Shoulder Pain
Usually the rotator cuff tendons complaining (pain lifting the arm, lying on it) or a frozen shoulder (pain, then stiffness). Most settle with time, smart pain relief and the right exercises.
The shoulder pain ladder
Exercise is the main treatment for rotator cuff pain. Frozen shoulder gets better on its own over 1–3 years; treatment eases the ride.
- Step 1 · Self-careKeep it moving, ease off the aggravatorsUse the arm for everyday tasks, avoid heavy overhead work for now, and use heat or a wrapped cold pack for up to 20 minutes.
- Works
- Pain usually starts to ease within about 2 weeks; full recovery can take 6 months or more
- Cost
- Free
- How long
- Weeks to months
- Watch for
- Don’t strap or sling a sore shoulder for long unless told to; it stiffens fast.
A shoulder kept in cotton wool turns into a frozen one.
- Step 2 · PharmacyPain relief (paracetamol, ibuprofen or anti-inflammatory gel)To make movement and sleep possible, not as the treatment itself.
- Works
- Short-term pain relief that helps you keep moving
- Cost
- About $5–15 a pack
- How long
- A week or two at a time
- Watch for
- Anti-inflammatories: stomach, kidney and blood pressure risks. Check with a pharmacist if you have other conditions.
Painkillers buy you time to do the exercises. Spend it wisely.
- Step 3 · Allied healthShoulder strengthening exercisesRotator cuff and shoulder-blade exercises done most days, ideally with a physio to start. Frozen shoulder: gentle stretches within comfort.
- Works
- In a Swedish trial, 1 in 5 doing specific exercises still chose surgery, vs 3 in 5 doing general exercises
- Cost
- Free at home with our handout; physio about $80–120 a session (Medicare rebates with a GP care plan)
- How long
- At least 12 weeks
- Watch for
- Some discomfort (up to 5/10) is fine if it settles by the next day.
The boring exercises are the ones that work. Sorry.
- Step 4 · PrescriptionSteroid injectionInto the space above the rotator cuff, or into the joint for frozen shoulder, often guided by ultrasound.
- Works
- Rotator cuff: modest relief, best at about 2 months and gone by 3. Frozen shoulder: less pain for 3–6 months, best given early
- Cost
- Medicare rebates; out-of-pocket fees vary
- How long
- Usually one, sometimes repeated; not many a year
- Watch for
- Short-lived flare, skin thinning or paler skin at the site, and raised blood sugar for a few days in diabetes.
A window of relief to get exercising, not a fix on its own.
- Step 5 · SpecialistSpecialist proceduresFor frozen shoulder that stays severe: manipulation under anaesthetic or keyhole release. For a tendon tear after a fall or sudden weakness: surgical review.
- Works
- Frozen shoulder: in a UK trial, physio plus injection, manipulation and keyhole release all worked about equally at a year; about 1 in 7 after physio needed more treatment, vs 1 in 25 after surgery
- Cost
- Public waiting lists; private fees vary
- How long
- Recovery over weeks to months, with exercises afterwards
- Watch for
- Surgery has the most complications and costs the most. A sudden tear in a younger, active person needs prompt review.
Bigger isn’t automatically better. Ask what each option adds.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Decompression surgery for impingementIn a large UK trial, shaving bone off the shoulder did no better than a fake (look-only) operation. Exercise first.
- Therapeutic ultrasoundAdds no useful benefit to exercise in trials. The machine hums; the tendon doesn’t care.
- TENS machinesEvidence is very low quality and uncertain. Fine if it helps you move, but don’t buy one expecting a cure.
- Repeated injectionsRepeat injections were no better than one in the short term, and relief fades. Use them to start rehab, not instead of it.
What you can do
- Follow our shoulder exercise handout: one printable page of rotator cuff and shoulder-blade exercises with pain rules.
- Keep using the arm for light daily tasks below shoulder height.
- Sleep on the other side with a pillow hugged in front to support the sore arm.
- At work, bring tasks closer and lower so you’re not reaching overhead for long.
- With diabetes, keep sugars well controlled; frozen shoulder is more common and can last longer.
See your GP if
- Pain is getting worse, or not starting to ease after 2 weeks
- You can’t lift your arm properly, or it’s waking you most nights
- Pins and needles or pain going down the arm, which may be coming from your neck
- Pain in both shoulders, or you feel generally unwell with it
Get urgent help for shoulder or arm pain with chest pain, breathlessness, sweating or nausea, which can be a heart attack: call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries. See a doctor the same day after a fall or injury if the shoulder looks deformed, you can’t move or lift the arm, or the arm is numb, cold or a different colour; or for a hot, swollen shoulder with fever.
Common questions
What are the symptoms of rotator cuff pain?
An ache in the outer upper arm, worse lifting the arm out to the side or overhead, reaching behind your back, or lying on that side at night. Movement is usually still possible, just painful.
How is frozen shoulder different?
It starts with pain, then the shoulder gets stiff in every direction, so even with help it won’t move far. It’s more common in people with diabetes, and usually settles over 1–3 years, sometimes longer.
Do I need a scan?
Usually not to start. Your GP can usually tell from examining your shoulder. Ultrasound or X-ray helps if it isn’t improving, after an injury, or if an injection or surgery is being considered.
What causes it?
Often overload: a sudden increase in lifting, painting, gardening, sport or overhead work, on top of the tendon changes that come with age. Frozen shoulder may follow an injury or surgery, but often has no clear cause.
Helpful resources
- Shoulder pain exercise handoutPrintable, one page, with sets, pain rules and a 12-week plan. Free, from us.
- Self-help for frozen shoulderPrintable leaflet with gentle stretches and advice on pain. Free, from an NHS orthopaedic hospital (UK).
Evidence and more information
- NHS: Shoulder pain
- NI Direct (NHS): Frozen shoulder
- BMJ (2012): Specific exercise and the need for shoulder surgery
- NIHR: CSAW trial of decompression surgery (Lancet 2018)
- NIHR: UK FROST frozen shoulder trial (Lancet 2020)
- NIHR: Steroid injections for rotator cuff disorders
- Review (2017): Steroid injections for frozen shoulder
- Cochrane (2016): Electrotherapy for rotator cuff disease
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