that people return to work about a month earlier if they have mini-open surgery rather than open surgery.

As with frozen shoulder surgery, you will need physiotherapy after your operation to help you regain a full range of movement in your shoulder joint.

Surgery for shoulder instability

If your shoulder dislocates (the ball comes out of the socket) regularly or severely, you may need surgery to prevent it happening again and to prevent surrounding tissues and nerves from becoming damaged. Depending on the type of instability you have, surgery may involve: 

  • tightening stretched ligaments or reattaching them if they have torn (ligaments are tough bands of connective tissue that link two bones together at a joint)
  • tightening the shoulder capsule by using heat to shrink it or tightening it with sutures (stitches)

Surgery for shoulder instability can either be done using keyhole or open surgery. After the operation, your shoulder will need to be immobilised (prevented from moving) using a special sling for several weeks. You will also need physiotherapy to improve your strength. Full recovery may take several months.

Page last reviewed: 26/10/2012

Next review due: 26/10/2014

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

StevenT said on 18 October 2014

Hello all, thanks for taking the time to help.
Over the last two years I've had excruciating pain in my shoulder(s) that feels as if someone is stabbing needles into my skin. I call it an 'Itch pain' as I feel the need to scratch the area with sandpaper, or even rip my shoulder out!
Doctors are baffled (had blood test, physiotherapy, cervical C5 root block etc) and nothing has worked. (Not sure if they look for everything in blood tests and MRI scans anyway)
But a neck MRI showed up a problem with the C5 disc that might be ‘pinching the nerve.’ BUT, the symptoms don't match those of nerve root issues, and an operation (C4/5 anterior discectomy and fusion) has just a 50% -60% success rate. The neck feels fine, yet exact lines in the front of my shoulders (mostly left) are painful. yet, not painful all the time!.....
What brings on the 'itch pain'? Sometimes; Sitting awkwardly, driving, reaching / stretching, lying on my side and restrictive or tight clothing. But, normally the pain does not begin straight away and can ‘attack’ even whilst sitting comfortably, later on. (I know that stressful situations can increase the pain but not necessarily cause it)
Any ideas as to the cause? I'm a driver for a living, and when an 'attack' hits, it almost causes me to crash. Seriously, it's that painful. GP’s are reluctant to do another MRI on the exact area (although one hasn't been done yet)

Thanks, here’s hoping!

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