Introduction

Shoulder care · Shoulder pain

Shoulder pain

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Dr Sean LeoOrthopaedic Surgeon, Singapore

Clinic enquiries · Not an emergency service

Illustrative image

Shoulder pain can come from more than one structure.

Shoulder pain is one of the most common physical complaints, and it can arise from more than one structure.^[2] The same two words can describe quite different problems, so the words alone do not point to one cause.^[1][2]
This page is for anyone in Singapore trying to make sense of it. It names the common causes in plain words, shows where each is explained in full, and describes how to tell an assessor what you are feeling. It does not ask you to name your own cause. An assessment, not a webpage, works out which cause is likely.
Most shoulder problems fall into four major categories: tendon inflammation (bursitis or tendinitis) or a tendon tear, instability, arthritis, and fracture (a broken bone). So the list of possibilities is shorter than it first seems.^[1]
OrthoKinetics is Dr Sean Leo’s professional brand. Clinical consultations and treatment are provided through OrthoSports Orthopaedic & Sports Surgery. Dr Sean Leo is a specialist orthopaedic surgeon who cares for shoulder problems.

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What’s covered on this webpage

Follow the route in order, or jump to the stop you need. Stops you have read are marked.

The shoulder is several joints working together.

What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of movement in the arm, from scratching your back to throwing a ball.^[1] Because more than one of those structures can produce pain, the words “shoulder pain” describe a symptom, not a diagnosis.^[1][2]

The joints include:

The glenohumeral joint. This is the ball-and-socket joint where the top of the upper arm bone (the humerus) fits into a rounded socket in the shoulder blade (the scapula).^[1][9]
The acromioclavicular (AC) joint. This is at the top of the shoulder, where the collarbone (the clavicle) meets the acromion, a part of the shoulder blade.^[9]
The sternoclavicular (SC) joint. This is where the inner end of the collarbone meets the breastbone (the sternum).^[9]

That is why the uncertainty is not a failure on your part. It is built into the anatomy.

Which parts are often involved

A tendon is a cord that connects muscle to bone.^[1] The rotator cuff tendons and muscles, which are responsible for moving the shoulder, are a frequent cause of shoulder pain.^[2]

Most shoulder problems fall into a few common causes.

Most shoulder problems fall into four major categories: tendon inflammation (bursitis or tendinitis) or a tendon tear, instability, arthritis, and fracture (a broken bone).^[1] Much less common causes of shoulder pain are tumours, infection and nerve-related problems.^[1] A broken bone is a possible cause after an injury, and the injury pattern is described in the next section.^[7]

Each common cause below gets a short description and a link to the page that explains it in full. Reading them is not a way to pick your own cause.

Rotator cuff problems

Rotator cuff problems are a frequent cause of shoulder pain.^[2] They can be inflammation of the tendons (tendinitis), inflammation of the bursa (bursitis) or a tear.^[2][3] A torn rotator cuff may weaken the shoulder, so that everyday tasks like combing your hair or getting dressed become painful and difficult.^[3]

Shoulder impingement

The space between the top of your shoulder (the acromion) and the rotator cuff tendons becomes smaller when you raise your arm. The acromion can rub against the tendon and the bursa below, causing irritation and pain.^[2] This can lead to bursitis and tendinitis, with pain and limited movement.^[1] Some people know this as a bone spur problem.

Frozen shoulder (adhesive capsulitis)

Frozen shoulder (adhesive capsulitis) causes pain and stiffness, and over time the shoulder becomes very hard to move.^[4] The hallmark is severe pain and being unable to move the shoulder, either on your own or with someone else’s help.^[4] It most commonly affects people between 40 and 60 and occurs more often in women than in men, and people with diabetes or thyroid conditions are at increased risk.^[4]

Shoulder dislocation and instability

The shoulder is the most mobile joint in the body, which is also what makes it an easy joint to come out of the socket (dislocate).^[5] Dislocations can be complete or partial and usually occur after a trauma, such as a fall or motor vehicle collision, most commonly by sliding forward out of the socket.^[5] Once the ligaments, tendons and muscles around the shoulder become loose or torn, dislocations can occur repeatedly.^[1]

Arthritis

Shoulder pain can also result from arthritis. The most common type in the shoulder is osteoarthritis, also known as wear-and-tear arthritis.^[1] Pain and stiffness typically begin in middle age, and osteoarthritis develops slowly, with pain that worsens over time.^[1] The pain is aggravated by activity, and limited movement is a common symptom.^[6]

Whether arthritis is part of the picture is something an assessment can help clarify.^[2] See when should shoulder pain be assessed?.

