Shoulder pain: causes, assessment and exercise

Shoulder pain is a collective term, and several conditions can lie behind it. NHI states that tendon inflammation accounts for 75 percent of shoulder disorders, and that about four out of five of these involve the tendon of supraspinatus, one of the rotator cuff muscles [3]. Other causes are bursitis and inflammation of the joint capsule, often called frozen shoulder, which each account for about ten percent or less [3].

The Danish Lægehåndbogen uses the term subacromial pain syndrome when the tendon, bursa and rotator cuff are irritated below shoulder height. Tendinitis, bursitis and partial rotator cuff lesions cannot be told apart clinically, and are therefore treated together [1].

You can read more about individual conditions on the pages about frozen shoulder, rotator cuff and supraspinatus tendinitis.

The pain typically gets worse with certain movements, and which movements depends on which tendon is irritated. In supraspinatus tendinopathy, lifting the arm out to the side is particularly painful [2]. Many get pain when working with the arms above shoulder height, and shoulder function can be reduced [1].

Pain at night, with waking and difficulty finding a comfortable position, is described as characteristic [1]. Acute cases can have severe pain at rest as well, while long-standing problems are often more moderate and related to activity [1].

The diagnosis is often made from the history: where the pain is, how severe it is, which movements trigger it and any risk factors [2]. The clinical examination is a systematic review of range of motion and strength. A painful arc when the arm is raised is regarded as the main criterion for subacromial pain syndrome, but the individual tests have low accuracy on their own and are often positive in several conditions [1].

X-ray is usually unnecessary in tendon inflammation of the shoulder, but may be relevant in repeated inflammations [2]. Lægehåndbogen describes ultrasound as useful for excluding structural tendon damage, and MRI as an option when a larger rotator cuff injury or frozen shoulder is suspected [1].

Lægehåndbogen describes exercise as the first choice, either as supervised exercise or as guided home exercise, over at least three months [1]. The Danish national clinical guideline says that supervised exercise can be considered for adults with symptoms lasting at least one month. The programme should last at least three months, progress gradually and focus on the muscles around the shoulder blade and the rotator cuff. The recommendation is weak [4].

The first step is to adapt activity and avoid movements that cause pain, but the arm should not be kept completely still, because the shoulder can then stiffen [2]. Painkillers and anti-inflammatory medicines are used mainly for pain and for a short time [2].

According to the guideline, corticosteroid injections have little benefit, and should only be used after careful consideration and together with exercise [1][4]. Surgery should not be offered when symptoms have lasted less than six months, and can only be considered later after a full exercise programme without improvement, where the evidence is limited [1][4]. According to NHI, shockwave therapy can be used when there is calcification in the shoulder, but is not recommended without calcification [2].

It varies. NHI writes that most shoulder disorders resolve on their own with time, but that it can take months or years [3]. Lægehåndbogen often describes spontaneous improvement over time, but the course can be long [1]. Repeated or inadequately treated inflammations can lead to long-lasting problems [2].

NHI mentions that you should contact a doctor in case of severe pain, persistent symptoms, and when pain follows an injury to the shoulder. After a fall or sports injury, a fracture must be ruled out [3].

Pain in the shoulder can also come from other organs, including the heart and lungs, and a doctor will consider this when the picture does not fit a shoulder disorder [1]. If the symptoms do not improve after a properly carried out exercise programme, there is reason to have them assessed again [1].

A chiropractor can examine the shoulder, neck and upper back, go through what triggers the pain and make a plan for exercise and loading together with you. You do not need a referral from a doctor. When the diagnosis is uncertain, diagnostic ultrasound can be used as part of the examination.

What is the most common cause of shoulder pain?

According to NHI, tendon inflammation, or tendinopathy, accounts for about 75 percent of shoulder disorders. About four out of five of these involve the tendon of supraspinatus [3].

How long does shoulder pain last?

It varies. Most shoulder disorders resolve on their own, but it can take months or years [3].

Should I keep my shoulder still when it hurts?

NHI recommends adapting activity and avoiding movements that cause pain, but not keeping the arm completely still, because the shoulder can then stiffen [2].

Why does my shoulder hurt at night?

Pain at night is described as characteristic of subacromial pain syndrome [1]. Acute bursitis can also cause sudden pain that disturbs sleep [3].

The pages about frozen shoulder and rotator cuff describe conditions that can cause similar symptoms. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Olsen BS. Subacromielt smertesyndrom, afklemning skulder, impingement (subacromial pain syndrome). Lægehåndbogen, sundhed.dk. Edited 28 November 2025. Link

2. Senebetennelse i skulderen (Tendon inflammation in the shoulder). NHI.no. Last updated 15 October 2024. Link

3. Skuldersmerter (Shoulder pain). NHI.no. Last updated 5 October 2020. Link

4. Sundhedsstyrelsen (Danish Health Authority). National klinisk retningslinje for behandling af patienter med subakromielt smertesyndrom i skulderen (impingement syndrom/rotator-cuff syndrom), quick guide. February 2021. Link