Shoulder Pain: Causes and Symptoms
Shoulder pain that makes it difficult to lift your arm, get dressed, reach overhead or sleep comfortably can affect far more than just your shoulder. At Healthy Bones and Joints Clinic in Margao, Dr. Amol Narkhede assesses shoulder pain by first understanding your symptoms, examining how your shoulder moves and identifying what may be causing the problem. Whether your pain is related to a tendon injury, frozen shoulder, arthritis or another condition, the aim is to establish the cause and discuss treatment options suited to your needs.
Shoulder pain can develop gradually or begin suddenly after a fall, accident, lifting injury or sporting activity. It may originate from the shoulder joint itself, the muscles and tendons surrounding it, or structures in the neck that affect the shoulder and arm.
Identifying the underlying cause is important because different shoulder conditions can produce similar symptoms but require different approaches to treatment.
Common causes of shoulder pain
Rotator cuff injuries
The rotator cuff is a group of muscles and tendons that helps keep the shoulder stable and allows you to lift and rotate your arm. Tendon irritation, degeneration or a tear can cause pain when raising your arm, reaching overhead or lying on the affected shoulder.
Frozen shoulder
Frozen shoulder causes progressive pain and stiffness, making it increasingly difficult to move the arm. You may struggle to reach behind your back, dress yourself or raise your hand above your head. The restriction affects both movements you perform yourself and certain movements when someone else moves your arm.
Shoulder arthritis
Arthritis can damage the cartilage within the shoulder joint, leading to pain, stiffness and reduced movement. Symptoms may develop gradually and become more noticeable during everyday activities. In advanced cases, pain can persist even when the shoulder is resting or disturb sleep.
Shoulder impingement and tendon problems
Pain may develop when structures around the shoulder become irritated during particular movements. You might notice discomfort when lifting your arm sideways, reaching overhead or performing repetitive activities. Tendon inflammation and related conditions can cause similar symptoms.
Bursitis
The small fluid-filled sacs that help reduce friction around the shoulder can become irritated and inflamed. This may produce pain during movement, particularly when raising the arm or lying on the affected side.
Shoulder dislocation and instability
A dislocation occurs when the upper arm bone moves out of its normal position in the shoulder socket. Some people also experience recurrent instability, in which the shoulder feels as though it might slip out of place.
Fractures and traumatic injuries
Falls, road accidents and other injuries can damage the bones around the shoulder. Significant injuries may also affect the surrounding tendons, ligaments and other soft tissues.
Pain originating from the neck
Not all pain around the shoulder comes from the shoulder joint itself. Problems affecting nerves in the neck can cause pain that travels into the shoulder or arm, sometimes accompanied by tingling, numbness or weakness.
What shoulder pain can feel like
Patients experiencing shoulder problems may notice:
- Pain when lifting the arm above the head
- Difficulty reaching behind the back
- Pain while dressing, bathing or combing the hair
- Discomfort when lifting or carrying objects
- Shoulder stiffness, particularly after periods of rest
- Pain that becomes worse when lying on the affected side
- Difficulty sleeping because of shoulder discomfort
- Weakness when lifting or rotating the arm
- Clicking, catching or a sensation of instability
- Reduced ability to move the shoulder freely
- Pain spreading from the neck into the shoulder or arm
- Tingling or numbness in the arm or hand
The combination of symptoms matters. For example, pronounced stiffness may suggest a different problem from pain and weakness when lifting the arm. A shoulder that becomes painful after an injury also needs to be assessed differently from one that has gradually become stiff over several months.
How Dr. Narkhede Evaluates Shoulder Pain
At Healthy Bones and Joints Clinic, the consultation begins with listening.
Dr. Amol Narkhede gives patients time to describe their symptoms before proceeding to a physical examination. Rather than treating every shoulder complaint in the same way, he asks questions based on the problem you are experiencing.
For shoulder pain, this may include when the pain started, whether there was an injury, which movements aggravate it, whether you can raise your arm, whether you experience stiffness and whether the discomfort affects your sleep or everyday activities.
He also considers symptoms such as weakness, clicking, instability, tingling or pain travelling from the neck into the arm. These details help establish which structures may be involved.
The physical examination
Depending on your symptoms, Dr. Narkhede may examine your shoulder while you are sitting or standing, or ask you to lie on the examination bed.
You may be asked to raise your arm, rotate it, reach in particular directions or perform specific movements. He may also move your arm himself to assess its range of motion and understand where pain or restriction occurs.
The examination is tailored to the suspected problem. Restricted movement may require a different assessment from suspected rotator cuff injury, shoulder instability or arthritis.
The findings are considered alongside your medical history and symptoms to determine the likely cause and whether further investigation is needed.
When is an X-ray or MRI required?
Not every patient with shoulder pain needs imaging.
If an X-ray is indicated, Healthy Bones and Joints Clinic has digital radiography X-ray facilities on the same floor as the consultation rooms. This allows you to have the required X-ray at the clinic rather than searching for a separate imaging facility.
Once the image is available, you return to Dr. Narkhede, who reviews the findings and explains what they may mean in relation to your symptoms and examination.
X-rays can help assess the bones, joint alignment and certain changes associated with arthritis or fractures. An MRI may be considered when further information about the rotator cuff, other tendons or additional soft-tissue structures is needed.
The appropriate investigation depends on the suspected condition. Imaging is used to answer a clinical question rather than being ordered automatically for every shoulder complaint.