A woman reaches into a pale wood pantry cabinet for a plain ceramic mug.

Pain patterns, and what they might point to.

Three patterns are worth describing at an assessment: pain at night, stiffness rather than weakness, and pain that began with an injury. They are descriptions to report. They are not tests you can apply on your own, and each one appears in more than one cause.

Pain that is worst at night

Pain that is worst at night, sometimes enough to affect sleep, is described in impingement and rotator cuff pain.^[2] Night pain is also common as arthritis progresses, and sleeping may be difficult.^[6] Because it appears in more than one cause, night pain by itself does not point to a single one.

Stiffness, or weakness

As a broad pattern, frozen shoulder is mainly stiffness with lost movement, including when someone else tries to move the arm.^[4][8] A rotator cuff problem more often shows as weakness, which can make everyday tasks such as combing your hair painful and difficult.^[3] The two can overlap. An examination, not a webpage, is what tells them apart.^[3][4]

Pain that began with an injury

A problem that began suddenly with an injury, such as a fall or a collision, points toward a dislocation, which usually follows a trauma,^[5] or a sudden tear of the rotator cuff.^[3] That is different from pain and stiffness that build up gradually.^[1][8] Intense pain after an injury is a reason to be seen as soon as possible.^[1]

The neck

Shoulder pain can also come from the neck, which is why an assessment looks at the whole picture and not the shoulder alone.^[2]

A pinched nerve in the neck is called cervical radiculopathy. “Cervical” means the neck. “Radiculopathy” means a problem with a nerve root, the part of a nerve that branches away from the spinal cord. It happens when that nerve is squeezed or irritated as it leaves the spine in the neck.^[10][11]

The nerve supplies parts of the shoulder and arm. That is why the pain can be felt there, and not only in the neck.^[10][11]

Some features make the neck a more likely source than the shoulder. Published sources describe:

pain that starts in the neck and travels down the arm, sometimes beyond the elbow;^[10][12]
pins and needles, numbness or weakness in the arm, hand or fingers;^[10]
pain that gets worse with some neck movements, such as turning the head;^[10][12]
pain that eases when the hand is rested on top of the head.^[10][12]

None of these settles the question on its own. The two problems can also exist together, so an assessment examines the neck and the shoulder together.^[12] Which care suits you depends on whether the pain is coming from the shoulder, the neck or both.^[12]

How to describe your pain at an appointment

Where do you feel it? When does it appear, and when is it worst? What changes it, and what can you no longer do? Did it begin with an injury, or did it build up over time? A plain, specific description gives your clinician more to work with than a guess at the cause.

When should shoulder pain be assessed

When should shoulder pain be assessed?

You can usually do things to ease shoulder pain yourself, and managing it for a while is common.^[7] Arrange an assessment with a GP or family doctor if the pain is getting worse, if it has not started to feel better after about a couple of weeks, or if it is very difficult to move your arm or shoulder.^[7]

Intense pain that began with an injury is a reason to be seen promptly.^[1] It belongs to the urgent-care route, not to this webpage.

Some signs mean a shoulder should be seen urgently rather than at a routine appointment. Those signs are listed under Final next step at the end of this page.

Safety note: This webpage is not an emergency service. No list on this page can rule out a serious problem remotely.

A man gently rolls his shoulders back during a break at a desk in a bright living room.

Assessment sorts out which pattern fits.

An assessment starts with your story: when the problem began, whether an injury started it or it built up, where you feel it and what changes it. That history is what links the patterns in the previous section to the likely structure.

It continues with an examination of how far and how strongly the shoulder moves. That is where the difference between stiffness and weakness is sorted out.^[3][4] Because more than one structure can produce shoulder pain, the assessment looks at the whole picture.^[2]

Whether a scan would help is part of that conversation. The Shoulder hub explains in more depth what tests can and cannot show.

A small group of older adults performs slow arm movements together in a landscaped estate garden.

Many people can ease shoulder pain with simple measures and time.

