The shoulder trades stability for movement, which is why it is the most commonly dislocated joint in the body and why cuff problems are so frequent after 40. Pain reaching overhead, difficulty sleeping on one side, or a shoulder that slips out during sport all point to distinct diagnoses that respond to very different treatments.
Symptoms checklist
- Pain lifting the arm overhead or reaching behind the back
- Night pain, especially lying on the affected side
- Weakness lifting or carrying objects
- A shoulder that feels loose or slips out
- Progressive stiffness in all directions
- Clicking or catching with rotation
When to see a doctor
- Sudden weakness after a fall — a possible acute cuff tear
- The shoulder has dislocated more than once
- Total loss of rotation with severe night pain
- Numbness or tingling down the arm
- Pain persisting beyond six weeks of physiotherapy
Common causes
Rotator cuff tendinopathy or tear
Wear or a traumatic tear of the tendons that lift and rotate the arm — the commonest cause of shoulder pain after 40.
Frozen shoulder (adhesive capsulitis)
Inflammation and contracture of the joint capsule, more common in diabetics, causing painful global stiffness.
Recurrent instability
Bankart or SLAP lesions after a first dislocation, leaving the shoulder prone to slipping out again.
Subacromial impingement
Pinching of the cuff beneath the acromion during overhead activity, aggravated by poor scapular control.
Shoulder arthritis
Cartilage wear producing deep aching pain, grinding and loss of rotation.
Treatment ladder
Treatment always begins with the least invasive option that can work — surgery is considered only when simpler measures have been given a fair trial.
- 1
Step 1
Self-care
Avoid painful overhead loading, apply heat before stretching, and correct desk and sleeping posture.
- 2
Step 2
Physiotherapy
Cuff and scapular strengthening with a graded stretching programme — the mainstay for impingement and frozen shoulder.
- 3
Step 3
Injections and PRP
A guided subacromial or intra-articular injection to break the pain cycle, or PRP in selected tendinopathy.
- 4
Step 4
Arthroscopic surgery
Key-hole rotator cuff repair, Bankart / SLAP repair for instability, or capsular release for a resistant frozen shoulder.
- 5
Step 5
Shoulder replacement
Reserved for advanced arthritis or irreparable cuff tears with significant functional loss.
