Shoulder Pain

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Shoulder pain is one of the most frequent, complex, and exhausting problems that modern man faces. Whether it is an acute, piercing pain that appeared suddenly, or a chronic, distressing discomfort that deprives you of sleep and quality of life, the shoulder has its own way of “protesting” when its flawless biomechanics are disrupted.

As an Orthopaedic Surgeon, my approach to pain is never superficial. In medicine, pain is simply the “alarm” — it is not the diagnosis. I treat every case as a researcher. I am sceptical by nature towards easy and quick answers. I know that neither I nor imaging examinations on their own are always right at first glance. Accuracy requires us to double-check the data, to combine the medical history with the clinical examination and the MRI scans, and to seek out the real cause. Due to the particular complexity of the anatomy of the shoulder, it is extremely common for many pathologies to coexist simultaneously.

In this extensive and fully documented guide, we will analyse in depth what lies behind shoulder pain, how this remarkable mechanism works, what the warning signs are, how we differentiate the various conditions, and what the most modern conservative and surgical treatments are to get your life back.

The Complex Anatomy of the Shoulder: A Marvel of Flexibility

To understand why the shoulder hurts, we must first understand how it is constructed. The shoulder is not a simple joint, but a complex system of three bones that cooperate in perfect harmony:

The Humerus: The long bone of the arm, the upper part of which ends in a spherical structure (the head).
The Scapula: The flat bone at the back of the thorax. It has a shallow socket, the glenoid, into which the ball of the humerus fits.
The Clavicle: The bone that connects the shoulder to the sternum, functioning as a strut.

The ball of the humerus “clips into” the shallow glenoid just as a golf ball sits on its small wooden tee. Because the socket is so shallow, the joint acquires the greatest range of motion in the human body, but at the same time, “sacrifices” its stability.

To prevent the joint from coming apart, the body has a network of strong ligaments and a joint capsule that keep the ball centred. Above all of these is the “engine” of the shoulder: the rotator cuff. It is a group of four muscles and their tendons, which embrace the head and allow lifting, rotation, and dynamic stabilisation of the arm. Any wear, inflammation, or tear in this extremely sensitive system is immediately translated into pain.

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What Are the Main Causes of Shoulder Pain?

Shoulder pain is an umbrella symptom. At the practice, we are called upon to disentangle a labyrinth of possible causes. Let us analyse the most frequent and important pathologies that hide behind your discomfort.

Conditions and Tears of the Rotator Cuff

They are, by far, the most common cause of pain. The rotator cuff (the supraspinatus, the infraspinatus, the subscapularis, and the teres minor) is overstressed daily. The conditions here are divided into three categories:

Tendinitis: The acute or chronic inflammation of the fibres of the tendon due to overuse, poor posture, or age-related degeneration. The tendon swells and hurts.
Bursitis: Above the tendons, there is a small sac filled with minimal fluid (the bursa), which functions as a “cushion” so that the tendons do not rub against the bones. When this sac becomes inflamed, it fills with fluid and swells (bursitis). Bursitis almost always coexists with tendinitis.
Rotator Cuff Tear: The most serious development. The tendons of the rotator cuff, either due to a sudden injury (e.g., lifting a weight) or due to normal, progressive wear over the years, tear and detach from the bone.

The symptoms: Painful movements when lifting the arm (especially to the side and above the head). There is a significant weakness. The hallmark of a rotator cuff tear is intense nocturnal pain. It is extremely common for patients to be unable to sleep on the side of the affected shoulder, while they often wake from the pain. Furthermore, an inability to move actively is observed (you cannot lift the arm), but if the doctor lifts your arm (passive movement), it moves freely.

Shoulder Impingement Syndrome

One of the most common conditions is directly linked to overhead movements. It happens when the space between the head of the humerus and the “roof” of the shoulder (the acromion) narrows. Every time you lift your arm, the tendons and the bursa become trapped and undergo friction (catching) between the bones. This causes chronic tendinitis and pain when dressing, swimming, or doing household chores.

Frozen Shoulder (Adhesive Capsulitis)

Frozen shoulder leads to extreme stiffness of the joint and continuous, exhausting pain. The joint capsule becomes inflamed, contracts (shrinks), and creates hard bands (adhesions).

Its characteristic feature: In contrast to a tendon tear, in frozen shoulder, there is significant loss of both active and passive movement. Even if the doctor tries to move your arm, it “hits a wall”, it is locked. It is closely related to Diabetes Mellitus and thyroid disorders.

Calcific Tendinitis

It is the condition during which crystals of calcium salts (like chalk or toothpaste) are deposited within the mass of the tendons of the rotator cuff. It is not related to diet. It causes a massive chemical inflammation and a very severe, dramatic, and unbearable pain, which sets in suddenly, is worse at night, and makes the slightest movement impossible (pseudoparalysis).