You can usually do things to ease shoulder pain yourself.^[7] Stay active and gently move your shoulder. Try shoulder exercises. Use simple pain relief, or heat or cold packs, so you can keep moving. Do not completely stop using the shoulder, because that can stop it getting better, and do not do things that seem to make it worse.^[7]

Recovery commonly takes months rather than days. One national health-service guide says it can take 6 months or longer to recover from shoulder pain.^[7] That is a general range, not a date, and your clinician can tell you what to expect for your own shoulder.

Which care suits you depends on the cause, which is why each cause page explains its own options. Seeing a specialist orthopaedic surgeon about a shoulder problem does not mean surgery has already been decided.

Structure / Patient / Goal

Deciding together

Structure / Patient / Goal

Structure: what is affected?

Structure is which part of the shoulder might be affected. With shoulder pain that is still to be worked out, and an assessment is where it is identified.

Patient: how does it affect you?

Patient means you as a whole person. Your symptoms, how active you are, your general health, your preferences and your circumstances all shape which options are reasonable.

Goal: what are you hoping to return to?

Goal is what matters to you, whether that is reaching and lifting in daily life, work above shoulder height or sport. A useful plan starts from a clear purpose.

Your plan

No single factor decides the plan alone, whether that is a scan, a symptom or your motivation.

OrthoKinetics Recovery Reflection

Recovery reflection

If shoulder pain settles by receding rather than ending on a single day, what would you notice first?

For many people, an easing shoulder does not announce itself. It is less a day when the pain stops and more a slow receding over weeks and months.^[7] The ache that used to be waiting at bedtime is not there one evening. The arm goes into a sleeve without the small flinch you had learned to expect. Recovery of this kind is often recognised in hindsight.

What has already quietly stopped hurting that you have not yet given yourself credit for?

It may be something too ordinary to have registered: turning over in bed, reaching for a cup, carrying a bag on that side. None of these arrives with a moment to mark it. Noticing them is not tempting fate. It is keeping an accurate account of how the shoulder is really doing, and it is yours to keep.

A shoulder that is settling can go quiet without saying so. Recovery is often recognised by what no longer hurts, more than by any one day on which the pain ended.

Illustrative image

Meet Dr Sean Leo

A consultant orthopaedic surgeon whose clinical focus is the knee, sports injuries and the lower limb.

Dr Sean Leo is a consultant orthopaedic surgeon. OrthoKinetics is his professional brand; clinical services are provided through OrthoSports Orthopaedic & Sports Surgery at Mount Elizabeth Novena Specialist Centre and Connexion, Farrer Park Hospital.
His clinical interests include sports injuries, including those in adolescent athletes; ligament reconstruction; realignment surgery; cartilage repair and joint-preservation approaches; knee replacement; and technology-assisted hip and knee surgery.
The consistent aim is to return people to meaningful function and activity while avoiding unnecessary downtime.
Qualifications: MBBS, MRCS (Ed), MMed (Ortho), FRCSEd (Ortho).

More detail: Meet Dr Sean Leo

Training and career: Dr Leo trained in medicine at the National University of Singapore and served in the Singapore Armed Forces Medical Corps from 2000 to 2012, where his work included the care of soldiers in physically demanding roles. He completed postgraduate orthopaedic training in 2009 and a one-year clinical fellowship at Royal North Shore Hospital in Sydney, Australia, before joining Changi General Hospital as an orthopaedic consultant in 2012, where he later held the positions of Senior Consultant and Director of the Hip and Knee Service. With seniority, his educational contribution has evolved towards mentorship and support for junior doctors.

About Dr Sean Leo

Dr Sean Leo standing in clinical scrubs against a plain wall — **Dr Sean Leo**Orthopaedic Surgeon · consultations through OrthoSports

Questions people often ask

Common shoulder pain questions

What causes shoulder pain?

Most shoulder problems fall into four major categories: tendon inflammation (bursitis or tendinitis) or a tendon tear, instability, arthritis and fracture (a broken bone). Much less common causes are tumours, infection and nerve-related problems. The words “shoulder pain” alone do not point to one cause, so an assessment is how the likely one is identified.^[1][2]

Which shoulder structure is causing my pain, and how can I tell?

Three patterns are worth describing at an assessment: pain at night, stiffness rather than weakness, and pain that began with an injury. Each appears in more than one cause and none confirms a structure on its own. An examination, not a webpage, links a pattern to the likely cause.^{[2][3][4][5][6]}

Why does my shoulder hurt when I lift my arm or reach overhead?

