Conditions Covered Under This Heading

• Rotator cuff tear — night pain, loss of strength raising the arm
• Shoulder impingement syndrome — pain appearing at a particular angle
• Frozen shoulder — restriction of both active and passive movement
• Shoulder dislocation and instability — a sense the shoulder will come out, recurrent dislocation
• Tennis elbow and elbow symptoms
• Carpal tunnel syndrome and wrist problems — see Hand and Wrist Surgery

Shoulder Pain: Telling Three Pictures Apart

In a patient presenting with shoulder pain, the first aim of examination is to separate these three pictures:

1. Impingement syndrome: pain predominates and becomes marked while raising the arm at a particular angle; passive movement is generally preserved.
2. Rotator cuff tear: pain is accompanied by loss of strength; weakness on raising the arm sideways and rotating it outwards.
3. Frozen shoulder: not only the patient’s movement but the movement the physician performs is also restricted; loss of external rotation is typical.

For a detailed comparison see Shoulder Pain: Rotator Cuff Tear, Impingement or Frozen Shoulder?

Not Forgetting the Neck

Nerve compression arising from the neck can mimic shoulder and arm pain. If shoulder examination does not give the expected findings, or if numbness and tingling accompany the symptoms, the neck is assessed. In some patients both problems are present together.

Assessment

1. History: onset of pain, night pain, injury, occupational and sporting overhead use.
2. Examination: comparison of active and passive movement, strength tests, impingement and instability tests, assessment of shoulder blade movement.
3. X-ray: for the bony structures, calcification, joint space and the position of the head of the arm bone.
4. MRI / ultrasound: the presence and size of a tendon tear and fatty change in the muscle; CT where bone loss is suspected in instability.

Treatment Approach

For the great majority of shoulder problems treatment begins without surgery. At the centre of the programme are strengthening of the rotator cuff and shoulder blade muscles, stretching of the posterior capsule and postural correction. Results come over weeks; regularity is decisive.

Surgery is considered in traumatic full-thickness tears, in young and active patients, where there is marked loss of strength, in recurrent dislocations, and where an adequate period of the programme has not produced a response. Procedures are largely performed by arthroscopic methods. Protection and a graded movement programme afterwards directly affect the outcome; see the Shoulder Arthroscopy Aftercare Guide.

When Should You Seek Assessment?

• If shoulder pain interrupts your sleep at night
• If you have difficulty raising your arm above head height
• If you have noticed marked loss of strength in the arm
• If your shoulder has dislocated or you feel it will come out
• If numbness and tingling accompany the symptoms

When to Seek Medical Help Without Delay

• Being unable to raise the arm at all after an injury, or obvious deformity of the shoulder
• Numbness, coldness, colour change or absence of a pulse in the arm
• Redness, warmth and severe pain in the shoulder together with fever
• Sudden, progressive weakness of the arm

These findings require urgent assessment. Outside office hours, go to the nearest emergency department.

Frequently Asked Questions

Do I need an MRI straight away for shoulder pain?

Generally no. The diagnosis is largely made by examination; MRI is requested to confirm findings and to plan surgery. Early imaging is considered in situations such as being unable to raise the arm after an injury.

Why is night pain so marked?

Lying down changes the pressure around the shoulder and removes the balance that the muscles provide during the day. Night pain is therefore typical in shoulder problems. Sleeping with the back slightly raised and avoiding lying on the affected side may help.

Would it help to rest the arm completely?

No. Complete immobility increases the risk of frozen shoulder in particular and reduces muscle strength. Continuing to move within the limits of pain is part of the programme.

Should I have a steroid injection?

In selected patients it can reduce pain and make it easier to start exercise. However, repeated injections into the tendon may adversely affect tissue quality; the decision is made by your physician according to the clinical picture.

If there is a tear, does it always mean surgery?

No. In partial tears, in patients with lower functional demands and in some large tears, adequate function can be achieved with physiotherapy. The decision is based on the type of tear, loss of strength, age and expectations.

How long will I use a sling after surgery?

The duration varies with the size of the tear and the repair performed; the wider the repair, the longer the protection. Your physician determines the exact period according to your recovery.

Academic Work

Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of shoulder arthroscopy and upper limb surgery and related areas. The publication list and verifiable academic sources are available on the Publications page.

Related Pages

• Rotator Cuff Tear
• Shoulder Impingement Syndrome
• Frozen Shoulder (Adhesive Capsulitis)
• Shoulder Dislocation and Shoulder Instability
• Shoulder Arthroscopy

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The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.

Last updated: 8 August 2026

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