Shoulder and elbow care: common problems, scans, treatment and when surgery is considered

The shoulder is the most mobile joint in the body, and the elbow combines hinge and rotation movements, so both are prone to overuse, injury and wear. Shoulder and elbow surgery is a subspecialty of orthopaedic surgery. The British Elbow & Shoulder Society is the professional body, and it publishes a patient resource on shoulder pain and supports training for surgeons and allied health professionals.

Most people never see a surgeon. First-line care is delivered by GPs, first contact physiotherapists and community musculoskeletal (MSK) services, then extended-scope physiotherapists or sports and exercise physicians, with orthopaedic shoulder and elbow surgeons involved where surgery or complex diagnosis is needed. Radiologists perform ultrasound-guided injections and imaging, and occupational and hand therapists help with function after surgery.

A consultant shoulder and elbow surgeon is an orthopaedic surgeon who has completed general orthopaedic training and a fellowship or equivalent focused on shoulder and elbow conditions, so it is reasonable to ask what proportion of their work this represents.

• Rotator cuff problems, from tendon irritation and impingement to partial and full-thickness tears, causing pain with overhead movement and night pain.

• Frozen shoulder, where the tissue around the joint becomes inflamed and tight, causing pain and stiffness. The NHS says it can follow injury or surgery and is more common in people with diabetes.

• Calcific tendinitis, where calcium deposits in a tendon cause severe pain.

• Shoulder instability and dislocation, often after sport or a fall, with risk of recurrence in younger people.

• Shoulder osteoarthritis and acromioclavicular joint arthritis, causing grinding, stiffness and pain.

• Tennis elbow (lateral epicondylitis) and golfer's elbow, tendon problems from repetitive gripping and wrist movements, which the NHS says are more common between 35 and 54.

• Elbow arthritis, stiffness after injury, cubital tunnel syndrome and ulnar nerve problems, biceps tendon injuries and fractures around the shoulder and elbow.

Diagnosis relies heavily on history and examination. The clinician looks at posture and muscle bulk, tests active and passive range of movement, strength and stability, and checks the neck because neck problems can cause pain felt in the shoulder. The NHS says a health professional will examine you and might send you for tests such as an X-ray to check the cause.

X-ray shows bone, joint space and calcification and is usually the first image. Ultrasound shows tendons and fluid in real time and can guide injections, while MRI gives detailed images of the rotator cuff, labrum, cartilage and bone, and may be combined with contrast for instability. CT is used for bony detail before replacement surgery. Nerve conduction tests are used if nerve compression is suspected.

Imaging findings need interpretation, because many tendon changes appear on scans of people with no symptoms. Treatment decisions usually combine the picture on imaging with symptoms and function.

Initial treatment is conservative. The NHS advises staying active and gently moving the shoulder, using painkillers, heat or cold packs, and doing exercises for 6 to 8 weeks to stop pain returning, while avoiding strenuous self-designed exercise. For frozen shoulder it describes three steps: pain relief, stronger pain relief which may include steroid injection, and getting movement back with exercises and physiotherapy. For tennis elbow it suggests avoiding aggravating activity, painkillers or gel, simple exercises, and a strap or brace, with physiotherapy if there is no improvement after 6 weeks.

Injections can calm pain and allow rehabilitation, though they are not a cure and repeated steroid injections can weaken tendons. Surgery is considered when function is limited despite adequate non-surgical treatment, or for specific injuries. Procedures include keyhole shoulder arthroscopy with repair of the rotator cuff or labrum, stabilisation for recurrent dislocation, subacromial decompression in selected cases, manipulation or release for stubborn frozen shoulder, tendon release or repair at the elbow, and shoulder, reverse shoulder or elbow replacement for advanced arthritis or irreparable damage.

Recovery after surgery is staged, often with a sling for several weeks, early supervised movement and progressive strengthening over months. Realistic timescales and rehabilitation commitment are part of the decision.

In many areas the NHS says you can self-refer to community MSK services for back or joint problems without a GP referral. These services assess, treat with exercise and advice, arrange imaging or injections and escalate to a shoulder and elbow surgeon if needed. Waiting times for assessment and elective surgery vary regionally.

Privately, you can usually see an orthopaedic shoulder specialist or physiotherapist directly, with imaging and injections often available at the same visit. Ask what the fee covers, whether physiotherapy after surgery is included, which implants are used for replacement and whether the surgeon contributes to national registries, as outcomes monitoring is a marker of quality.

• What is the likely diagnosis and what does the scan actually add to my decision?

• What exercises should I be doing, how often and for how long before the plan is reassessed?

• What are the risks and benefits of an injection, and how many are sensible?

• If surgery is suggested, what is the expected improvement, the recovery timeline and the chance of needing further surgery?

• How long before I can drive, return to work, lift or play sport?

• Get urgent advice from NHS 111 or a GP for sudden severe pain, loss of movement, a changed shape of the shoulder, numbness or pins and needles that do not settle, or pain after a fall. Seek help for a hot, red, swollen joint with fever.