Four Things Cause Almost All The Shoulder Pain I See In Clinic
There are four things causing almost all the shoulder pain I see in clinic. By the end of this article, you'll probably know which one's causing yours.
Here's the quick version. If it hurts when you reach up or lift your arm out to the side, and it catches somewhere in the middle of that movement, that might suggest a shoulder impingement. If your arm feels weak, you struggle to hold it out or lift it at all, and it keeps you awake at night, that might suggest more of a rotator cuff tear. If your shoulder's gone stiff — not just that it hurts to move, it genuinely will not move, even if someone else tries to move it for you — that might suggest a frozen shoulder. And if it's clicking, catching, or feeling like it's going to give way, especially if you're younger or it started after a specific injury, that might suggest a labral tear.
I'm not going to overwhelm you with every possible thing that can go wrong in a shoulder — there's a long list, and most of it is rare. I'm going to take you through those four properly: what each one actually is, and exactly how it shows up in real life, so you can listen out for the one that sounds most like you.
My name's Joe. I'm an ex-professional football head physio and multi-clinic owner here in the UK. This is a guide to help you understand what might be going on and spot your own pattern — it's not a diagnostic tool. Shoulders are very individual, and the only way to know for sure is to get it properly assessed. Use this as a guide to point you in the right direction.
Shoulder Impingement
This is the most common thing I see in clinic with shoulder pain patients. Impingement just means something is getting pinched or compressed as you lift your arm. There's a space in the shoulder that the tendons of your rotator cuff run through, and when you lift your arm, that space gets smaller. If it closes down too much, those tendons get compressed, irritated, and impinged every time your arm goes up.
In real life, that shows up as pain reaching overhead — putting something on a high shelf, washing your hair. There's usually a telling sign called the painful arc: you lift your arm out to the side, the first bit feels fine, then somewhere in the middle it hurts, and as you go right above your head, the pain eases off again. Pain in the middle of the movement, better at the top — that's a real giveaway. You'll often struggle to put a coat on, reach behind you for your back pocket, or do up a bra strap. And it usually comes on gradually — there's rarely a specific injury, it builds up over weeks and months.
Rotator Cuff Tear
The rotator cuff is a group of four muscles that sit around the shoulder joint. Their collective job is to hold the ball in the socket and control the joint as the shoulder moves. Like any tendon, they can tear — either suddenly, from a fall or lifting something too heavy, or gradually over time as they wear.
The key thing that separates a tear from an impingement is weakness. With impingement, it hurts. With a proper tear, it'll hurt too, but it'll also be genuinely weak — you'll go to lift your arm out to the side and it drops with a bit of resistance, or you can get it up but can't hold it there. Some people describe it as not trusting the shoulder anymore. The other big one, particularly with larger tears, is night pain. People with a cuff problem really struggle at night — they can't lie on that side, don't like pressure on it, and it wakes them up in an awkward position. So: weakness lifting or holding the arm out to the side, plus bad night pain, points more towards a rotator cuff tear.
Frozen Shoulder
This is very common in clinic, and it's different to everything else — because although you do get pain, it's not really about pain. It's about stiffness. The shoulder capsule, the sleeve of tissue around the joint, gets inflamed, thickens, and tightens, clamping down on the joint.
Here's the giveaway, and it's how I tell frozen shoulder from everything else: with most shoulder problems, it hurts to move, but the movement is there. With a frozen shoulder, the movement generally isn't there, or if there is some, it's not all of it. The test is this — if someone else moves your arm for you while you completely relax, with a frozen shoulder it still won't go. With impingement or a cuff tear, if you relax and someone else lifts your arm, it'll usually go. With a frozen shoulder, it stops dead and feels blocked. Turning your arm outwards is usually the worst movement, and reaching behind you — tucking your shirt in, doing up a bra — becomes almost impossible. It often comes on for no reason at all, with no injury, and gets stiffer and stiffer over weeks and months. It's more common between about 40 and 60, more common if you're diabetic, and affects females slightly more than males.
Labral Tear
We don't see these as much as the others in clinic, but they're not uncommon. The labrum is a rim of cartilage around the edge of the socket — it deepens the socket and helps keep the ball where it should be. Like any tissue, it can tear, usually from an injury. The shoulder might dislocate, or sublux — almost dislocate, then come back in on its own. A fall on an outstretched arm or repeated heavy loading overhead can cause it too, which is why it's common in throwers, swimmers, racket sports players, and people who lift heavy weights.
In real life: clicking, catching, or clunking is a big giveaway, along with a sense that something's moving in there that shouldn't be. The big one is a feeling of instability — like the shoulder might give way or come out of the socket, or just feels a bit loose. It's often a deep pain in the joint itself, rather than the pain on the outside of the arm you get with impingement. It tends to affect a younger population more, though not always — I've had patients in their 50s, 60s and 70s with labral tears — particularly people who play a lot of sport, and usually there's a specific injury they can point to.
What's Actually Causing It
So there's your four: impingement, rotator cuff tear, frozen shoulder, and labral tear. Here's what I'd leave you with. All four of these are about the structures within the shoulder — what's actually damaged or irritated in the joint. But something caused that. Something closed that joint space down and led to the impingement. Something overloaded that tendon and caused it to tear. In the next video, I'll go through the mechanical causes — the reasons these things happen in the first place.
This article is a guide to help you understand what might be going on with your shoulder pain. It's not a diagnostic tool. Shoulders are very individual, and the only way to know for sure what's causing yours is to get it properly assessed by a professional.
Request A Free Discovery Call & Ask All The Questions You Need