One common pattern is pain when you raise your arm. The space between the top of the shoulder (the acromion) and the rotator cuff tendons becomes smaller, and the acromion can rub against the tendon and bursa. This is shoulder impingement, which has its own page. Other problems can feel similar, so this is a clue, not a diagnosis.^[1][2]

Why is my shoulder pain worse at night, or when I lie on it?

Pain that is worst at night, sometimes enough to affect sleep, is described in impingement and rotator cuff pain, and night pain is also common as arthritis progresses. Because it appears in more than one cause, it is a pattern to report at an assessment. It is not a diagnosis by itself.^[2][6]

What does it mean if my shoulder is stiff and I can’t reach behind my back?

Stiffness with lost movement, including when someone else tries to move your arm, is the hallmark of frozen shoulder (adhesive capsulitis), which builds up over time. A rotator cuff problem more often shows as weakness. The two can overlap, so an examination tells them apart. See the frozen shoulder page.^[3][4][8]

What does it mean if my arm feels weak along with the pain?

A torn rotator cuff may weaken the shoulder, so that everyday tasks like combing your hair or getting dressed become painful and difficult. Weakness is a pattern more often seen in rotator cuff problems than in frozen shoulder (adhesive capsulitis), but only an examination can say which applies. See rotator cuff tear.^[3][4]

Is my shoulder dislocated, or just sore?

A dislocation can be complete or partial and usually follows a trauma, such as a fall or a motor vehicle collision. Only an assessment can tell whether a shoulder has dislocated. Intense pain after an injury is a reason to be seen as soon as possible, and some signs need urgent care, listed under Final next step.^[1][5]

Can shoulder pain come from the neck?

Yes. A pinched nerve in the neck (cervical radiculopathy) can cause pain that is felt in the shoulder or arm. Pain that starts in the neck and travels down the arm, pins and needles or numbness in the hand, and pain that gets worse with neck movements make the neck a more likely source. None of these settles the question on its own, and the neck and shoulder problems can exist together. An assessment examines both.^[10][11][12]

Can shoulder pain heal on its own without treatment?

You can usually do things to ease shoulder pain yourself: stay active, gently move the shoulder, try exercises and use simple pain relief or heat or cold. Recovery can take months. Which care suits you depends on the cause, so if the pain is worsening or has not improved after about a couple of weeks, arrange an assessment.^[7]

When should I see a doctor for shoulder pain, and should I go to a GP or a specialist first?

Arrange an assessment if the pain is getting worse, has not started to improve after about a couple of weeks, or makes it very difficult to move your arm or shoulder.^[7] You can begin with a GP or family doctor. Dr Sean Leo is a specialist orthopaedic surgeon who cares for shoulder problems.

Costs and insurance

Practicalities

Cost, Medisave and insurance

Logos of Great Eastern, HSBC Life, Prudential, Singlife, Alliance Medinet and iXchange, the insurers and corporate health plan administrators on whose panels Dr Sean Leo is listed

Ask the clinic team for current information about fees, panel status, pre-authorisation and expected payment arrangements. Insurance coverage and out-of-pocket costs depend on the individual policy and the insurer’s decision; no coverage is guaranteed.

A cost estimate for surgery can be given only after a consultation and assessment, once a surgical plan has been developed. Each individual condition is unique — implants used, time taken, and other factors contribute to the overall estimate. The estimate will be provided to you by the clinic should you decide on surgical management, and will also be used to assist in obtaining pre-authorisation from insurance where applicable.

Insurance panels. Dr Sean Leo, Orthopaedic Surgeon, is on the specialist panels of Great Eastern (GE Panel), HSBC Life (HSBC Life Shield) and Singlife (Singlife Shield), and on the Prudential Panel. AXA Insurance Singapore became part of HSBC Life in 2023, and former AXA Shield plans are now HSBC Life Shield plans.

Corporate health plans. Dr Leo is on the panels of both Alliance Medinet and iXchange, which administer medical benefits for many company health plans. If your company plan uses either panel, you can see Dr Leo as a panel doctor.

If your company uses a different panel. Some company plans still let you see a doctor of your choice outside their panel, then claim reimbursement. This varies from plan to plan, as may the co-payment, so please check your benefits with your company’s HR department.

Panel arrangements change from time to time, so please confirm with your insurer or your company’s plan administrator before your appointment.

Dr Leo is on the panels shown. If your insurer is not listed, you may ask whether co-management with an Orthosports surgeon partner on that panel is clinically and administratively appropriate. Orthosports surgeon partners are collectively on the panels of all Shield plans.

