Orthopaedics · Shoulder

Shoulder pain and conditions

Shoulder pain may be caused by tendinopathy or bursitis, a rotator cuff tear, adhesive capsulitis or osteoarthritis. Identifying the source is essential to select the right treatment and avoid unnecessary procedures.

See conditions Treatment options

Assessment and treatment of shoulder conditions

Common symptoms

Which symptoms suggest a shoulder problem?

Pain location, weakness and the pattern of movement loss help distinguish tendon, bursa, capsule and joint degeneration problems.

Pain when lifting the arm

Common with rotator cuff tendinopathy and subacromial pain, particularly during overhead activities.

Night pain

Can occur with rotator cuff disease, bursitis or arthritis and may make it difficult to sleep on the affected side.

Loss of strength

Difficulty lifting the arm or holding weight may suggest a rotator cuff tear, especially after an injury.

Marked stiffness

If both active and passive movement are restricted, adhesive capsulitis or glenohumeral arthritis should be considered.

Clicking or grinding

May accompany degenerative changes, tendon disease or mechanical shoulder problems.

Pain after a fall or sudden pull

A sudden loss of strength after trauma warrants early assessment to rule out an acute tear.

Understanding the diagnosis

Not every painful shoulder is “tendinitis”.

The shoulder contains tendons, a bursa, a capsule and a joint. Rotator cuff tendinopathy and subacromial bursitis often cause pain with movement, while a tear may also cause weakness. Adhesive capsulitis is characterised by a global and progressive loss of motion.

Glenohumeral osteoarthritis is a different degenerative process in which joint cartilage wears down. These conditions are not necessarily consecutive stages of one disease: treatment depends on the diagnosis, symptom severity, clinical examination and imaging.

Main conditions

From subacromial pain to arthritis: different problems need different treatments.

Management usually starts with non-operative measures and progresses only when symptoms, function and imaging support the next step.

01 · Tendinopathy and bursitis

Pain when lifting the arm, overload and subacromial tenderness. Initial care usually includes education, activity modification, pain relief and physiotherapy.

02 · Rotator cuff tears

May be partial or full-thickness, degenerative or traumatic. Not every tear needs surgery, but weakness, tear size, functional age and progression matter.

03 · Adhesive capsulitis

Pain with progressive loss of both active and passive motion. Early treatment focuses on pain control and gradual recovery of movement.

04 · Glenohumeral arthritis

As cartilage wears down, pain, stiffness and functional limitation increase. In advanced disease, shoulder replacement may be considered.

Tendon and bursa

Rotator cuff tendinopathy, bursitis and tears

Most subacromial pain is treated non-operatively first. For tears, the decision depends on whether the tear is traumatic or degenerative, partial or full-thickness, and on the patient’s strength and function.

Early stage

Temporarily reduce painful activities, maintain movement, use pain relief or anti-inflammatory medication when appropriate, and start a structured physiotherapy programme.

Persistent pain

If symptoms do not improve, we reassess the diagnosis and may use ultrasound or MRI. A corticosteroid injection can provide short-term relief in selected cases, while repeated injections without a clear indication are avoided.

Partial or degenerative tear

Many small or partial tears can improve clinically with physiotherapy. Persistent pain and limitation may lead to individual consideration of arthroscopic repair or other options.

Full-thickness or traumatic tear

An acute tear with substantial weakness, a symptomatic repairable tear or a tear that is progressing may warrant early surgical assessment for tendon repair.

Physiotherapy can improve pain and function even in some full-thickness tears; however, certain tears may enlarge over time. Clinical and imaging follow-up is therefore individualised when later repair remains a realistic option.

Adhesive capsulitis

A frozen shoulder commonly progresses through phases.

Adhesive capsulitis causes pain and global loss of motion. It generally improves over time, although recovery can be slow and treatment is adapted to the predominant phase.

1 · Painful / freezing phase

Pain predominates and motion gradually decreases. We prioritise pain control, gentle exercises and, in selected patients, an intra-articular corticosteroid injection.

2 · Frozen / stiff phase

Pain may lessen but stiffness remains. Physiotherapy focuses on recovering movement without excessively forcing a very irritable joint.

3 · Recovery phase

Movement gradually improves. Range-of-motion, strength and functional exercises are progressed according to tolerance.

If it does not improve

For resistant cases, options may include hydrodilatation and, rarely, manipulation under anaesthesia or arthroscopic capsular release.

Shoulder osteoarthritis

Arthritis treatment depends more on symptoms than on an X-ray alone.

Glenohumeral osteoarthritis causes cartilage loss between the humeral head and glenoid. Treatment decisions combine pain, range of motion, function, X-rays and rotator cuff status.

Early arthritis

Activity modification, exercise, physiotherapy and individualised pain management. The aim is to preserve movement and control symptoms.

Moderate arthritis

If pain persists, selected injections may be considered and the exercise programme adjusted. Rotator cuff function and joint anatomy are also reviewed.

Advanced arthritis

Frequent or night pain, major stiffness and loss of independence despite conservative treatment may justify discussing surgery.

Advanced arthritis + major limitation

When wear is severe and quality of life is clearly affected, joint replacement may provide the most reliable pain relief and functional improvement.

Joint replacement

Anatomic or reverse shoulder replacement: they are different operations.

An anatomic shoulder replacement recreates normal shoulder anatomy and is commonly considered for glenohumeral arthritis when the rotator cuff is functional and the anatomy is suitable.

A reverse shoulder replacement changes joint mechanics and allows the deltoid to play a greater role. It is particularly useful when the rotator cuff is deficient and in selected complex cases involving arthritis, bone deformity or previous surgery.

Anatomic replacement

Used in selected patients with arthritis, suitable bone and a competent rotator cuff.

Reverse replacement

Particularly useful in cuff-tear arthropathy, irreparable cuff tears with arthritis and selected complex shoulders.

Individual planning

X-rays and, when needed, CT or MRI help assess the glenoid, bone stock, rotator cuff and implant sizing.

Rehabilitation

Recovery is progressive and depends on the type of implant, tissue quality and the patient’s functional goals.

When to seek assessment

Some shoulder problems should be assessed early.

Sudden loss of strength after a fall or pulling injury.
Inability to raise the arm after trauma.
A red, hot, markedly swollen shoulder or fever.
Progressive stiffness that interferes with dressing, personal care or sleep.
Pain that persists despite an appropriate course of conservative treatment.

Frequently asked questions

Common questions about shoulder pain

Does every rotator cuff tear need surgery?

No. Many degenerative, partial or small tears can be managed initially with physiotherapy. Surgery is individualised according to symptoms, strength, tear characteristics and expectations.

Does an injection cure tendinopathy or bursitis?

It may reduce short-term pain in selected cases, but it does not replace rehabilitation or repair a torn tendon. It should be used as part of an overall plan.

Does frozen shoulder always require surgery?

No. Most patients improve with time and non-operative treatment. Surgery is reserved for persistent and severely limiting cases.

When is shoulder replacement considered?

When advanced arthritis or arthropathy causes substantial pain and loss of function and non-operative treatment no longer provides adequate control.

Related areas

Do you have shoulder pain, weakness or stiffness?

We review your symptoms, examination and imaging to distinguish tendon, bursa, capsule and arthritis problems and explain which options make sense for your case.

Phone682 663 856

Emailadministracionconsulta@inbscp.com

CentreClínica Sagrada Família