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If you want to know more precisely, here are the key features of the most common triggers, precise rather than general.
With impingement, the space under the bony shoulder roof becomes too narrow, so that the supraspinatus tendon and the bursa below it are pinched during certain movements. Typical is pain when lifting to the side and overhead, often with the painful arc. Especially affected are people who work a lot overhead or do sport with throwing and overhead movements. The treatment is usually conservative, with physiotherapy as the most important building block.
With a calcific shoulder, calcium is deposited in a shoulder tendon, in around four out of five cases in the supraspinatus tendon. This runs in phases: for a long time it can stay quiet, then comes an often very intense, also nighttime pain flare. The good news is that the calcium frequently dissolves again on its own. If that does not help, shockwave therapy, a needling with aspiration of the calcium or a corticosteroid injection are proven options.
With shoulder osteoarthritis, the joint cartilage wears down. It is rarer than knee or hip osteoarthritis and often develops after injuries, instability or a long-standing impingement. Because cartilage has no pain sensors, the osteoarthritis is often felt only late. Typical are start-up pain after rest, a slowly decreasing mobility and later also pain at rest. Reaching behind the back becomes increasingly difficult.
With a frozen shoulder, the joint capsule thickens and becomes inflamed, making the shoulder increasingly stiff and painful. It typically runs in three phases, from the painful freezing through the stiff phase to the gradual thawing, which together can take many months. People with diabetes, among others, have a higher risk. It is important to keep the shoulder gently moving and to be patient.
With a few simple movements you get a feeling for where the symptoms might come from. Important: these tests are only a guide and do not replace a medical examination. Do them slowly and only as far as the pain allows.
Note which movements hurt and when. This later helps the medical practice to narrow down the cause more quickly.
Act immediately if
a sudden pain especially in the left shoulder or arm occurs together with pressure or tightness in the chest, shortness of breath, nausea or cold sweat. This can be a heart attack and is an emergency, call emergency services. You should also have a shoulder deformed after a fall, the inability to lift the arm, a hot, red and swollen joint with fever and shoulder pain with numbness or weakness in the arm medically assessed.
These warning signs are rare but important. In the vast majority of cases shoulder pain is harmless and treatable. With persistent or recurring symptoms, an orthopaedic assessment is still worthwhile.
For most shoulder pain the treatment follows a clear stepwise plan, from the simple to the more involved. This way you avoid unnecessary procedures and give the body the chance to heal on its own.
How the doctor finds the cause
It starts with the conversation and simple movement and strength tests, which already reveal a lot. To confirm, imaging methods help that complement each other well: ultrasound shows tendons, bursae and calcium deposits without radiation. X-ray shows the bones, calcium deposits and signs of osteoarthritis. MRI provides the most precise images of tendons, tears and the joint capsule. With this, impingement, a calcific shoulder and osteoarthritis can be reliably distinguished, which is the basis for the right, targeted treatment.
Which examination is needed is decided by the medical practice depending on the findings.
Which step makes sense for you depends on the exact cause and is decided in the medical practice. The order matters: first calm and move, then build up, then targeted procedures.
If shoulder osteoarthritis is behind the symptoms, the same principles apply as for other joints: movement, targeted muscle building and pain relief keep the joint functional as long as possible, complemented by injections and, in severe cases, an artificial joint. Read more in our article on osteoarthritis.
Sometimes shoulder pain is part of an inflammatory rheumatic condition that affects several joints. Clues are morning stiffness over a longer time, swelling in several joints or a general feeling of illness. Then a rheumatology assessment makes sense. Read more in our article on rheumatism. How shoulder pain fits into the bigger picture of joint pain is shown in the corresponding article.
Painkillers can bridge a painful phase so that you become mobile again. For inflammatory shoulder pain an anti-inflammatory such as ibuprofen or diclofenac often works well, short and at a low dose. On the question of heat or cold, a closer look pays off: in the acute, inflammatory phase, for example with a calcific shoulder, cooling is usually more comfortable, while heat can intensify an acute inflammation. With chronic, tension-related symptoms without acute inflammation, on the other hand, many find heat soothing. Anyone who regularly takes other medications, is pregnant or has pre-existing conditions should discuss the choice with a doctor or pharmacy. Read more on effect and caution on our page about ibuprofen.
So that short-term help does not become a permanent solution: brite helps you manage your remedies, get reminded of the maximum duration and check interactions.
A lot can be prevented by keeping the shoulder strong and mobile. Regularly include exercises for the rotator cuff and the shoulder blade muscles, as a stable muscle system guides the upper arm head cleanly and relieves the tendons. Pay attention to an upright posture, especially with a lot of desk work, and avoid a constantly forward-pulled shoulder profile. Anyone who works or trains a lot overhead should dose the load, warm up well and increase volume slowly. Regular movement breaks loosen the shoulders and prevent tension.
There is also a lot you can do in everyday life. Carry heavy bags close to the body and switch sides rather than carrying on one side. Set up your workplace so that the forearms rest relaxed and the shoulders are not constantly pulled up. Anyone who suffers from shoulder pain at night should avoid lying on the affected side and can place a pillow under the arm for support. These small adjustments noticeably relieve the shoulder and support every other measure. Acting early often prevents a harmless irritation from turning into a stubborn, chronic problem.
The bottom line: shoulder pain can usually be treated well if you know the cause and follow the treatment path instead of randomly trying different remedies. Keep mobility, build up specifically and do not hesitate with warning signs, that is the common thread through almost every form of shoulder pain. With some patience, most people get rid of their shoulder pain again. And if the symptoms do not ease despite all self-help or one of the warning signs appears, a medical assessment is the safest way to quickly reach the right treatment and avoid follow-on damage.
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This article is for general information and does not replace medical advice, diagnosis or treatment. Self-tests are only a guide. With strong, persistent or post-accident shoulder pain, or with signs of an emergency, please contact a doctor or the emergency services.
