How to diagnose and
treat shoulder pain

How do clinicians diagnose shoulder pain?

Shoulder pain can come from several structures in and around the joint, so clinicians start by understanding your story. They often ask when the pain began, what movements make it worse, and how it affects your daily activities like reaching, dressing, or sleeping. They also look for signs of a recent injury or changes in strength that may point to a tendon tear or instability (popping out sensation or dislocation episodes).

A physical exam usually follows. This includes checking how far you can move your arm, which motions are painful, and how strong the shoulder muscles feel during simple tests. Most people with nontraumatic shoulder pain have near-normal passive motion , especially in rotator cuff–related shoulder pain, while frozen shoulder causes a clear loss of both active and passive movement ¹. Clinicians may also check the neck and upper back to see if pain is coming from another area.

Imaging is not always needed. For common, gradual-onset shoulder pain, guidelines recommend starting with active care first. Imaging is usually reserved for cases that involve trauma, concerning symptoms(like weakness or loss of motion), or a lack of improvement after several weeks of care ². X-rays help rule out fractures after a fall, while ultrasound or MRI may be used later if there is concern for a significant tear that might change the treatment plan.

Clinical insight

Many clinical guidelines highlight that shoulder pain is usually diagnosed through a careful history and exam, not immediate imaging. Early scans rarely change treatment for non-traumatic cases, and most people improve with movement-based care rather than imaging-driven decisions ².

What are the treatment options for shoulder pain?

Most treatment plans start simple. Clinicians typically begin with education, symptom management, and exercises that help the shoulder move with less pain. This stepwise approach allows you to build strength and confidence while avoiding unnecessary procedures.

1. Education and activity changesYou may learn ways to adjust painful tasks and find positions that help you sleep. Most people are encouraged to keep the shoulder moving within a comfortable range rather than resting completely ².
2. Exercise-based rehabilitationA structured exercise program is the foundation of recovery for many shoulder conditions. Strengthening the rotator cuff and shoulder blade muscles improves control and reduces pain over time. Stretching can help if stiffness is a key part of your pain. This active approach is strongly supported by research for rotator cuff–related shoulder pain and for stiffness-related problems like frozen shoulder ^{3 4}.
3. Medications Short courses of common pain relievers, including anti-inflammatory medicines, can help ease symptoms so you can stay active. A clinician will consider your general health and any risk factors before recommending them ².
4. InjectionsCorticosteroid injections may provide short-term relief, especially if night pain or irritation is limiting your ability to do exercises. Their benefit tends to decrease after several weeks, so clinicians usually pair them with a strengthening program to help with longer-term progress ⁵.
5. Other procedures
   Shockwave therapy or ultrasound-guided lavage may be considered for calcific tendinopathy that does not improve with exercise ⁶. For frozen shoulder, treatments like stretch the tissues of the joint capsule with saline solution or nerve blocks (injection of  medication near a specific nerve to block pain) or nerve blocks may be options in specific cases.
6. SurgerySurgery is rarely needed for nontraumatic shoulder pain. It may be considered after significant injury, for large acute tears, for recurrent instability, or when months of active care do not improve symptoms and imaging shows a problem that surgery can help ⁷. Large trials show that surgery that increases space in the shoulder does not improve outcomes for rotator cuff–related shoulder pain without a full-tendon tear ^{8 9}.

How can I find pain relief for shoulder pain?

Small, daily adjustments can reduce strain and make movement more comfortable. Try gentle motion instead of complete rest, since staying still for too long can make the shoulder feel tighter. Short, frequent breaks during overhead tasks can also help. If sleeping on your side is painful, try placing a pillow under your arm for support.

Pain flares are common and usually temporary. They do not mean you have caused damage. Moving within a comfortable range and gradually returning to activities can help the shoulder settle. If pain continues for several weeks or limits daily function, a clinician can guide you through a personalized recovery plan.

Sword's approach

Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.

Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.

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