Specific benefits, pre-authorisation, reimbursement and cashless treatment depend on the individual policy and insurer approval and are not guaranteed.

Arrange a consultation: the appointment section is further down this page.

Sources

References

American Academy of Orthopaedic Surgeons (AAOS). Shoulder Pain and Common Shoulder Problems. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/shoulder-pain-and-common-shoulder-problems
American Academy of Orthopaedic Surgeons (AAOS). Shoulder Impingement/Rotator Cuff Tendinitis. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis
American Academy of Orthopaedic Surgeons (AAOS). Rotator Cuff Tears. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/rotator-cuff-tears
American Academy of Orthopaedic Surgeons (AAOS). Frozen Shoulder. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/frozen-shoulder
American Academy of Orthopaedic Surgeons (AAOS). Shoulder Dislocation. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/dislocated-shoulder
American Academy of Orthopaedic Surgeons (AAOS). Arthritis of the Shoulder. OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/arthritis-of-the-shoulder
NHS. Shoulder pain. Available at: https://www.nhs.uk/symptoms/shoulder-pain/
Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder Pain and Mobility Deficits: Adhesive Capsulitis. J Orthop Sports Phys Ther. 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302.
Donnelly TD, Ashwin S, MacFarlane RJ, Waseem M. Clinical Assessment of the Shoulder. The Open Orthopaedics Journal. 2013. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3785041/
American Academy of Orthopaedic Surgeons (AAOS). Cervical Radiculopathy (Pinched Nerve). OrthoInfo. Available at: https://www.orthoinfo.org/diseases–conditions/cervical-radiculopathy-pinched-nerve
NICE Clinical Knowledge Summaries. Neck pain – cervical radiculopathy. Last revised November 2023. Available at: https://cks.nice.org.uk/topics/neck-pain-cervical-radiculopathy/
Daher M, Fares MY, Boufadel P, et al. Untwining the intertwined: a comprehensive review on differentiating pathologies of the shoulder and spine. JSES Rev Rep Tech. 2024;4(3):385-392. doi:10.1016/j.xrrt.2024.02.007. PMID 39157237. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11329023/

Final next step

Next step

Final next step

Reading about a problem is a starting point. An assessment brings together the history, an examination where needed and any useful tests, and helps you and your clinician decide what to do next. How much physical examination is needed is a matter of clinical judgement. It may be limited when pain makes an examination unreliable, or when imaging clearly shows a problem that matches the symptoms, such as a fracture seen on an X-ray or an MRI scan that clearly shows an injury consistent with the symptoms. The Singapore Medical Council and the UK General Medical Council both allow remote medical consultations, where a physical examination is not possible, with safeguards: the doctor must be clear about the limits of an opinion formed without an examination, and whether an in-person examination is needed, or referral to other services, is left to the clinical judgement of the attending doctor.

Signs that need urgent help

Some symptoms should not wait for a routine appointment. Each item below says where to go.

After an injury

After a fall or other injury, the shoulder looks out of place or has changed shape, you cannot move your arm, or the shoulder is painful, bruised or swollen. Go to an emergency department or call 995.
After an injury, the arm or hand is numb, tingling, cool to the touch, or has turned white or purple. Go to an emergency department or call 995.
After a fall, you have intense pain, a snapping feeling and sudden weakness in your upper arm. Arrange a prompt assessment.

At any time

A joint, such as the shoulder, is suddenly very painful, hot, red and swollen (redness may be harder to see on darker skin), especially with a fever or feeling generally unwell. Go to an emergency department or call 995.
You have chest pain that feels tight or like squeezing, or chest pain that spreads to your arm, neck or jaw, or you have severe difficulty breathing. Go to an emergency department or call 995.
Your shoulder symptoms come with fever, night sweats or weight loss. Arrange an urgent same-day assessment.

If you are admitted by the doctor at the urgent care centre of one of these private hospitals, the Parkway Pantai hospitals (Mount Elizabeth Orchard, Mount Elizabeth Novena, Gleneagles and Parkway East), Farrer Park Hospital and Thomson Medical Centre, you may ask for Dr Sean Leo to be your attending orthopaedic surgeon. If you are instead discharged and referred for orthopaedic follow-up, you may contact the clinic to arrange an appointment. Both are subject to the hospital’s admission processes and to Dr Leo’s availability.

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