Conditions of the Biceps Tendon (Tendinitis and Rupture)

The long tendon of the biceps muscle starts from the arm and passes through the shoulder joint itself.

Tendinitis: Related to inflammation due to friction. Patients feel acute pain right in the front part of the shoulder, which radiates downwards, to the muscle of the arm. It is worsened by lifting weights with a straight arm.

Tendon Rupture: It usually happens suddenly. The patient often hears a sudden, intense sound (“pop”). The pain is accompanied by bruises, swelling, and the characteristic creation of a bulge on the arm (the so-called “Popeye sign”), due to the retraction of the muscle towards the elbow.

SLAP Lesions (Tear of the Labrum)

It is a tear (rip) from front to back (Superior Labrum Anterior to Posterior) in the upper part of the labrum, exactly where the biceps tendon attaches. This lesion usually happens after a fall on an outstretched arm, or is the result of chronic overuse in throwing athletes (tennis, volleyball, baseball). It causes a deep, indefinable pain inside the shoulder, a feeling of instability, and a characteristic mechanical “click” or “catch” in specific movements.

Shoulder Arthritis

It is the gradual, mechanical wear and disappearance of the protective cartilage of the joint. As the bones begin to rub against each other (bone-on-bone), the patient describes a deep pain, intense crepitus (friction sound), and progressive stiffness. It can often be confused with frozen shoulder on clinical examination, which is why the X-ray is decisive.

Conditions of the Acromioclavicular Joint

The acromioclavicular joint is located at the top of the shoulder (the “bump” we feel up there).

Acromioclavicular Arthritis: The pain is located strictly at the top. The patient characteristically hurts when they try to bring the arm across the chest (e.g. to grab the opposite shoulder).
Dislocation / Separation: The result of direct trauma (e.g. falling with the shoulder onto the ground). The clavicle separates from the scapula, often creating an intense, painful bulge under the skin.
Distal Clavicular Osteolysis: A wear condition of the end of the clavicle. It is observed extremely often in weightlifters and people who systematically lift heavy objects above shoulder level.

Shoulder Instability and Dislocation

Instability indicates a loose joint. A dislocation occurs when the ball comes completely out of the socket after a trauma. When this happens, the normal ligaments and the cartilage suffer a tear. If they are not treated, the shoulder will have a tendency to dislocate again or to give a continuous sense of insecurity. Some people have constitutionally “losse ligaments”, leading to chronic multidirectional instability, which often causes a feeling of numbness in the arm (dead arm syndrome) and an excessive, painful range of motion.

Fractures (Broken Bones)

A fall, especially at older ages with osteoporosis, or a road traffic accident, can cause a fracture in the clavicle, the proximal humerus, or the scapula. They are characterised by acute, unbearable pain, extensive swelling, inability to move, and large bruises in the following days.

Pain that “Radiates” (Neck and Heart)

Here, great medical attention is required.

Cervical Syndrome: A herniated disc in the neck can press on a nerve. This pain “travels” (radiates) to the shoulder, the scapula, and the arm, often accompanied by numbness and tingling in the fingers. Patients often think that they have a shoulder problem, while the source is the spine.
Heart Attack: Pain in the left shoulder or the left arm, especially if accompanied by tightness in the chest, sweating, dizziness, or shortness of breath, may be a symptom of an impending heart attack and constitutes an immediate, life-threatening medical emergency.

The Sceptical Diagnostic Approach: Finding the Truth

Given that there are so many possible causes that often overlap, a quick diagnosis is usually wrong. At the practice, the approach is exhaustive.

Initially, I take a detailed medical history: When do you hurt? What job do you do? How do you sleep? Then, a detailed, targeted clinical examination of the shoulder follows (with special provocative tests that isolate each tendon separately), but also of the neck to rule out neurological involvement. A complete neurological examination must be performed in every case of pain and numbness.

Because, as a scientist I must “see” beneath the skin, imaging examinations are the tools of confirmation:

Simple X-rays: They are the first, basic line. They reveal fractures, narrowing of the space (arthritis), calcium deposits (calcific tendinitis), and large osteophytes (spurs).
Ultrasound: An excellent, direct, dynamic, and non-invasive tool. In real time, during movement, I can see the inflammation of the bursa, the collection of fluid, and the presence of tears in the rotator cuff.
Magnetic Resonance Imaging (MRI): The “queen” of imaging for the soft tissues. It is the examination of choice. It provides incredibly detailed and accurate imaging of the tendons, the ligaments, and the muscles. It gives us critical information about the exact position, the size, and the shape of a rotator cuff tear and, above all, the degree of muscle atrophy, a fact that determines the viability of an operation.
Computed Tomography (CT Scan): It is used mainly to evaluate the three-dimensional architecture of the bones in cases of severe deforming arthritis or complex fractures.

