Shoulder and arm conditions

Shoulders are slow. That is the first thing worth knowing, because almost every disappointment with shoulder treatment comes from expecting it to behave like a sore knee.

More information

The shoulder trades stability for range of movement, so it depends heavily on muscle control rather than on bony architecture. It also stiffens remarkably quickly when you stop using it fully because of pain. Put those together and you get a joint where recovery is measured in months, and where getting assessed early matters more than it does almost anywhere else in the body.

Which page do I need

If your shoulder has become severely stiff and you are losing range week by week, read frozen shoulder, which has its own timeline and its own rules. If it hurts to reach overhead or behind you, and aches at night when you lie on it, start with rotator cuff injury. If the pain arrives in a particular arc as you lift the arm out and up, read shoulder impingement. Pain on the outside of the elbow when gripping is tennis elbow. Numbness and tingling in the fingers, worse at night, is carpal tunnel syndrome.

Is it my shoulder or my neck

A genuinely common confusion, and an expensive one, because months can be spent treating the wrong structure. The neck refers pain into the shoulder blade and upper arm, and the shoulder refers pain up into the neck. As a rough guide, pain travelling below the elbow, or pins and needles reaching the hand, more often starts at the neck. Establishing which it is properly is one of the main jobs of an assessment.

Why loading is the treatment

Most shoulder and elbow problems here are tendon problems, and tendons adapt to load rather than to rest. That is why treatment is a progressive strengthening programme rather than a course of hands on work, why some discomfort during the exercises is expected, and why stopping when the pain settles is the commonest reason a shoulder problem returns. The tendon usually needs longer than the pain does.

Where surgery fits

Less often than people assume for several of these conditions. The evidence on subacromial decompression and on many rotator cuff tears now points firmly towards exercise first. Where a well executed programme has genuinely not worked, or where there has been a significant traumatic tear, a surgical opinion is appropriate and we will write to your GP.

Translucent blue torso skeleton showing a bright red, inflamed shoulder joint
Person extends clenched fist forward while another person supports their forearm and shoulderBearded man stretches bright blue resistance band with another man standing behind

Frequently Asked Questions

Why do shoulder problems take so long to get better?
The shoulder trades stability for range of movement, so it relies heavily on muscle control, and it stiffens quickly when you stop using it fully because of pain. That combination means recovery is measured in months rather than weeks for several common shoulder conditions, which is worth knowing at the start rather than discovering later.
Is it my shoulder or my neck?
It is a genuinely common confusion, because neck problems refer pain into the shoulder and upper arm. Pain that travels below the elbow, or comes with pins and needles, more often starts at the neck. Telling them apart properly is one of the things the assessment is for, and treating the wrong one wastes months.
Should I rest a painful shoulder?
Rarely completely. Shoulders stiffen fast when they stop moving, and a stiff shoulder is a harder problem than a sore one. We will usually give you movement to keep within a comfortable range while we settle the pain.