Shoulder Pain Treatment Options
Treatment depends on the underlying diagnosis, the severity of the symptoms and how much the problem affects your daily life. Many shoulder conditions can initially be managed without surgery, while certain injuries or advanced joint problems may require a different approach.
Activity modification and movement
Some shoulder problems improve with temporary changes to activities that aggravate the symptoms. This may involve reducing repetitive overhead movements, avoiding painful lifting or adjusting certain daily activities while maintaining appropriate movement.
Complete and prolonged avoidance of shoulder movement is not advisable for many conditions because stiffness can become a further problem. The appropriate balance between rest and movement depends on the diagnosis.
Medication for pain and inflammation
Medication may be considered when shoulder pain interferes with sleep, movement or everyday activities.
Dr. Narkhede takes a measured approach to prescribing and considers whether medication is actually needed. The choice depends on the suspected cause, symptom severity, medical history and other medicines the patient may be taking.
Pain medication is not a substitute for identifying the underlying problem. Where medication is recommended, its intended role and appropriate use should be explained.
Physiotherapy and rehabilitation
Physiotherapy can be an important part of treating shoulder stiffness, certain tendon problems and recovery following some injuries.
At Healthy Bones and Joints Clinic, physiotherapy is available through Dr. Rucha Narkhede (PT), consultant physiotherapist (orthopaedics and sports), within the same clinic.
Depending on your diagnosis, rehabilitation may involve exercises to improve shoulder movement, strengthen supporting muscles, restore function and gradually return you to normal activities.
Dr. Rucha demonstrates the prescribed exercises so that you can understand how to perform them correctly. If you would find it helpful, she can also record you performing the exercises correctly on your own phone, giving you a reference when practising at home.
The clinic has separate treatment rooms and equipment for physiotherapy modalities, including electrotherapy when clinically indicated.
Physiotherapy is not identical for every shoulder problem. A patient with frozen shoulder may require a different rehabilitation approach from someone recovering from a tendon injury. The programme should reflect the condition and the patient’s stage of recovery.
Injections and other non-surgical treatments
Certain patients may be considered for an injection or another non-surgical intervention when symptoms persist or particular conditions warrant it.
These treatments are not appropriate for every shoulder problem. The decision depends on the diagnosis, expected benefits, potential limitations and available alternatives.
Shoulder surgery
Surgery may be considered when a particular structural problem is unlikely to improve sufficiently with conservative treatment, or when the nature of the injury makes an operation the preferred option.
The type of surgery depends on the diagnosis. Some tendon injuries or shoulder instability problems may be treated with arthroscopic procedures, while severe arthritis or certain complex fractures may require shoulder joint replacement.
Dr. Narkhede has extensive experience in joint replacement surgery, including more than 500 shoulder joint replacements, alongside his broader experience in orthopaedic surgery.
For patients with advanced shoulder arthritis, joint replacement may be considered when pain and loss of function substantially affect daily life and non-surgical treatments have not provided sufficient relief.
However, shoulder pain alone is not an indication for joint replacement. The decision depends on the underlying condition, examination findings, imaging, functional limitations and the expected benefits and risks of surgery.
When Should You See an Orthopaedic Specialist for Shoulder Pain?
Mild shoulder discomfort following an unusual activity may settle with appropriate self-care and temporary activity modification.
However, an orthopaedic assessment is worth considering when:
- Shoulder pain persists for more than a couple of weeks without improvement
- Pain keeps returning or is progressively worsening
- You have difficulty raising your arm or reaching overhead
- Shoulder stiffness interferes with dressing, bathing or other daily activities
- Pain regularly disturbs your sleep
- You experience weakness when lifting or rotating your arm
- The shoulder repeatedly feels unstable or as though it may slip out of place
- You have persistent pain following a fall, accident or sporting injury
- You experience shoulder pain alongside tingling, numbness or weakness in the arm
When shoulder pain needs urgent attention
Seek urgent medical assessment if you develop sudden, severe shoulder pain, cannot move your arm, have a visibly deformed or severely swollen shoulder, or experience persistent loss of sensation.
A hot, red or unusually painful shoulder accompanied by fever or feeling unwell also needs prompt assessment.
If shoulder pain occurs alongside chest pressure, breathlessness, sweating or pain spreading to the jaw or arm, seek emergency medical attention because these symptoms can indicate a heart-related emergency rather than a shoulder problem.
Your Care Journey at Healthy Bones and Joints Clinic
Your care begins by contacting Healthy Bones and Joints Clinic by phone or WhatsApp to enquire about a consultation with Dr. Amol Narkhede.
During the consultation, you can explain your symptoms in your own words. Dr. Narkhede takes time to understand the problem, asks questions relevant to your symptoms and examines how your shoulder moves.
If an X-ray is required, digital radiography facilities are available on the same floor as the consultation rooms. Once the image is available, you return to Dr. Narkhede, who reviews the findings and explains how they relate to your symptoms and examination.
He then discusses the likely diagnosis, answers your questions and explains the available treatment options.
Depending on the condition, the next step may involve medication, activity modification, physiotherapy, additional investigations or consideration of surgery.
If physiotherapy is recommended, you can also consult Dr. Rucha Narkhede within the same clinic. She can explain the exercises and rehabilitation approach suited to your condition.
The aim is to help you understand what may be causing your shoulder pain and what the available treatment options mean for you, rather than leaving you with an unexplained diagnosis or investigation report.