Conservative Treatment: The First Line of Defence

The treatment for shoulder pain depends entirely on the cause of the problem. Blind prescribing of pills is not medicine. The most important thing is for the doctor to arrive at the correct diagnosis. In most cases, we begin with a conservative plan:

Rest and Modification: The first treatment for many overuse conditions is to rest the joint, avoiding painful movements, to allow the inflammation to subside. Be careful, however: It is dangerous to prolong absolute immobilisation (in a sling), because this can cause secondary frozen shoulder.
Cryotherapy: The application of ice for 15–20 minutes several times a day is an excellent method for reducing swelling and acute pain.

Pharmaceutical Therapy: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications in tablet form that reduce chemical inflammation in conditions such as bursitis. It is important that they are used only for a short period of time. People with hypertension, asthma, a history of stomach ulcers, liver or kidney disease must avoid them or first consult their doctor.

Intra-articular Injections: Cortisone and Local Anaesthetic: An extremely targeted treatment. The cortisone “puts out” the inflammation locally.

Biological Therapies (Platelet Injections / PRP): They use the growth factors from your own blood to promote healing. The logic behind injections is not simply to mask the pain, but to function as a “window of opportunity”, allowing the patient to do their physiotherapy painlessly.
Specialised Physiotherapy: Perhaps the most critical stage. Physiotherapy is of paramount importance in almost all orthopaedic conditions. The experienced physiotherapists we work with use modern techniques (deep tissue massage, tecar therapy, dry needling) for the pain. Then, they apply special exercises (isometric, proprioception) for stretching the contracted tissues, restoring mobility, and strengthening the stabiliser muscles of the scapula.

Surgical Treatment: The Arthroscopic Solution

There are cases where conservative treatment has failed, or the injury (e.g. a complete tendon detachment) is so serious from the outset that surgery is the only indicated scientific solution. We do not allow a young person with a torn tendon to develop arthritis simply by observing them.

Modern orthopaedics no longer relies on large, open operations (except for joint replacement and severe fractures). The method of choice is Shoulder Arthroscopy.

Apart from severe fractures, instability with huge bone loss (requiring grafting), or severe osteoarthritis requiring arthroplasty, all other conditions (tendon tears, frozen shoulder, SLAP, calcific tendinitis) are excellently treated through minimally invasive arthroscopic surgery.

Through 2–3 openings in the skin, the camera and the micro-instruments correct the problem (suture tendons, remove calcium, clean the capsule), ensuring a bloodless, painless experience with very rapid, controlled, and reliable recovery.

When Should I See a Specialist Immediately (Red Flags)?

Do not ignore the pain when your body sends you loud warning signs. You must visit us urgently if you develop:

Complete inability to carry objects or inability to actively lift the arm.
Pain in the shoulder that worsens at night or does not allow you to sleep.
An injury that causes visible deformity of the joint or a bulge.
Pain that persists steadily beyond a few days despite rest.
Extensive swelling or significant bruises around the shoulder or the arm.
Signs of infection: fever, chills, intense redness of the skin, and increased temperature in the area of the shoulder.

ATTENTION: Any other unusual symptoms that coexist, such as tightness or pain in the chest, difficulty breathing, sweating, dizziness, or abdominal pain, require immediate transfer to a hospital, as they may indicate a heart attack.

Prevention: How to Protect Your Shoulders

Because the overwhelming majority of pain cases are caused by chronic overuse, the best treatment is prevention. The underlying conditions, such as poor body posture at the office or poor technique during sport, function cumulatively.

Apply these basic rules of protection:

Body Posture: Avoid sitting with your shoulders hunched forwards (computer posture). This closes the subacromial space and “rubs” the tendons.
Gradual Start: When you start a new sport or work, start slowly. Initially use reduced force (lighter weights) and limited repetitions, giving time for the tendons to adapt.
Listen to Your Body: Stop any activity immediately if acute, unusual pain appears. “No pain, no gain” is a disastrous mindset for the shoulder.
Technique: Correct your technique (e.g. in the tennis serve, in swimming, or in gym exercises) with the help of a specialised trainer.
Maintenance of Flexibility: Visit a specialised physiotherapist to teach you the correct exercises of stretching and strengthening of the stabiliser muscles of the scapula.

Meet the Doctor: Dr. Ioannis Polyzois

The diagnosis and treatment of shoulder pain do not allow for speculation or half-measures. They require medical depth, experience, and absolute surgical specialisation. As an Orthopaedic Surgeon, fully and exclusively specialised in the conditions, trauma, and arthroscopic/reconstructive surgery of the shoulder and upper limb, my primary goal is to offer you a safe, definitive, and strictly evidence-based solution.

Having served as a permanent Consultant in Orthopaedics in the National Health Service of Great Britain (NHS) for more than 10 years, I was trained in a system that requires excellence and documentation. My extensive further training at the largest centres abroad enables me to apply the most advanced international techniques in Greece.

