Shoulder Pain: Causes, Symptoms, Diagnosis and Treatments in Singapore

Why shoulder pain

The shoulder is built for movement. It relies on a combination of muscles, tendons, and the labrum to keep the joint stable. Because of this, irritation or injury to just one structure can affect how the whole shoulder moves and feels.

Common causes of shoulder pain

Shoulder pain is not one diagnosis. These are some of the more common causes doctors consider.

Rotator cuff problems

The rotator cuff is a common source of shoulder pain. Tendon irritation and impingement can cause pain with lifting the arm and reaching overhead, and symptoms are often worse at night.

Bursitis

Inflammation of the bursa can occur together with rotator cuff irritation and contribute to pain, especially with overhead movement.

Frozen shoulder

Frozen shoulder (adhesive capsulitis) typically causes progressive stiffness and a significant reduction in range of motion, often with pain early on.

Arthritis

Wear and tear changes of the shoulder joint can cause aching pain, stiffness, and pain with use.

Instability and dislocation

Some people feel the shoulder “slip” or feel unstable in certain positions. A true dislocation is usually obvious and very painful, often after an injury.

Referred pain and medical causes

Sometimes pain felt in the shoulder is referred from the neck, or rarely from non-musculoskeletal causes. In Singapore, HealthHub highlights urgent review if shoulder pain is associated with symptoms such as chest or jaw pain, shortness of breath, or cold sweat.

Symptoms that often come with shoulder pain

People may notice:

• Pain when lifting the arm or reaching overhead
• Night pain, especially lying on the affected side
• Stiffness and reduced range of motion
• Weakness or loss of function
• Clicking, catching, or a feeling of instability

When to seek urgent medical attention

Seek urgent care if you have shoulder pain after a fall or accident and you notice:

• A deformed looking shoulder joint
• Inability to move the arm away from the body
• Intense pain or sudden swelling

Also seek urgent review if there are red flags such as significant trauma or deformity, or if the shoulder pain is accompanied by chest or jaw pain, shortness of breath, or cold sweat.

When to get it checked

It is worth seeing a doctor if:

• The pain is getting worse or not improving after about 2 weeks
• It is very difficult to move the shoulder
• Pain is persistently affecting sleep and daily activities
• There is immediate weakness after an injury

AAOS (American Academy of Orthopaedic Surgeons) also notes that severe pain after an acute injury should be assessed promptly, and ongoing symptoms that do not settle within a short period of rest should be evaluated.

How shoulder pain is diagnosed

Diagnosis usually involves:

1. History and examination
   A clinician assesses where the pain is, what movements trigger it, whether there is stiffness or weakness, and whether there are signs of instability.
2. Imaging when needed
   X-rays can help assess joint alignment and arthritis. Ultrasound or MRI may be used to evaluate soft tissue structures such as the rotator cuff and bursa.

Shoulder pain treatment

Treatment depends on the cause, severity, and duration of symptoms.

Self-care for mild, recent pain

If the pain is mild and not caused by a major injury, a short period of rest from aggravating activities may be reasonable. It may be safe to rest for a few days for less severe pain, and seek review if symptoms persist.

Helpful measures often include:

• Avoiding movements that flare symptoms, especially repeated overhead reaching, for a short period
• Ice for acute flare-ups, especially early inflammation related to tendon or bursa irritation
• Simple pain relief if appropriate for you

Physiotherapy and rehabilitation

For many shoulder conditions, physiotherapy is a key part of recovery. It aims to restore range of motion, improve shoulder blade control, and build rotator cuff and supporting muscle strength. This approach is commonly used for rotator cuff related pain, stiffness patterns, and return to activity.

Medication and injections

Anti-inflammatory medication may help in selected cases. Some patients may be offered an injection when pain is limiting rehabilitation, depending on the diagnosis and clinical findings.

Surgery

Surgery may be considered when there is a clear structural problem that has not improved with appropriate non-surgical care, or when there is an acute injury that requires repair.

Prevention and reducing recurrence

You cannot prevent every cause of shoulder pain, but you can reduce risk by:

• Building rotator cuff and shoulder blade strength with a guided programme
• Warming up before sports and gradually increasing training loads
• Improving posture and workstation ergonomics if you do a lot of desk work
• Avoiding repeated painful overhead activity until symptoms settle