Shoulder pain when lifting your arm: causes, red flags and when to get it checked

The shoulder is a ball-and-socket joint held by the rotator cuff tendons, which pass under a bony arch as the arm lifts. When these tendons are inflamed, thickened or torn, they are pinched during elevation, causing pain at the characteristic part of the lift.

• Rotator cuff tendinopathy and subacromial pain syndrome (impingement): overuse, repetitive overhead work, and age-related change.

• Partial or full-thickness rotator cuff tear, after a fall or gradual wear, with weakness lifting the arm.

• Frozen shoulder (adhesive capsulitis): progressive pain and stiffness, often associated with diabetes, thyroid disease or immobility.

• Calcific tendinitis: sudden severe pain from calcium deposits in the tendon.

• Acromioclavicular joint arthritis or injury, with pain at the top of the shoulder.

• Neck problems with referred pain or nerve root irritation.

• Glenohumeral arthritis, instability, labral tear and biceps tendon problems.

• Heart, lung, gallbladder and diaphragm problems referring pain, and rarely tumours or infection.

Sudden inability to lift the arm after an injury, deformity, fever with a hot swollen joint, constant night pain, unexplained weight loss, a history of cancer, chest pain or breathlessness with shoulder pain, and neurological symptoms in the arm warrant prompt attention.

• Call 999: shoulder or arm pain with chest pressure, sweating, breathlessness or collapse.

• A&E or same-day GP: shoulder deformity, suspected dislocation or fracture, or fever with a hot swollen joint.

• GP within days to weeks: pain with arm weakness after injury, or persistent night pain.

• Routine GP or physiotherapy: painful arc and aches when working overhead for several weeks.

The clinician asks about onset, injury, work and sport, night pain, weakness, neck symptoms, diabetes and medical history. They look at posture, range of movement (active and passive), painful arc, strength of rotator cuff muscles, impingement and instability tests and examine the neck.

• Usually none initially; clinical examination guides diagnosis.

• X-ray: for arthritis, calcification, fracture or alignment.

• Ultrasound: shows tendon tears, calcification and bursitis, and can guide injections.

• MRI: for suspected significant tears, labral injury or when surgery is considered.

• Blood tests if inflammatory arthritis or diabetes is suspected.

Relative rest from aggravating activities, keeping the shoulder moving within comfort, ice or heat and simple painkillers can help. An exercise-based physiotherapy programme for the rotator cuff and shoulder blade muscles is first-line treatment. Adjust workstation and avoid sustained overhead activity. Corticosteroid injection can give short-term relief in selected cases.

The NHS route is a GP and physiotherapy, with shoulder clinics or surgery for persistent problems. Private physiotherapy, ultrasound, injection and orthopaedic review are available directly.