To date, I have performed more than 9,000 arthroscopic and open surgical operations. This vast, documented surgical and clinical experience makes me the most competent doctor for the management and successful execution of both simple and extremely complex conditions. Every patient is unique to me. At our practice, you do not hear vague diagnoses. We are here to investigate your problem with care, to evaluate your examinations, and to design together the map of your recovery.

Cost and Price: The Treatment of Shoulder Pain

The management and treatment of shoulder pain varies dramatically, a fact that makes the dogmatic reference to “price lists” over the internet impossible and unscientific. Medical care is not a product, but an entirely personalised health service.

The financial aspect is determined exclusively by the final diagnosis and the treatment plan. A simple conservative treatment (such as an intra-articular injection at the practice) has a completely different and affordable cost, compared to the need for a complex surgical intervention. If surgery is required (e.g. arthroscopic tendon repair), the final cost is influenced by the nature and the number of the specialised implants (such as bioabsorbable titanium anchors), the cost of the clinic (hospitalisation, surgical materials, one-day clinic) and, of course, your insurance coverage (EOPYY or Private Health Insurance contracts, which often absorb the entire cost).

Our commitment to you is absolute transparency. The final, exact cost, without any hidden charges or “surprise”, is discussed and analysed fully exclusively after the scheduling of an appointment, your clinical examination, and the diagnosis at our practice.

Movement is life!

There is no reason to allow the pain to control your daily life and to deprive you of sleep and independence. Modern orthopaedics provides absolutely safe, tested, and permanent solutions.

Contact our practice today to schedule your own diagnostic appointment. With strict scientific accuracy, we will diagnose the real cause, I will answer every question of yours with absolute honesty, and together we will design the most specialised orthopaedic care, fully tailored to your needs, to return you to health and normality.

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Συχνές ερωτήσεις

When is shoulder pain considered chronic?

In orthopaedics, pain is characterised as acute when it lasts from a few days to 3–4 weeks (usually after an injury or sudden inflammation). Pain is considered chronic when it persists, with small remissions and exacerbations, for a period longer than 3 to 6 months. Chronic pain indicates permanent structural damage (e.g. arthritis or an unhealed tendon tear) that can no longer heal on its own.

Is it normal for the shoulder to hurt only in specific movements?

Yes, it is absolutely a characteristic feature of mechanical problems. If you hurt when lifting the arm to the side between 60 and 120 degrees (the painful arc), the diagnosis is directed towards impingement syndrome. If you hurt when you put your hand behind your back (e.g. to tie an apron), the problem is often located in the subscapularis tendon or in a beginning frozen shoulder. This specialisation of pain greatly assists clinical diagnosis.

Can shoulder pain appear without any preceding injury?

Of course. The majority of cases I examine daily do not concern patients who have fallen or hit themselves. Conditions such as osteoarthritis (wear of the cartilage), calcific tendinitis (formation of calcium deposits from cellular change), idiopathic frozen shoulder, and degenerative tearing of the tendons due to age, develop spontaneously, insidiously, and gradually “out of nowhere”.

Is there a relationship between shoulder pain and sleep?

The relationship is huge and extremely diagnostic. Gravity and the change of blood flow during lying down increase the pressure on the inflamed tissues of the shoulder. The distressing nocturnal pain, the patient’s inability to sleep on their side, and the frequent waking during the night, is perhaps the strongest clinical indication for a severe tear in the rotator cuff or active adhesive capsulitis.

What is the “click” (sound) I hear when I move my shoulder, is it dangerous?

Sounds (creaking) in the joints are common. If the sound is not accompanied by pain, it is usually innocent (movement of joint fluid or tendon slipping over bone). However, if the “click” or the creaking is accompanied by pain, a feeling of catching, or weakness, then it most likely indicates damage of the labrum (SLAP lesion), a tendon tear, or advanced arthritis, and requires medical evaluation.

Can shoulder pain affect daily life in the long term?

To a tremendous degree. Pain instinctively leads to a restriction of arm use (reflexive immobilisation). This causes atrophy of the muscles, weakness, and development of stiffness. Simple daily acts such as personal hygiene, combing, driving, dressing, and of course work, are transformed into insurmountable obstacles. The psychological burden from chronic lack of sleep and constant pain seriously affects the general quality of life.

When is Magnetic Resonance Imaging (MRI) necessary?

The MRI is not the first action for every pain. The medical history, the clinical examination, and the simple X-ray always come first. If the pain does not subside with conservative means (medication, rest) after a few weeks, if there is a clear loss of muscle strength, suspicion of a tendon tear, or significant damage to the cartilage, then the MRI is the most decisive tool for confirming the diagnosis and planning the possible surgical intervention.

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Frozen Shoulder: Causes, Stages, and Effective Treatment